Elevated CRP in patients with RA linked to myocardial infarction risk

Markers of inflammation linked to disease activity in patients with rheumatoid arthritis were linked to the risk of myocardial infarction, according to recently published research.

Analysis of data from 11,285 patients with rheumatoid arthritis (RA) enrolled in the prospective German biologics register RABBIT cohort at the inception of biologic or conventional disease-modifying rheumatic drugs (DMARDs) was conducted. Patients were evaluated by a rheumatologist at baseline, 3 months and 6 months, and every 6 months thereafter. Researchers identified 112 patients who developed myocardial infarction (MI).

Elevated levels of C-reactive protein (CRP) were associated with the incidence of MI, but disease activity (based on 28-joint counts) was not, regardless of DMARD type. The treatment of cardiovascular comorbidities was often less likely in patients who developed MI compared to matched control participants. Matching criteria included similar baseline history of hypertension, heart failure and other cardiovascular disease (CVD) comorbidities. Persistent use of DMARDs was also significantly lower among patients with RA who developed MI.

Univariate analysis showed a 5 mg/L increase in CRP 6 months prior to the index date was associated with an increased risk of MI, as well as averaged and log-transformed CRP levels during the observation period. Patients with an absence of baseline treatment of cardiovascular conditions were also more likely to develop MI, as were patients who received glucocorticoids above 5 mg per day. This was particularly true for patients who received 10 mg per day, as well as those who had current smoking status.

“An obvious but rather unexpected risk factor was detected in our data: In patients with a future MI, pre-existing CV comorbidities were less frequently treated than in the corresponding control patients,” the researchers wrote. “This suggests that insufficient consideration of CV risk in patients with known CV comorbidities is a further risk factor for MI. There seems to be a gap between the knowledge about CV risk in RA, respective recommendations and the daily management of patients. Our findings confirm suboptimal risk management of CVD.” -by Shirley Pulawski

Disclosures: Meissner reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures.

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Meissner Y. Arth Res Ther. 2016;doi:10.1186/s13075-016-1077-z.