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It does not come as a surprise to anyone anymore that Acute Coronary Syndrome (ACS) is one of the major causes of morbidity and preterm mortality in RA. What we don’t know is what measures need to be taken to modify the risk and how effective such measures are.
This nationwide population-based cohort study addresses the issue of efficacy of treatment options and treatment algorithms in reduction of ACS in RA patients.
Newly diagnosed RA patients (Diagnosis within 12 month of symptom onset) from the Swedish Rheumatology Quality (SRQ) were matched randomly with individuals from the Swedish Population Register. Patients with preexisting ACS were excluded.
After 15,744 patients with RA and 70,899 comparator subjects were analyzed. In both groups incidence of ACS was higher Among men and increased with age.
RA was found to be associated with approximately 40% higher risk of ACS, HR 1.41 (95% CI 1.29 to 1.54). Amongst RA patients, ACS risk was higher with seropositive RA and in patients with DAS28 above 3.2 at diagnosis. The decline in incidence over time was equally pronounced in the RA cohort as in the general population.
Given that incidence of ACS was higher in the first year after diagnosis, the authors speculated that use of prescribed or over-the-counter COX inhibitors or oral glucocorticoids during the first months of RA disease and high disease activity may contribute to the increased morbidity during the first year.
Results of the study suggest that patients with RA may have benefited from the CVD prevention and risk factors identification and intervention.