Secondary CVD prevention ‘should be priority’ after myocardial infarction in RA patients
medwireNews: Following myocardial infarction (MI), people with rheumatoid arthritis (RA) have an elevated long-term risk for mortality and further cardiovascular disease (CVD) events, researchers report.
The Finnish nationwide registry study included 1614 patients with RA and 8070 propensity score-matched individuals without RA who were admitted to hospital for MI between 2005 and 2014. Patients were aged an average of 74 years and approximately 60% were women.
During a median follow-up of 7.3 years, 62.9% of the RA group and 55.2% of controls died. Antti Palomäki (Turku University Hospital, Finland) and colleagues report that people with RA had a significant 25% higher risk for mortality 14 years after MI than those without RA, with cumulative rates of 80.4% and 72.3%, respectively.
Cumulative mortality rates were higher in RA patients relative to controls at all timepoints studied, at 13.8% versus 12.8% at 30 days, 25.8% versus 22.7% at 1 year, 51.0% versus 43.0% at 5 years, and 68.6% versus 60.8% at 10 years.
Palomäki et al also found that RA patients had a significant 22% elevated risk for new MI during follow-up compared with controls, as well as a 22% higher risk for fatal MI and a 27% higher risk for revascularization.
These findings suggest that “[s]econdary prevention of cardiovascular disease should be a treatment priority after MI in RA patients,” write the researchers in Rheumatology. They note, however, that people with RA had significantly lower rates of statin use than those without (73.1 vs 77.3%), highlighting the need for “comprehensive evaluation and optimisation of treatment to improve long-term outcomes.”
In the second part of their study, the authors used multivariate analysis to evaluate predictors of adverse outcomes in RA patients. Disease duration was significantly associated with mortality risk, with each 5-year increment linked to a 6% increased risk. People taking corticosteroids had a significant 27% higher mortality risk than those who were not, while each mg/day increase in corticosteroid dose was associated with a 5% increased risk.
The use of methotrexate or biologics was not significantly associated with survival outcomes in the multivariate analysis, but the researchers note that these drugs were taken by just 38% and 3% of the study population, respectively, and these findings may not be applicable to younger people with RA “who are, on average, treated with more effective treatment regimens.”
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