Risk of Heart Attack Nearly Doubles within First 10 Years of RA Diagnosis

A person’s risk of heart attack nearly doubles within the first ten years after being diagnosed with rheumatoid arthritis, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

Using the Swedish RA Register, researchers identified 7,954 patients who were newly diagnosed with RA, and—for comparison—matched them with 38,913 individuals from the general population. Patients in the RA group were, on average, 57 years old and 69 percent female. The two groups were followed for over 10 years, and researchers collected information from both groups on heart attacks and deaths from heart attacks, as well as death from other causes.

After adjusting for high blood pressure and diabetes, researchers assessed the average rate at which participants experienced a heart attack, died from a heart attack, and died from all other causes compared with people without RA. Their investigation showed that before diagnosis, those who were eventually diagnosed with RA were not more likely to have had heart attacks. However, once diagnosed with RA, these numbers changed dramatically. The relative risk for heart attack in the RA group increased continuously after diagnosis, and death from a heart attack increased over time (beginning five or more years after diagnosis). During their first decade with the disease, these patients had nearly double the number of heart attacks and deaths due to heart attacks.

“This study shows that having rheumatoid arthritis confers an increased risk of having a myocardial infarction, and that this risk increase is manifest already early in RA disease progress, explains Marie Gunnarsson, PhD student; Institute of Environmental Medicine, department of cardiovascular epidemiology; Karolinska Institutet, Stockholm, Sweden. “The fact that there is no increased risk prior to RA diagnosis suggests that there is something in the RA disease itself, such as inflammatory processes that lead to this increased risk. Measures to bring down inflammation in RA might, thus, be beneficial also from a cardiovascular prevention point of view in this population.”

Editor’s Notes: Dr. Gunnarsson will present this research during the ACR Annual Scientific Meeting at the Moscone Center from 9:00 – 11:00 AM on Monday, October 27, in Hall A.

Presentation Number: L5

From No Increase to Doubled Risk After Ten Years: Morbidity and Mortality from Myocardial Infarction in Newly Diagnosed Rheumatoid Arthritis

Marie Gunnarsson1, Lars Alfredsson1, Lennart Jacobsson2, Lars Klareskog3, Solbritt Rantapää Dahlqvist4, Johan Askling3. 1Karolinska Institute, Institute of Environmental Medicine, Stockholm, Sweden; 2Rheumatology Unit, Department of Medicine, Malmö University Hospital, Malmö, Sweden; 3Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden; 4Department of Rheumatology, Umeå University Hospital, Umeå, Sweden