Rheumatoid arthritis (RA) patients who present high levels of inflammation markers have an increased risk for myocardial infarction (heart attack) according to the study “Impact of disease activity and treatment of comorbidities on the risk of myocardial infarction in rheumatoid arthritis,” recently published in Arthritis Research & Therapy.
Researchers wanted to understand the impact of individual risk factors particularly inflammation but also RA therapies on the likelihood of myocardial infarction in patients. They also wanted to understand the impact of treating for cardiovascular comorbidities.
The team analyzed data from 11,285 RA patients who were enrolled in the prospective cohort study RABBIT (Rheumatoid Arthritis: Observation of Biologic Therapy) at the start conventional synthetic DMARDs (disease-modifying antirheumatic drugs) or biological DMARDs (bDMARDS). Therapies studied included DMARDs, bDMARDS and concomitant glucocorticoids.
Upon enrollment, patients were expected to stay in the study for at least 5-10 years and complete regular assessments by rheumatologists at baseline, three months and six months, and every six months following.
A detailed and in-depth comparison analysis was performed between patients who developed myocardial infarction with the remaining cohort.
In total, 112 patients developed myocardial infarction during follow-up. The analysis revealed that those patients carried higher levels of two standard inflammation markers, erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP), when compared to controls and the remaining cohort. Specifically, researchers found a strong association between higher CRP and myocardial infarction (but no association was found for disease activity, according to 28-joint-count disease activity score, DAS28).
While baseline treatment with DMARDs was similar across all groups, during follow-up the use of bDMARDs was significantly lower among patients with RA who developed myocardial infarction. Additionally, cardiovascular comorbidities were treated less often in myocardial infarction cases versus matched controls — a trend researchers found statistically significant.
When considering the impact of each type of treatment, the team found that prednisone at doses more or equal to 10 mg/day, TNF inhibitors, or other bDMARDs was not associated with higher risk for heart attack.
The results show that high CRP levels are associated with a higher risk of myocardial infarction. Disease control measures must include not only global disease activity, but also CRP as an individual marker for inflammation and risk for myocardial infarction. In some patients, the available treatment options were insufficient or insufficiently used both for treating RA and cardiovascular comorbidities, which confirmed a suboptimal risk management of cardiovascular disease in RA patients.
