A Potential Key in RA Treatment Personalization: The Presence of CAD
Treatment strategies for patients with rheumatoid arthritis (RA) may be further personalized based on the presence or absence of coronary artery disease (CAD), according to new research.
The determination comes after new study findings showed that, among patients undergoing coronary angiography (CAG), RA was significantly associated with the 10-year risk of myocardial infarction (MI), major adverse cardiovascular events (MACE), and all-cause mortality. While the association was present regardless of whether or not the patients had CAD, patients with both RA and CAD had the highest risk.
“Among patients with RA, risk stratification by presence or absence of documented CAD may allow for screening and personalized treatment strategies,” the researchers wrote.
To assess the relationship between RA and the risk of adverse cardiovascular events among patients with or without CAD, the researchers analyzed data on 125,331 patients registered in the Western Denmark Heart Registry who had undergone CAG between 2003 and 2016. In all, 1732 patients had RA. The median follow-up was 5.2 years.
Patients who had neither RA nor CAD had a cumulative MI incidence of 2.7%. Using this finding as a reference, the researchers found that the 10-year risk of MI increased for patients with RA alone (3.8%) as well as for patients with CAD alone (9.9%). However, the 10-year risk of MI was highest among patients with both RA and CAD (12.2%).
The researchers observed similar associations for MACE (defined as MI, ischemic stroke, and cardiac death) and all-cause mortality.
Løgstrup BB, Olesen KKW, Masic D, et al. Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease. Ann Rheum Dis. 2020;79(9):1182-1188. doi:10.1136/annrheumdis-2020-217154