Major Finding: Following diagnosis of rheumatoid arthritis, patients had a 45% increased risk for developing atrial fibrillation and a 41% increased risk for stroke compared with the general adult population without rheumatoid arthritis.
Data Source: Ten-year follow-up of national medical records for 4.2 million Danish citizens, including 11,038 with new-onset rheumatoid arthritis.
Disclosures: Dr. Lindhardsen said that he had no disclosures.
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.
The increased stroke risk in rheumatoid arthritis (RA) patients appeared independent of their increased likelihood for having atrial fibrillation, a known stroke risk factor, reported Dr. Jesper Lindhardsen.
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 that was 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 study population was 47 years in 1997, compared with an average age of 56 at the time of new RA diagnosis. The entire Danish population included 51% women, compared with 70% of those diagnosed with RA. Average follow-up for the entire group was 9 years; the average follow-up after 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 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 subjects with incident stroke to examine whether atrial fibrillation boosted the stroke risk of RA patients. They found similar risks in patients with RA alone and in those with RA and atrial fibrillation.