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Cardiovascular comorbidities antedating the diagnosis of rheumatoid arthritis
Anne M Kerola1, Tuomas Kerola, Markku J Kauppi
1Medical School, University of Helsinki, , Helsinki, Finland.
Insights
Rheumatoid arthritis patients show an increased risk of coronary heart disease at diagnosis, especially those with early-onset disease. Early prevention of atherosclerosis is crucial for all rheumatoid arthritis patients, irrespective of rheumatoid factor status.
Area of Science:
- Rheumatology
- Cardiology
- Epidemiology
Background:
- Rheumatoid arthritis (RA) is a chronic inflammatory disease.
- Cardiovascular comorbidities, including coronary heart disease (CHD) and chronic hypertension, are significant concerns in RA patients.
Purpose of the Study:
- To determine the prevalence of CHD and chronic hypertension in RA patients at diagnosis compared to non-RA individuals.
- To investigate the influence of age at RA onset, gender, and rheumatoid factor (RF) status on the risk of these comorbidities.
Main Methods:
- A cohort of 7209 RA patients diagnosed between 2004-2007 was identified using a Finnish nationwide register.
- Prevalence of pre-existing CHD and hypertension was identified from the same register.
- Standardised rate ratios (SRRs) were calculated comparing RA patients to the general Finnish population.
Main Results:
- A slightly elevated risk of CHD (SRR 1.10) was observed at RA diagnosis.
- Younger age at RA onset was associated with a higher SRR for CHD.
- Increased prevalence of hypertension (SRR 1.19) and CHD (SRR 1.15) was noted in rheumatoid factor-negative RA patients.
Conclusions:
- Coronary heart disease risk is elevated in RA patients at disease onset, particularly in early-onset RA.
- These findings emphasize the necessity of early atherosclerosis prevention strategies in RA management.
- The importance of early prevention is highlighted regardless of rheumatoid factor status.
Objectives:
To assess the prevalence of coronary heart disease (CHD) and chronic hypertension among patients with rheumatoid arthritis (RA) at the time of diagnosis, in comparison with age-specific and sex-specific non-RA subjects. Furthermore, the impacts of age at the onset of RA, as well as gender and the presence of rheumatoid factor (RF) on the risk of these comorbidities, were evaluated.
Methods:
A cohort of 7209 RA patients diagnosed between January 2004 and December 2007 was identified, based on a Finnish nationwide register on special reimbursements for medication costs. The presence of CHD and chronic hypertension antedating the diagnosis of RA was identified from the same register. The prevalence of the cardiovascular comorbidities was compared with the general Finnish population, and a standardised rate ratio (SRR) for both these cardiovascular diseases was calculated.
Results:
The risk of having CHD at RA diagnosis was slightly elevated, the SRR being 1.10 (95% CI 1.01 to 1.20). Younger age at the onset of RA seemed to be related with higher SRR for CHD. In a subset analysis, an increased prevalence of hypertension (SRR 1.19, 95% CI 1.10 to 1.30) and CHD (SRR 1.15, 95% CI 1.00 to 1.32) was apparent only among the RF negative RA cases.
Conclusions:
The SRR for CHD is augmented in RA patients already at disease onset, and more pronouncedly in early onset RA. The findings highlight the importance of early prevention of atherosclerosis, regardless of RF status.
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