The incidence of acute coronary syndrome declined from 1997 to 2012 in persons who have rheumatoid arthritis and in those who do not, but even with these declines, the risk is 40% higher in patients who have the disease.
In this study, the 40% increase in acute coronary syndrome risk in patients with rheumatoid arthritis was restricted to those who had Disease Activity Scores in 28 joints (DAS28) greater than 3.2 and those who were rheumatoid factor positive.
Marie Holmqvist and colleagues in Sweden pointed out that although disease activity in rheumatoid arthritis has been linked to cardiovascular risk, whether good management of rheumatoid arthritis leads to reductions in acute coronary syndrome risk is unknown.
The authors conducted the study to determine whether advances in rheumatoid arthritis management and vigilance for cardiovascular risk factors have led to a decrease in risk of acute coronary syndrome. They presented their findings in a recent Annals of the Rheumatic Diseases article.
The authors conducted a nationwide population-based cohort study that examined patients with newly diagnosed rheumatoid arthritis. Ultimately, 15,744 patients with rheumatoid arthritis and 70,899 comparator subjects without rheumatoid arthritis were included in the analysis.
• In 103,835 person-years of follow-up, a first episode of acute coronary syndrome developed in 772 subjects with rheumatoid arthritis (4.9%); over 466,930 person years of follow-up, acute coronary syndrome developed in 2418 comparator subjects (3.4%).
• Of patients who had rheumatoid arthritis, 1685 (10.7%) died during follow-up, compared with 7336 (10.4%) of patients who did not.
• Excess incidence of acute coronary syndrome increased from 1 in 1000 person-years during the first year after rheumatoid arthritis diagnosis to between 2 and 3 in 1000 person-years over the next 10 years.
Funding was provided for this project by the Swedish research Council, the Swedish Foundation for Strategic research, Stockholm County Council (ALF), Heart Lung Foundation, and the Karolinska Institutet (Strategic research Area Epidemiology).
Holmqvist M, Ljung L, Askling J. “Acute coronary syndrome in new-onset rheumatoid arthritis: a population-based nationwide cohort study of time trends in risks and excess risks.” Ann Rheum Dis. 2017 Oct;76(10):1642-1647. doi: 10.1136/annrheumdis-2016-211066. Epub 2017 Jul 14.