Elevated MI Risk Appears One Year After RA Diagnosis


COPENHAGEN — The increased risk for myocardial infarction in patients with rheumatoid arthritis starts to become apparent a year after rheumatoid arthritis is first diagnosed, based on a case-control study of more than 45,000 people.

“The increased risk of myocardial infarction is evident earlier in the course of rheumatoid arthritis than previously thought,” Marie Gunnarsson said at the annual European Congress of Rheumatology.

“The finding underscores the need for early heart disease prevention measures in this population,” added Ms. Gunnarsson, an epidemiology researcher in the Institute of Environmental Medicine at the Karolinska Institute in Stockholm.

The spike in MI risk occurs precipitously with rheumatoid arthritis [RA] diagnosis. In a prior report, Ms. Gunnarsson and her associates showed no excess risk for MI exists when RA is first diagnosed.

The study included 7,653 patients diagnosed with RA from 1996 to January 2007 and entered into the Swedish RA register. Each patient was newly diagnosed, within 18 months of RA symptom onset. Each patient was matched by gender, age, and residential area with five people from the general Swedish population.

Information on hospital discharges and deaths came from Swedish national registries. The average age of the RA patients and matched comparators was 57 years; 71% were women.

During an average follow-up of almost 5 years in both groups, patients with RA faced a 70% increased risk of hospitalization for an acute MI during years 2–4 following RA diagnosis compared with controls, a statistically significant difference, Ms. Gunnarsson reported.

Hospitalizations for MI also were 70% higher among patients with RA during years 5–10 following diagnosis (see table). In contrast, during the first year following RA diagnosis, the patients also had an increased rate of MI hospitalizations compared with the controls in the study, but the difference was not statistically significant.

The analysis showed no significant differences in the rates of MI death between the RA patients and controls during any follow-up period. The rate of death from any cause was also not significantly different between the two groups during most follow-up periods. The exception was during the period 5–10 years following RA diagnosis, when the RA patients had a 10% increased rate compared with the controls, a difference on the cusp of statistical significance.

The study was funded in part by Astra Zeneca. Ms. Gunnarsson and associates had no other disclosures to report.

'The finding underscores the need for early heart disease prevention measures in this population.'



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