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Heart Attack Risk Up to Sixfold in Rheumatoid Arthritis


If you have rheumatoid arthritis, your risk of experiencing a heart attack (myocardial infarction) is increased by up to sixfold, according to the results of a new study presented at the Annual Congress of the European League against Rheumatism (EULAR). The risk is highest among women younger than 50 years old.

Rheumatoid arthritis is an autoimmune disease that affects about 1.3 million Americans, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases. Although it is often recognized as an inflammatory condition that causes pain, swelling, stiffness, and loss of function in the joints, it can also impact other parts of the body.

Some people with rheumatoid arthritis, for example, develop anemia, neck pain, dry eyes, dry mouth, and inflammation of the blood vessels (vasculitis), the lining of the lungs (pleurisy), or the sac that encloses the heart (pericarditis). Rheumatoid arthritis is also a known risk factor for hardening of the arteries, which can lead to heart attack and stroke as much as ten years earlier than in people who do not have arthritis.

In the new study, which spanned ten years, patients with rheumatoid arthritis and diabetes were compared to determine their individual risk of developing a heart attack over time. The data included the entire Danish population (4,614,840 people) and was evaluated for incidence of diabetes and rheumatoid arthritis. A total of 10,547 individuals developed rheumatoid arthritis and 132,868 developed diabetes.

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When the incidence of heart attack was analyzed, the researchers found that it was similar between the two groups: 1.65 increased risk among individuals with rheumatoid arthritis and 1.73 among those with diabetes. However, an analysis of women with rheumatoid arthritis who were younger than 50 revealed a sixfold increased risk of heart attack, which was comparable with their peers in the diabetes group. Among male patients, the risk of heart attack in those with rheumatoid arthritis and diabetes was similar: 1.66 increased risk in the arthritis group and 1.59 in the diabetes group.

In previous studies, it has been shown that patients with rheumatoid arthritis who were treated with disease-modifying anti-rheumatic drugs (DMARDs) could have a reduced risk of heart attack and stroke. Investigators from one study, for example, reported that patients who took methotrexate (the most widely used DMARD) for one year had an 18 percent reduced risk of heart attack and an 11 decreased risk of stroke.

Dr. Jesper Lindhardsen, Department of Cardiology, Gentofte University Hospital, and lead author of the Danish study, noted that their study results highlighted the increased risk of heart attack among patients with rheumatoid arthritis and that it is similar to that among patients with diabetes. Diabetics, however, “are routinely considered for intensive cardiovascular risk management,” while those with rheumatoid arthritis are not.

Therefore, the new findings point out “the importance of implementing EULAR recommendations advocating early detection and management of cardiovascular risk factors,” along with making sure patients with rheumatoid arthritis are treated for their disease to reduce the significant risk of heart attack associated with it. This risk is especially significant among women younger than 50 who have rheumatoid arthritis.

European League against Rheumatism, June 19, 2010
National Institute of Arthritis and Musculoskeletal and Skin Diseases