Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease
Brian Bridal Løgstrup,Kevin Kris Warnakula Olesen,Dzenan Masic,Christine Gyldenkerne,Pernille Gro Thrane,Torkell Ellingsen,Hans Erik Bøtker,Michael Maeng +7 more
TLDR
In patients undergoing CAG, RA is significantly associated with the 10-year risk of MI, MACE and all-cause mortality regardless of the presence of CAD, however, patients with RA and CAD carry the largest risk, while the additive risk of RA in patients without CAD is minor.Abstract:
Introduction Rheumatoid arthritis (RA) is a risk factor for cardiovascular disease. The clinical consequences of coincident RA and coronary artery disease (CAD) are unknown. Objective We aimed to estimate the impact of RA on the risk of adverse cardiovascular events in patients with and without CAD. Methods A population-based cohort of patients registered in the Western Denmark Heart Registry, who underwent coronary angiography (CAG) between 2003 and 2016, was stratified according to the presence of RA and CAD. Endpoints were myocardial infarction (MI), major adverse cardiovascular events (MACE; MI, ischaemic stroke and cardiac death) and all-cause mortality. Results A total of 125 331 patients were included (RA: n=1732). Median follow-up was 5.2 years. Using patients with neither RA nor CAD as reference (cumulative MI incidence 2.7%), the 10-year risk of MI was increased for patients with RA alone (3.8%; adjusted incidence rate ratio (IRRadj) 1.63, 95% CI 1.04 to 2.54), for patients with CAD alone (9.9%; IRRadj 3.35, 95% CI 3.10 to 3.62), and highest for patients with both RA and CAD (12.2%; IRRadj 4.53, 95% CI 3.66 to 5.59). Similar associations were observed for MACE an all-cause mortality. Conclusions In patients undergoing CAG, RA is significantly associated with the 10-year risk of MI, MACE and all-cause mortality regardless of the presence of CAD. However, patients with RA and CAD carry the largest risk, while the additive risk of RA in patients without CAD is minor. Among patients with RA, risk stratification by presence or absence of documented CAD may allow for screening and personalised treatment strategiesread more
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References
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Journal ArticleDOI
Existing data sources for clinical epidemiology: The Western Denmark Heart Registry.
Morten Schmidt,Michael Maeng,Carl-Johan Jakobsen,Morten Madsen,Leif Thuesen,Per Hostrup Nielsen,Hans Erik Bøtker,Henrik Toft Sørensen +7 more
TL;DR: The WDHR is a valuable research tool because it provides ongoing longitudinal registration of detailed patient and procedural data and allows complete follow-up for medical events after cardiac intervention by linkage with multiple medical databases.
Journal ArticleDOI
Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease
TL;DR: RA patients without CAD have higher prevalence, extent, and severity of all types of coronary plaque, and quantitative measures of stenotic plaque severity and extent were higher in RA, even after adjustments for cardiac risk factors.
Journal ArticleDOI
Rheumatoid arthritis-specific cardiovascular risk scores are not superior to general risk scores: a validation analysis of patients from seven countries.
Cynthia S. Crowson,Sherine E. Gabriel,Anne Grete Semb,Piet L. C. M. van Riel,George Karpouzas,Patrick H Dessein,Carol A. Hitchon,Virginia Pascual-Ramos,George D. Kitas +8 more
TL;DR: The QRISK2, EULAR multiplier and ERS-RA algorithms did not predict CVD risk more accurately in patients with RA than CVDrisk calculators developed for the general population.
Journal ArticleDOI
Heart Disease and Rheumatoid Arthritis: Understanding the Risks
TL;DR: RA-specific cardiovascular risk prediction tools are needed, as well as clinical trials to assess the impact of therapies and tight control of inflammation in RA patients on cardiovascular outcomes and mortality.
Journal ArticleDOI
Validity of rheumatoid arthritis diagnoses in the Danish National Patient Registry.
TL;DR: The conclusion is that with careful attention to the limitations in the data, discharge diagnoses for patients with records of RA in the Danish NPR can be used for epidemiological research purposes; however, general carefulness is prompt when using non-audited registries for research in RA.
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