EXTENDED REPORT

Impact of parental history on patients’ cardiovascular mortality in rheumatoid arthritis

L Björnådal¹, L Brandt², L Klareskog¹, J Askling²

¹ Rheumatology Unit, Department of Medicine, Karolinska University Hospital Solna, and Karolinska Institutet, Stockholm, Sweden
² Clinical Epidemiology Unit, Department of Medicine, Karolinska University Hospital Solna, and Karolinska Institutet

Correspondence to:
Dr Lena Björnådal
Rheumatology Unit, Karolinska University Hospital Solna, SE-171 76 Stockholm, Sweden; Lena.Bjornadal{at}karolinska.se

Background: Patients with rheumatoid arthritis are at increased risk of death from cardiovascular disease (CVD). This risk is influenced by the inflammatory activity of the rheumatoid arthritis as well as by traditional risk factors for CVD. However, little is known about whether or to what extent hereditary factors for CVD contribute additional risk in patients with rheumatoid arthritis.

Objective: To assess the clinical impact of a parental history of CVD in patients with rheumatoid arthritis.

Methods: Population based cohort study of 10 805 Swedish patients with rheumatoid arthritis aged 16–67 years during follow up (1990–2000). Parents, and cardiovascular deaths among patients and parents, were identified through register linkages. Relative risk of death v the general population was assessed using standardised mortality ratios (SMR), which were compared by Poisson regression.

Results: Rheumatoid patients with a parental history of fatal CVD had an SMR of death from CVD of 2.9 (95% confidence interval, 2.5 to 3.4). By contrast, rheumatoid patients without a parental history of fatal CVD had an SMR of 1.7 (1.2 to 2.3). A parental death from CVD was associated with a 70% increase in the risk of fatal CVD in rheumatoid arthritis (SMR ratio = 1.7 (1.2 to 2.4), and an increase in the 10 year mortality from CVD from 5% to 10% in men and from 2% to 4% in women aged 50 to 67 years.

Conclusions: Parental history of death from CVD is an important (and easily assessable) risk factor for fatal CVD in rheumatoid arthritis.

Abbreviations: ACR, American College of Rheumatology; CVD, cardiovascular disease; NRN, national registration number; SMR, standardised mortality ratio

Keywords: rheumatoid arthritis; mortality; cardiovascular; relatives; Sweden

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