Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease

Løgstrup, Brian Bridal; Olesen, Kevin Kris Warnakula; Mašić, Dženan; Gyldenkerne, Christine; Thrane, Pernille Gro; Ellingsen, Torkell; Bøtker, Hans Erik; Mæng, Michael

doi:10.1136/annrheumdis-2020-217154

Cited by 22 publications

(20 citation statements)

References 40 publications

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“…In a large population cohort study in Denmark of patients undergoing coronary angiography, the 10-year risk of MI was higher in patients with RA and coincident CAD compared with non-RA patients with CAD (12.2% vs. 9.9%). Similar associations were observed for major adverse CV events (MACE) and all-cause mortality [32]. Worse outcomes were also noted in a recent meta-analysis, which demonstrated that patients with co-existing CAD and RA had significantly increased risks of all-cause mortality, cardiac death and congestive heart failure compared with CAD patients without RA.…”

Section: Impact Of CV Comorbidities In Patients With Rasupporting

confidence: 67%

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

Taylor

Atzeni

Balsa

et al. 2021

JCM

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Comorbidities in patients with rheumatoid arthritis (RA) are often associated with poor health outcomes and increased mortality. Treatment decisions should take into account these comorbidities due to known or suspected associations with certain drug classes. In clinical practice, it is critical to balance potential treatment benefit against the possible risks for comorbidities as well as the articular manifestations of RA. This review summarises the current literature relating to prevalence and risk factors for the important comorbidities of cardiovascular disease, infections, lymphomas and nonmelanoma skin cancers in patients with RA. The impact on patient outcomes and the interplay between these comorbidities and the therapeutic options currently available, including tumour necrosis factor inhibitors and newer biological therapies, are also explored. As newer RA therapies are developed, and patients gain wider and earlier access to advanced therapies, in part due to the emergence of biosimilars, it is important to consider the prevention or treatment of comorbidities as part of the overall management of RA.

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Section: Impact Of CV Comorbidities In Patients With Rasupporting

confidence: 67%

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

Taylor

Atzeni

Balsa

et al. 2021

JCM

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“…5 Between 60% and 75% of those with RA are reported to have multimorbidity-two or more long-term conditions (LTCs)with higher number of LTCs reported with increasing age and disease activity. [6][7][8] Common comorbidities include cardiovascular conditions 9 such as coronary artery disease 10 and cardiac failure, 11 as well as mental health conditions such as depression. 12 Cardiovascular disease accounts for the majority of the excess mortality observed in RA, with raised inflammatory markers and shared risk factors implicated.…”

Section: Introductionmentioning

confidence: 99%

Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

et al. 2020

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ObjectiveTo investigate how the type and number of long-term conditions (LTCs) impact on all-cause mortality and major adverse cardiovascular events (MACE) in people with rheumatoid arthritis (RA).DesignPopulation-based longitudinal cohort study.SettingUK Biobank.ParticipantsUK Biobank participants (n=502 533) aged between 37 and 73 years old.Primary outcome measuresPrimary outcome measures were risk of all-cause mortality and MACE.MethodsWe examined the relationship between LTC count and individual comorbid LTCs (n=42) on adverse clinical outcomes in participants with self-reported RA (n=5658). Risk of all-cause mortality and MACE were compared using Cox’s proportional hazard models adjusted for lifestyle factors (smoking, alcohol intake, physical activity), demographic factors (sex, age, socioeconomic status) and rheumatoid factor.Results75.7% of participants with RA had multimorbidity and these individuals were at increased risk of all-cause mortality and MACE. RA and >4 LTCs showed a threefold increased risk of all-cause mortality (HR 3.30, 95% CI 2.61 to 4.16), and MACE (HR 3.45, 95% CI 2.66 to 4.49) compared with those without LTCs. Of the comorbid LTCs studied, osteoporosis was most strongly associated with adverse outcomes in participants with RA compared with those without RA or LTCs: twofold increased risk of all-cause mortality (HR 2.20, 95% CI 1.55 to 3.12) and threefold increased risk of MACE (HR 3.17, 95% CI 2.27 to 4.64). These findings remained in a subset (n=3683) with RA diagnosis validated from clinical records or medication reports.ConclusionThose with RA and other LTCs, particularly comorbid osteoporosis, are at increased risk of adverse outcomes, although the role of corticosteroids could not be evaluated in this study. These results are clinically relevant for the monitoring and management of RA across the healthcare system, and future clinical guidelines for RA should acknowledge the importance of multimorbidity.

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“…A recent study by Løgstrup et al. showed that patients with coronary angiography verified coronary artery disease, comorbid RA was associated with significantly higher risk of cardiovascular events and mortality [ 16 ]. Remarkably, there is some evidence indicating, that patients with RA might have better hospital survival when revascularized with PCI or CABG, even after suffering from myocardial infarction [ 9 , 10 , 17 ].…”

Section: Discussionmentioning

confidence: 99%

Long-term outcomes after coronary artery bypass surgery in patients with rheumatoid arthritis

et al. 2021

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Objective To investigate the long-term outcomes of coronary artery bypass grafting surgery (CABG) in patients with rheumatoid arthritis (RA). Methods Patients with RA ( n = 378) were retrospectively compared to patients without RA ( n = 7560), all treated with CABG in a multicentre, population-based cohort register study in Finland. The outcomes were studied with propensity score-matching adjustment for baseline features. The median follow-up was 9.7 years. Results Diagnosis of RA was associated with an increased risk of mortality after CABG compared to patients without RA (HR 1.50; CI 1.28–1.77; p < .0001). In addition, patients with RA were in higher risk of myocardial infarction during the follow-up period (HR 1.61; CI 1.28–2.04; p < .0001). Cumulative rate of repeated revascularization after CABG was 14.4% in RA patients and 12.0% in control patients ( p = .060). Duration of RA before CABG ( p = .011) and preoperative corticosteroid usage in RA ( p = .041) were independently associated with higher mortality after CABG. There were no differences between the study groups in 30-d mortality or in the post-operative usage of cardiovascular medications. Conclusions RA is independently associated with worse prognosis in coronary artery disease treated with CABG. Preoperative corticosteroid use and longer RA disease duration are additional risk factors for mortality. Key messages Patients with rheumatoid arthritis (RA) have impaired long-term outcomes after coronary artery bypass surgery (CABG). Glucocorticoid use before CABG and duration of RA are associated with higher mortality. Special attention should be paid in secondary prevention of cardiovascular disease in RA patients after CABG.

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Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease

Cited by 22 publications

References 40 publications

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

The Key Comorbidities in Patients with Rheumatoid Arthritis: A Narrative Review

Patterns of multimorbidity and their effects on adverse outcomes in rheumatoid arthritis: a study of 5658 UK Biobank participants

Long-term outcomes after coronary artery bypass surgery in patients with rheumatoid arthritis

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