Matters of the heart: cardiovascular disease and mortality in RA Save

Cardiovascular comorbidities represent a significant cause of morbidity and mortality in patients with rheumatoid arthritis, who are up to twice as likely to develop coronary artery disease compared with the general population (1). RA is also associated with an increased risk of related conditions, including atrial fibrillation and stroke (2).

Two large retrospective cohort studies presented by the team at Mayo Clinic, Rochester MN examine the burden of stroke, as well as overall and cause-specific mortality in people with RA (POS0591 and POS0592). 

The first, POS0591, included 2803 individuals (1402 with RA and 1401 without). People with RA were found to have a 60% increased risk of incident ischaemic and haemorrhagic stroke. This association remained significant even after adjusting for cardiovascular risk factors and the presence of atrial fibrillation. No significant difference was found between men and women with regards the association between RA and overall stroke risk as well as subtype.

The second study examined all-cause and cause-specific mortality in RA versus people without RA, and included 1337 patients with RA and 4011 without. People with RA were found to have higher overall mortality compared to those without. Importantly, the excess mortality was noted to have declined after 2000, with an improvement in 10-year survival in RA, perhaps reflecting the exponential increase in novel therapeutics and access to medication over this period. Cardiac and non-cardiac circulatory causes of death were significantly higher in RA when compared to people without RA, as well as mortality from respiratory, neoplastic and genitourinary.

These two analyses reinforce the burden of cardiovascular comorbidity as well as increased mortality in patients with RA. While the excess in mortality has declined over time, significant differences between people with RA and the general population remain. There is an ongoing need to better understand the RA-specific risk factors for stroke and related cardiovascular comorbidities, improve the management of comorbidities, and improve the monitoring of both of these aspects to improve survival in this patient group.

1. Crowson CS, Liao KP, Davis JM, Solomon DH, Matteson EL, Knutson KL, et al. Rheumatoid Arthritis and Cardiovascular Disease. Am Heart J2013. p. 622.

2. Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Svendsen JH, et al. Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study. BMJ. 2012;344(mar08 2):e1257-e.