In the Journals

Siblings of patients with RA at higher risk for acute cardiac syndrome

Siblings of patients with rheumatoid arthritis demonstrate an increased risk for acute cardiac syndrome, according to data published in the Annals of the Rheumatic Diseases.

“We recently reported that despite more efficient control of inflammation in RA during recent years, and despite a general decline in [acute coronary syndrome (ACS)] incidence in the general population, an excess risk for ACS among patients with RA remains,” Helga Westerlind, PhD, of the department of medicine at Karolinska Institute in Stockholm, and colleagues wrote. “These findings suggest that besides direct effects on the ACS risk exerted by the RA disease itself, there may be a shared susceptibility between RA and ACS.”

They added, “If the excess risk of ACS in patients with RA was increased due to such shared susceptibility, one might expect an increased risk of ACS also in individuals without RA but with otherwise similar genetic set-up and background as the patients, such as their siblings.”

 
Siblings of patients with RA demonstrate an increased risk for acute cardiac syndrome, according to data.
Source: Adobe

To evaluate this possible shared susceptibility between RA and acute coronary syndrome, Westerlind and colleagues evaluated the risk for the acute coronary syndrome among the siblings of those with and without RA. The researchers conducted a population-based, nationwide cohort study linking clinical data in the Swedish Rheumatology Quality register with prospectively recorded information on RA, family structure and acute coronary syndrome in various other registers.

The researchers linked Swedish Rheumatology Quality data to the Swedish Multi-generation Register, the National Patient Register, the Prescribed Drug Register, the Cause of Death Register and the Total Population Register. After linking these registries, the researchers identified 8,109 patients diagnosed with new-onset RA from 1996 through 2016, as well as 11,562 of their full siblings. These patients were matched based on age and sex to 38,092 individuals in the general population and their 50,793 full siblings, respectively.

The researchers used Cox regression to estimate HRs of acute coronary syndrome among patients with RA, as well as their siblings, compared with the general population. These results were then stratified by RA serostatus.

According to the researchers, compared with individuals in the general population, there is an increased risk for acute coronary syndrome among patients with RA (HR = 1.46; 95% CI, 1.28-1.67) and their siblings (HR = 1.22; 95% CI, 1.09-1.38). However, this increased risk appears to be limited to patients with seropositive RA (HR = 1.52; 95% CI, 1.3-1.79) and their siblings (HR = 1.27; 95% CI, 1.1-1.46). There was no significant increase in risk among siblings of patients with seronegative RA (HR = 1.13; 95% CI, 0.92-1.39).

“This study is important because it suggests there is a shared susceptibility between RA and ACS,” Westerlind told Healio Rheumatology. “The key message is that optimized disease control and treating the RA specific inflammation might not be enough to remove the excess risk of ACS present in RA patients. From a clinical perspective, patients with RA, and their full siblings, may benefit from additional cardio-preventive measures.” – by Jason Laday

Disclosure: Westerlind reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.

Siblings of patients with rheumatoid arthritis demonstrate an increased risk for acute cardiac syndrome, according to data published in the Annals of the Rheumatic Diseases.

“We recently reported that despite more efficient control of inflammation in RA during recent years, and despite a general decline in [acute coronary syndrome (ACS)] incidence in the general population, an excess risk for ACS among patients with RA remains,” Helga Westerlind, PhD, of the department of medicine at Karolinska Institute in Stockholm, and colleagues wrote. “These findings suggest that besides direct effects on the ACS risk exerted by the RA disease itself, there may be a shared susceptibility between RA and ACS.”

They added, “If the excess risk of ACS in patients with RA was increased due to such shared susceptibility, one might expect an increased risk of ACS also in individuals without RA but with otherwise similar genetic set-up and background as the patients, such as their siblings.”

 
Siblings of patients with RA demonstrate an increased risk for acute cardiac syndrome, according to data.
Source: Adobe

To evaluate this possible shared susceptibility between RA and acute coronary syndrome, Westerlind and colleagues evaluated the risk for the acute coronary syndrome among the siblings of those with and without RA. The researchers conducted a population-based, nationwide cohort study linking clinical data in the Swedish Rheumatology Quality register with prospectively recorded information on RA, family structure and acute coronary syndrome in various other registers.

The researchers linked Swedish Rheumatology Quality data to the Swedish Multi-generation Register, the National Patient Register, the Prescribed Drug Register, the Cause of Death Register and the Total Population Register. After linking these registries, the researchers identified 8,109 patients diagnosed with new-onset RA from 1996 through 2016, as well as 11,562 of their full siblings. These patients were matched based on age and sex to 38,092 individuals in the general population and their 50,793 full siblings, respectively.

The researchers used Cox regression to estimate HRs of acute coronary syndrome among patients with RA, as well as their siblings, compared with the general population. These results were then stratified by RA serostatus.

According to the researchers, compared with individuals in the general population, there is an increased risk for acute coronary syndrome among patients with RA (HR = 1.46; 95% CI, 1.28-1.67) and their siblings (HR = 1.22; 95% CI, 1.09-1.38). However, this increased risk appears to be limited to patients with seropositive RA (HR = 1.52; 95% CI, 1.3-1.79) and their siblings (HR = 1.27; 95% CI, 1.1-1.46). There was no significant increase in risk among siblings of patients with seronegative RA (HR = 1.13; 95% CI, 0.92-1.39).

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“This study is important because it suggests there is a shared susceptibility between RA and ACS,” Westerlind told Healio Rheumatology. “The key message is that optimized disease control and treating the RA specific inflammation might not be enough to remove the excess risk of ACS present in RA patients. From a clinical perspective, patients with RA, and their full siblings, may benefit from additional cardio-preventive measures.” – by Jason Laday

Disclosure: Westerlind reports no relevant financial disclosures. Please see the study for all other relevant financial disclosures.