STOCKHOLM – Patients with rheumatoid arthritis had a significantly increased risk for developing stroke and atrial fibrillation compared with the general population, in a study of more than 11,000 rheumatoid arthritis patients.
Dr. Jesper Lindhardsen
The increased stroke risk in rheumatoid arthritis (RA) patients appeared independent of their increased likelihood for having atrial fibrillation, a known stroke risk factor, Dr. Jesper Lindhardsen reported at the annual congress of the European Society of Cardiology.
The results “add to the growing awareness that RA patients need to be evaluated with respect to cardiovascular comorbidity,” said Dr. Lindhardsen, an internist in the department of cardiology at Gentofte Hospital in Hellerup, Denmark. The recommended annual assessment of RA patients for cardiovascular disease and risk should include an ECG evaluation for atrial fibrillation and should also pay attention to stroke risk factors, he said in an interview.
His study used data collected in Danish national registries for about 4.2 million citizens who were older than age 16 years in 1997, excluding those with a prior diagnosis of RA, stroke, or atrial fibrillation. During the following 10 years, 11,038 people received a diagnosis of new onset RA.
The average age of the entire population studied was 47 years in 1997, compared with an average age of 56 for people at the time of their new RA diagnosis. The entire Danish population included 51% women, compared with 70% women among those diagnosed with RA. Average follow-up for the entire group was 9 years, while the average follow-up following RA diagnosis was 4 years. Among those with incident RA, 14% regularly took one or more cardioprotective drugs, roughly similar to the 10% rate in the entire population.
During follow-up, stroke occurred 41% more often in the RA patients than in the general population, and atrial fibrillation occurred 45% more often. Both differences were statistically significant.
Age also had a significant impact on stroke risk but not on atrial fibrillation risk in the RA patients. The increased risk for atrial fibrillation in RA patients remained similar in people younger than 50 years, those aged 50-65 years, and in those older than 65 years.
In contrast, stroke risk ran more than 3-fold higher in RA patients younger than age 50 years compared with the general population. The stroke risk of RA patients who were aged 50-65 years ran 50% higher than in the general population, and RA patients older than 65 years had a 20% higher risk than did the general population.
Dr. Lindhardsen and his associates also used a case-control analysis of the subjects with an incident stroke to examine whether atrial fibrillation boosted the stroke risk of RA patients. They found similar stroke risks in patients with RA alone and in those with RA and atrial fibrillation.
Dr. Lindhardsen said he had no disclosures.