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Long-term outcomes and secondary prevention after acute coronary events in patients with rheumatoid arthritis
  1. Ängla Mantel1,
  2. Marie Holmqvist1,2,
  3. Tomas Jernberg3,
  4. Solveig Wållberg-Jonsson4,
  5. Johan Askling1,2
  1. 1Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden
  2. 2Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden
  3. 3Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden
  4. 4Department of Public Health and Clinical Medicine/Rheumatology, Umeå University Hospital, Umeå, Sweden
  1. Correspondence to Dr Ängla Mantel, Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; angla.mantel{at}


Objectives Patients with rheumatoid arthritis (RA) are at increased risk of acute coronary syndrome (ACS) and suffer from poorer short-term outcomes after ACS. The aims of this study were to assess long-term outcomes in patients with RA with ACS compared with non-RA patients with ACS, and to investigate whether the use of secondary preventive drugs could explain any differences in ACS outcome.

Methods We performed a cohort study based on 1135 patients with RA and 3184 non-RA patients who all developed an incident ACS between 2007 and 2010. We assessed 1-year and overall relative risks for ACS recurrence and mortality, as well as prescriptions of standard of care secondary preventive drugs.

Results The risk of ACS recurrence, and of mortality, was increased in RA, both at 1 year after adjusting for baseline comorbidities (HR=1.30(95% CI 1.04 to 1.62) and 1.38(95% CI 1.20 to 1.59), respectively) and throughout the complete (mean 2 years) follow-up (HR=1.27(95% CI 1.06 to 1.52) and 1.50(95% CI 1.34 to 1.68), respectively). Among certain subgroups of ACS, there was a tendency of lower usage of statins, whereas there were no apparent differences in others. The increased rates of ACS recurrence and mortality remained in subgroup analyses of individuals whose prescription pattern indicated both adequate initiation and persistence to secondary preventive treatments.

Conclusions Patients with RA suffer from an increased risk of ACS recurrence and of death following ACS compared with general population, which in the present study could not readily be explained by differences in usage of secondary preventive drugs.

  • rheumatoid arthritis
  • acute coronary syndrome
  • outcome
  • secondary prevention
  • epidemiology

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  • Contributors All authors have made substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data.

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

  • Competing interests AM and MH have nothing to declare. TJ reports personal fees from Astra Zeneca, personal fees from MSD, personal fees from Aspen, outside the submitted work. SWJ reports a fee for short talk at conference for Swedish cardiologists and general practitioners January 2016, arranged by Merck, Sharp & Dome. JA and Karolinska Institutet had research agreements with Abbvie, BMS, MSD, Pfizer, Roche, Astra-Zeneca, Lilly, Samsung and UCB, mainly in the context of safety monitoring of biologics via ARTIS/The Swedish Biologics Register. For these, JA has been principal investigator. Karolinska Institutet has received remuneration for JA participating in ad boards arranged by Pfizer and Lilly.

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