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Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease
  1. Brian Bridal Løgstrup1,
  2. Kevin Kris Warnakula Olesen1,
  3. Dzenan Masic2,
  4. Christine Gyldenkerne1,
  5. Pernille Gro Thrane1,
  6. Torkell Ellingsen3,
  7. Hans Erik Bøtker1,
  8. Michael Maeng1
  1. 1 Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
  2. 2 Department of Rheumatology, Silkeborg Regional Hospital, Silkeborg, Denmark
  3. 3 Department of Rheumatology, Odense University Hospital, Odense, Denmark
  1. Correspondence to Dr Brian Bridal Løgstrup, Department of Cardiology, Aarhus University Hospital, Aarhus 8200, Denmark; bbl{at}


Introduction Rheumatoid arthritis (RA) is a risk factor for cardiovascular disease. The clinical consequences of coincident RA and coronary artery disease (CAD) are unknown.

Objective We aimed to estimate the impact of RA on the risk of adverse cardiovascular events in patients with and without CAD.

Methods A population-based cohort of patients registered in the Western Denmark Heart Registry, who underwent coronary angiography (CAG) between 2003 and 2016, was stratified according to the presence of RA and CAD. Endpoints were myocardial infarction (MI), major adverse cardiovascular events (MACE; MI, ischaemic stroke and cardiac death) and all-cause mortality.

Results A total of 125 331 patients were included (RA: n=1732). Median follow-up was 5.2 years. Using patients with neither RA nor CAD as reference (cumulative MI incidence 2.7%), the 10-year risk of MI was increased for patients with RA alone (3.8%; adjusted incidence rate ratio (IRRadj) 1.63, 95% CI 1.04 to 2.54), for patients with CAD alone (9.9%; IRRadj 3.35, 95% CI 3.10 to 3.62), and highest for patients with both RA and CAD (12.2%; IRRadj 4.53, 95% CI 3.66 to 5.59). Similar associations were observed for MACE an all-cause mortality.

Conclusions In patients undergoing CAG, RA is significantly associated with the 10-year risk of MI, MACE and all-cause mortality regardless of the presence of CAD. However, patients with RA and CAD carry the largest risk, while the additive risk of RA in patients without CAD is minor. Among patients with RA, risk stratification by presence or absence of documented CAD may allow for screening and personalised treatment strategies

  • atherosclerosis
  • cardiovascular disease
  • rheumatoid arthritis
  • outcomes research
  • epidemiology

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  • Handling editor Josef S Smolen

  • Contributors All authors, BBL, KKWO, DM, CG, PGT, TE, HEB and MM, have substantially contributed to all aspects of this study. BBL, KKO, HEB and MM were involved in the conception and design of the study and performed acquisition of data. BBL, KKWO, HEB and MM were involved in the analysis and interpretation of clinical results. BBL, KKWO, HEB and MM performed drafting of the manuscript. BBL, KKWO, DM, CG, PGT, TE, HEB and MM were involved in the critical revision of the manuscript for important intellectual content. All authors approved the final manuscript before submission.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Danish Data Protection Agency (record no. 1-16-02-193-18).

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

  • Data availability statement Data may be obtained from a third party and are not publicly available. Registry data used with the approval from the Danish authorities.