Cardiovascular comorbidities antedating the diagnosis of rheumatoid arthritis
- Anne M Kerola1,2,3,
- Tuomas Kerola3,
- Markku J Kauppi2,4,
- Hannu Kautiainen5,
- Lauri J Virta6,
- Kari Puolakka7,
- Tuomo V M Nieminen3,4,8
- 1Medical School, University of Helsinki, Helsinki, Finland
- 2Department of Internal Medicine, Division of Rheumatology, Päijät-Häme Central Hospital, Lahti, Finland
- 3Department of Internal Medicine, Division of Cardiology, Päijät-Häme Central Hospital, Lahti, Finland
- 4Medical School, University of Tampere, Tampere, Finland
- 5Unit of Primary Health Care, Kuopio University Hospital, Kuopio, Finland
- 6Research Department, The Social Insurance Institution, Turku, Finland
- 7Department of Medicine, South Karelia Central Hospital, Lappeenranta, Finland
- 8Division of Cardiology, Helsinki University Central Hospital, Helsinki, Finland
- Correspondence to Dr Tuomo V M Nieminen, Division of Cardiology, Helsinki University Central Hospital, P.O. Box 340, FI-00029 Helsinki, Finland;
- Accepted 21 October 2012
- Published Online First 23 November 2012
Objectives To assess the prevalence of coronary heart disease (CHD) and chronic hypertension among patients with rheumatoid arthritis (RA) at the time of diagnosis, in comparison with age-specific and sex-specific non-RA subjects. Furthermore, the impacts of age at the onset of RA, as well as gender and the presence of rheumatoid factor (RF) on the risk of these comorbidities, were evaluated.
Methods A cohort of 7209 RA patients diagnosed between January 2004 and December 2007 was identified, based on a Finnish nationwide register on special reimbursements for medication costs. The presence of CHD and chronic hypertension antedating the diagnosis of RA was identified from the same register. The prevalence of the cardiovascular comorbidities was compared with the general Finnish population, and a standardised rate ratio (SRR) for both these cardiovascular diseases was calculated.
Results The risk of having CHD at RA diagnosis was slightly elevated, the SRR being 1.10 (95% CI 1.01 to 1.20). Younger age at the onset of RA seemed to be related with higher SRR for CHD. In a subset analysis, an increased prevalence of hypertension (SRR 1.19, 95% CI 1.10 to 1.30) and CHD (SRR 1.15, 95% CI 1.00 to 1.32) was apparent only among the RF negative RA cases.
Conclusions The SRR for CHD is augmented in RA patients already at disease onset, and more pronouncedly in early onset RA. The findings highlight the importance of early prevention of atherosclerosis, regardless of RF status.