Patients with coronary heart disease (CHD) have a higher risk of cardiovascular events if they also have rheumatoid arthritis. This is shown in a major study from Denmark published in May 2020.
The main finding is that when the two diseases meet, chronic inflammatory disease increases the risk of heart attacks. One reason for this could be that rheumatism patients form larger plaques and disease-related inflammatory processes fuel the CHD process.
The large Danish cohort study examined approximately 125,000 people who had received coronary angiography between 2003 and 2016. The participants were followed for a median of 5.2 years. Patients suffering from rheumatoid arthritis were identified using ICD codes.
The endpoints analysed included the occurrence of myocardial infarction, ischaemic stroke, all-cause mortality and cardiac death, and a combined endpoint of myocardial infarction/stroke/cardiac death.*
The 125,000 study participants were divided into the following four groups:
As expected, people who had neither rheumatism nor CHD had the lowest 10-year incidence and thus the lowest risk of heart attack (2.7), ischaemic stroke (2.9), all-cause mortality (21.6) and cardiac death (2.3). In the other three groups, the cardiovascular risk gradually increased.
In patients who only had rheumatoid arthritis, the 10-year incidence of myocardial infarction was 3.8, which was slightly higher. In patients with CHD, it increased to 9.9. The 10-year incidence was highest in patients who had rheumatoid arthritis and CHD together (12.2).
Similar results were found for the combined endpoint of myocardial infarction, stroke and cardiac death and for all-cause mortality.
The study thus shows that the cardiovascular risk is significantly increased when CHD and rheumatism overlap. According to the authors, rheumatism patients could possibly benefit from personalised prophylactic treatment, depending on their coronary status.
Source:
Løgstrup BB, Olesen NPP, Masic D, et al Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease. Ann Rheum Dis. 2020;79(9):1182-1188. doi:10.1136/annrheumdis-2020-217154
Note:
*The analysis was adjusted for factors and comorbidities such as smoking, high blood pressure, atrial fibrillation, diabetes, etc. Medication and extent of CHD were also considered.