Objective: Patients with rheumatoid arthritis (RA) are at greater risk of developing coronary heart disease (CHD) than the general population. Systemic inflammation may contribute to this risk. Therefore, this study investigated whether the level of disease activity is associated with the risk of developing myocardial infarction (MI) in RA patients.
Methods: We performed a case-control study within a large prospective cohort of RA patients. Cases were patients who developed their first MI after the diagnosis of RA, controls were RA patients without MI. Cases and controls had similar RA disease duration. Traditional and disease-specific risk factors for MI were collected and a time-averaged DAS28 was calculated. The data were analyzed using conditional logistic regression analysis.
Results MI cases had significantly higher age, were more often male, with higher BMI and total cholesterol and lower HDL serum levels than controls. Time-averaged disease activity however was similar for cases and controls. The raw OR for MI in patients with a “high” (> 4.0) versus a “low” („T 4.0) average DAS28 was 1.2 (95% CI 0.61-2.36). The OR (95%CI) corrected for age, gender, BMI, baseline HAQ and baseline HDL was 0.91 (0.39-2.12).
Conclusion: RA patients with MI had more classical risk factors, but not higher disease activity over time, than control RA patients. Low levels of inflammation may be sufficient for accelerated atherogenesis and excess risk of CVD in RA.