Following a heart attack, people with rheumatoid arthritis suffer greater heart-related complications, including an increased risk for dying, when compared to other heart attack patients, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.

Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.

It is well known that patients with RA are at increased risk for heart attack; however, little is known about the risk of heart failure and death following heart attacks in these patients.

Researchers recently followed 38 heart attack patients who had RA to compare their mortality rates to those patients who had suffered a heart attack but did not have RA. Most patients were female, with a mean age of 76 years.

Patients with RA were hospitalized for their first heart attack between 1976 and 2001. Researchers evaluated treatment of heart attacks and tracked patient outcomes (heart failure and death). Diagnosis of heart attack and heart failure were validated using established epidemiological criteria, and rates of heart failure and death following heart attacks in the general population were based on previously published rates during the same years.

Of the 38 RA patients in the study, nine had experienced heart failure prior to the heart attack; of the remainder, a total of 18 RA patients developed heart failure following their heart attacks – making the risk of heart failure following a heart attack in patients with RA 45 percent higher than expected in the general population. The risk of death was noted to be 75 percent higher in heart attack patients with RA, and was particularly high among patients with rheumatoid arthritis who had a positive blood test for rheumatoid factor.

In all, researchers determined that patients with RA do suffer higher mortality and may be at higher risk of heart failure after a heart attack, but reasons for these outcomes are still unknown. The results of this study emphasize the need for better strategies for prevention, diagnosis and treatment of heart attacks in these patients.

“Heart disease can remain silent in those with rheumatoid arthritis, but the risk is there soon after the onset of the disease” explains Hilal Maradit Kremers, MD; Mayo Clinic epidemiologist and lead author of the study. “Regular cardiac checkups are important—as is lowering traditional cardiac risk factors, such as taking care of blood pressure and cholesterol and quitting smoking.”

The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR’s annual meeting, see http://www.rheumatology.org/annual.

Editor’s Notes: Dr. Kremers will present this research during the ACR Annual Scientific Meeting at the Moscone Center from 5:00 to 5:15 PM on Sunday, October 26 in Room 304. Dr. Kremers will be available for media questions and briefing at 8:30 AM on Sunday, October 26 in the on-site press conference room, 114.

Presentation Number: 692

Increased Mortality after Acute Myocardial Infarction among Patients with Rheumatoid Arthritis

Hilal Maradit Kremers, Cynthia S. Crowson, Terry M. Therneau, Veronique L. Roger, Sherine E. Gabriel. Mayo Clinic, Rochester, MN

Purpose: Patients with rheumatoid arthritis (RA) are at high risk for acute myocardial infarction (MI). However, relatively little is known about prognosis and risk of heart failure (HF) following MI in RA patients. The objective of this study was to compare mortality and HF rates in MI patients with RA to rates from the general population.

Methods: This population based study included incident RA patients (defined by ACR 1987 criteria) who were hospitalized for their first acute MI between 1976 and 2001. Data collection included RA disease characteristics, outcomes (HF and death) and treatment of MI (reperfusion therapy, hospital and dismissal medications). Diagnoses of MI and HF were validated using established epidemiological criteria. Rates of HF and death following MI in the general population were based on previously published rates from an enumeration of all incident MI in the same underlying geographic area during the same years. Person-years methods were used to compare the rates of HF and death following MI observed in the RA patients to those expected in the general population, according to age, sex and calendar year. Logistic regression was used to compare use of therapies following MI to the proportions expected in the general population according to age, sex and calendar year of MI.

Results: The study population included 38 MI patients with RA (mean age 76 yrs; 66% female; 66% rheumatoid factor positive (RF+); 2.5 years median follow-up). Nine of these had HF prior to MI. Of the remainder, a total of 18 RA patients developed HF following their MI. The risk of HF following MI in RA patients was 45% higher (but not statistically significant) than expected in the general population (standardized incidence ratio (SIR): 1.45, 95% CI: 0.90, 2.34) . The risk of death was 75% higher (and statistically significant) in MI patients with RA (standardized mortality ratio (SMR) 1.75, 95% CI: 1.20, 2.54). Increased risk of death following MI was particularly high among RF+ RA patients (SMR: 1.94, 95% CI: 1.24, 3.05). There were no differences in the use of acute re-perfusion therapy (p=0.16) or medications at hospital discharge (p=0.21) in the RA compared to the general population.

Conclusions: Following a MI, RA patients suffer higher mortality and increased risk of HF, compared to MI patients in the general population. Reasons for these differences are unknown and emphasize the need to optimize preventive, diagnostic and treatment strategies for MI in RA patients.

Disclosure Block: H. Maradit Kremers, Amgen, 2; Pfizer, 2; Amgen, 5; C.S. Crowson, None; T.M. Therneau, None; V.L. Roger, None; S.E. Gabriel, None

Source: American College of Rheumatology (ACR)