Fractures in RA Patients Foreshadow Cardiovascular and Mortality Risk

The reasons for the association aren't yet clear, but experts are warning that you should consider a fracture a red flag for cardiovascular risk in a patient with rheumatoid arthritis.

Researchers at the Mayo Clinic looked at records for a population-based cohort of 1171 patients diagnosed with rheumatoid arthritis (RA), and compared their clinical course with another 1171 people in whom RA did not develop, over the course of a median 10 years (patients) and 12 years (non-patient controls). Persons with a history of cardiovascular disease were excluded from analysis.

Among subjects with RA who had a fracture at any major osteoporotic site (hip, spine, wrist, or shoulder), the subsequent risk for cardiovascular disease was substantially higher than among subjects who did not have RA. The hazard ratio was 1.80 for the former and 1.35 for the latter.

A new fracture in a patient with rheumatoid arthritis "should be considered a sentinel event that prompts further evaluation of their cardiovascular risk," advised the researchers in their report at the recent American College of Rheumatology meeting. (Abstract #820)

What's more, in the same cohort RA patients showed a significantly increased risk for mortality from all causes after a moderate fracture, irrespective of steroid use, seropositivity, or the presence of nodules or erosions. The Mayo team are on the hunt for characteristics or comorbidities that may explain the difference. (Abstract #822)

Not only fractures, but simple low bone mineral density should alert rheumatolotists to increased cardiovascular risk. Noting the previously observed links between osteoporosis and cardiovascular disease, a team from Galway University and the University of Ireland evaluated risks for cardiovascular disease and presence of osteoporosis among their cohort of 603 patients with RA. (Abstract #825)Low bone mineral density and the presence of vertebral fractures were independently associated with cardiovascular disease in multivariate analyses, they report, and outperformed standard measures of cardiovascular risk.