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Excess cardiovascular risk present in RA patients and their close relatives

05 Mar 2019

Rheumatoid arthritis (RA) is associated with increased susceptibility to acute coronary syndrome (ACS) not only in patients but also in their siblings, according to a study.

The study involved 8,109 patients with new-onset RA and 11,562 full siblings of these and 38,092 general population controls and 50,793 full siblings of these. Using Cox regression analysis, researchers examined the risk of incident ACS events in patients with RA and their siblings against that in the general population.

During a median follow-up of 6 years, the crude incidence rate of ACS per 1,000 person-years was 4.64 among RA patients and 4.74 among their siblings vs 3.18 among the matched general population controls and 3.84 among their siblings.

Analysis revealed that RA was associated with a 46-percent increase in the risk of developing ACS among the patients themselves (hazard ratio [HR], 1.46; 95 percent CI, 1.28–1.67) and a 22-percent risk increase among the patient’s siblings (HR, 1.22; 1.10–1.38) when compared with the general population.

The risk increase was notably limited to seropositive RA patients (HR, 1.52; 1.30–1.79) and their siblings (HR, 1.27; 1.10–1.46). On the other hand, siblings of patients with seronegative RA showed no excess ACS risk (HR, 1.13; 0.92–1.39). Controlling for 19 traditional cardiovascular risk factors did not significantly alter these associations.

The findings point to a shared susceptibility to RA and ACS, which cannot be explained by traditional cardiovascular risk factors, according to researchers, adding that more studies are needed to explore the nature of this association, be it genetic or environmental.

Additionally, reducing or removing RA-specific inflammation may in itself not be sufficient to eliminate the entire excess risk of ACS in RA, they said. Further cardiopreventive measures, such as optimization of traditional CV risk factors, may be beneficial to RA patients and their siblings.

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