RA Diagnosis Doubles Heart Attack Odds
Diagnosis of Rheumatoid Arthritis Increases Heart Attack Risk Within 10 Years, but Most Treatments Reduce Risk
By
Kathleen Doheny
WebMD Health News
Reviewed By
Elizabeth Klodas, MD, FACC
Oct. 30, 2008 -- Getting a diagnosis of rheumatoid arthritis doubles the
risk of having a heart attack within the next 10 years, according to Swedish
researchers presenting their findings this week at the annual meeting of the
American College of Rheumatology in San Francisco.
But that disturbing news was tempered by other research finding that
medications to lower cholesterol may lower the risk and that all but one
commonly used medication to treat RA also appear protective of the heart.
About 1.3 million Americans have RA, an inflammatory type of arthritis
marked by pain, swelling, stiffness, and problems in joint motion, according to
the American College of Rheumatology. Women are twice as likely as men to be
affected.
RA & Heart Attack Risk Study
The increased risk of heart attack and other cardiovascular problems in
patients with rheumatoid arthritis has long been known. "What we haven't
known before is when in the RA disease process this increased risk is
manifest," says Marie Gunnarsson, a doctoral student at Karolinska
Institute in Stockholm, who is presenting the study findings.
Her team used the Swedish RA Register to identify 7,954 patients newly
diagnosed with RA and matched them with 38,913 people from the general
population. They followed both groups for more than 10 years, beginning in
1995, collecting data on heart attacks, death from heart attacks, and other
causes.
They computed the average rate at which the heart attacks and deaths
happened. From the time of diagnosis to the first 10 years after it, the risk
of heart attack and death from heart attacks nearly doubled in the RA
group.
At the time of diagnosis, the patients were no more likely to have a heart
attack history than the control group, Gunnarsson and her colleagues found.
Over the years, experts have questioned whether there are common risk factors
for heart attack and rheumatoid arthritis. But Gunnarsson says the new finding
supports the idea that the disease itself has something to do with the
development of heart problems.
The inflammation that occurs with RA could be driving up the risk, she says.
Or there could be other aspects of the disease, as yet unknown, that are
driving up the risk, she says.
RA Treatments and Heart Attacks Study
In other research, investigators from the United Kingdom and the Netherlands
tried to put in perspective which risk factors for RA patients are most
important in predicting heart attack. Among them:
"There has been uncertainty about which factors are most important in
the risk of developing heart disease in individuals with RA," says
Christopher Edwards, MD, consultant rheumatologist and honorary senior lecturer
at Southampton University Hospitals in the U.K., who is presenting the
findings.
So his team drew from the large U.K. General Practice Research Data Base,
including the records of more than 7 million people. They found 34,364 adults
with RA and compared them with 103,089 similar people without the disease,
looking at the incidence of heart attack.
They found that those with RA had 6.49 heart attacks per 1,000 people per
year, while those without had 2.96 per 1,000 people per year.
The chances of having a heart attack among those with RA, overall, were less
in those who took medications for RA. Researchers looked at drugs known as
DMARDs (disease-modifying antirheumatic drugs) as well as the steroid
prednisolone.
When they looked individually at the medications, they found that all the
DMARD medications were protective of the heart but that prednisolone modestly
increased the risk. When they took into account risk factors such as high blood
pressure, the effects were no longer significant.
Edwards' team also found that cholesterol-lowering medication lowered the
rate of heart attack by 25%, but that blood pressure medicines had no
significant effect.
And when they compared the effect traditional risk factors had on the heart
attacks, they found that they were important, but the risk from having RA was
even greater.
The presence of the rheumatoid arthritis itself seems to be the biggest risk
factor for heart problems, Edwards says.
RA & Heart Attacks: Second Opinion
The studies provide valuable information for RA patients and doctors, says
Eric Matteson, MD, MPH, professor of medicine at Mayo Clinic in Rochester,
Minn., who reviewed the studies for WebMD.
The first study, he says, confirms that "it is the disease itself which
is a major risk factor for getting heart attacks."
The research also suggests that the traditional risk factors for heart
disease are very important for people with RA, he says, as well as the
increased risk from having RA.
The information about the RA drugs is mostly good, he adds. "If you have
this disease and you aren't taking these drugs, your chances of getting a heart
attack are much higher and you can reduce that risk by managing your rheumatoid
arthritis," he says. "You don't bring it back to the baseline risk, but
the good news is you can reduce the risk by taking the medications that control
the disease."
The information about prednisolone boosting risk is not surprising, Matteson
says, because the drug boosts blood fats. The increase in risk, he says, isn't
as much as the traditional risk factors, according to the study findings.
Still, he says, prednisolone is useful for managing the disease when
needed.
RA & Heart Attack: Advice
The message is simple for RA patients and physicians hoping to reduce heart
attack risk, Edwards tells WebMD. It's crucial to treat both the disease
symptoms and the heart attack risk factors. The attention needs to be focused
not just on the joints, but also on the blood vessels.
SOURCES: Christopher Edwards MD, FRCP, consultant rheumatologist and honorary senior
lecturer, Southampton University Hospitals, Southampton, U.K. Annual meeting, American College of Rheumatology and Association of
Rheumatology Health Professionals, San Francisco., Oct. 24-29, 2008. Marie Gunnarsson, doctoral student, Karolinska Institute, Stockholm,
Sweden. Eric Matteson, MD, MPH, professor of medicine, Rochester, Minn. News releases, American College of Rheumatology.
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