Article Text

Download PDFPDF
Extended report
Acute coronary syndrome in new-onset rheumatoid arthritis: a population-based nationwide cohort study of time trends in risks and excess risks
  1. Marie Holmqvist1,
  2. Lotta Ljung1,2,
  3. Johan Askling1
  1. 1Department of Medicine, Clinical Epidemiology Unit, Karolinska Institutet, Solna, Stockholm, Sweden
  2. 2Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
  1. Correspondence to Marie Holmqvist, Department of Medicine, Solna, Clinical Epidemiology Unit, Karolinska Institutet, T2, SE-17176 Stockholm, Sweden; marie.holmqvist{at}


Background Acute coronary syndrome (ACS) and other cardiovascular diseases are the main drivers of the increased morbidity and preterm mortality in rheumatoid arthritis (RA). ACS in RA has been linked to inflammation and RA severity. During recent years and with new therapeutic options and treat-to-target strategies, increasing efforts have been made to reach RA remission as soon as possible after diagnosis, and the average level of RA disease activity has declined. Whether this has resulted in declining excess risks for RA comorbidities remains unclear.

Methods We performed a nationwide population-based cohort study of patients with new-onset RA from 1997 to 2014, and matched general population comparators. In the Swedish healthcare system, all residents have equal access to healthcare services. Healthcare is monitored using high-quality population-based registers that can be linked together. 15 744 patients with new-onset RA, identified from the Swedish Rheumatology Quality Register, and 70 899 general population comparator subjects were included.

Results Seven hundred and seventy two patients with RA developed an ACS during 103 835 person-years of follow-up (crude incidence, 7.4 per 1000), corresponding to an overall HR versus the general population of 1.41 (95% CI 1.29 to 1.54). Whereas the ACS incidence declined over calendar time in both the RA and the general population cohort, the excess and the relative risks of ACS remained the same.

Conclusions Despite improved disease control in new-onset RA, the elevated risk of ACS in RA remains a concern.

  • Rheumatoid Arthritis
  • cardiovascular
  • cohort
  • risk
  • Sweden

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors MH had full access to all of the data used for analyses in this study and takes full responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: JA, MH, LL. Acquisition of data: MH, JA. Statistical analysis: MH, LL. Analysis and interpretation of data: MH, LL, JA. Drafting of manuscript: MH, LL. Critical revision of manuscript and final approval given: MH, LL, JA. Obtained funding: JA. Study supervision: JA.

  • Funding The Swedish Research Council, the Swedish Foundation for Strategic Research, Stockholm County Council (ALF), Heart Lung Foundation and Karolinska Institutet (Strategic Research Area Epidemiology). Funders had no impact on the design or interpretation of the study or its results.

  • Competing interests None declared.

  • Ethics approval Ethics committee in Stockholm, Sweden.

  • Provenance and peer review Not commissioned; externally peer reviewed.