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Siblings of patients with RA share increased risk for acute coronary syndrome
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AMSTERDAM — Siblings of patients diagnosed with rheumatoid arthritis were 23% more likely to have acute coronary syndrome compared with matched individuals-siblings in the general population, according to findings presented at the EULAR Annual Congress.
“We know that patients with RA are at increased risk for cardiovascular diseases and at increased risk for cardiovascular mortality, and among the cardiovascular diseases, acute coronary syndrome — basically, acute myocardial infarction — is one of the main disease entities,” Johan Askling, MD, PhD, of the department of medicine at Karolinska Institute in Stockholm, said during a press conference. “What is disturbing is that we would expect over time, with more effective RA treatment and more effective interventions, that the excess risk of cardiovascular diseases in RA would decline. However, when we look at the most recent cohorts available for 5- and 10-year risks, we still find an increased risk of cardiovascular diseases.”
He noted, “We then asked maybe the whole of the increase isn’t due to the RA disease itself, but rather perhaps cardiovascular disease and RA share risk factors, and that is why there is an increased risk.”
To evaluate whether there was potential shared susceptibility between RA and acute coronary syndrome, Askling and colleagues examined a cohort of patients with RA (n = 7,492) diagnosed between 1996 and 2015 from the Swedish Rheumatology Quality register, in addition to their full siblings (n = 10,671). The researchers then matched these patients by age/sex with individuals without RA (n = 35,120) as well as their full siblings (n = 47,137).
The researchers followed the cohorts for reports of acute coronary syndrome, which was defined as hospitalization or cause of death due to acute coronary syndrome or myocardial infarction, and censored at death, migration, RA diagnosis among individuals enrolled without RA or the conclusion of the study. Askling and colleagues calculated hazard ratios using a Cox proportional hazards model, adjusting for age, sex and calendar period of diagnosis.
According to study results, compared with matched individuals from the general population, patients with RA and their siblings were at a 44% and 23% increased risk for acute coronary syndrome. Additionally, a direct comparison of patients with their siblings demonstrated that patients with RA had a 19% greater risk for acute coronary syndrome than their siblings.
“We found that siblings of patients with seropositive RA are themselves also at increased risk of cardiovascular disease,” Askling said. “This would suggest that these two conditions have common pathways. To what extent this shared susceptibility is reflective of shared genetic or environmental risk factors remains to be further studied.”
He added, “From a rheumatology point of view, this means that since the siblings are also increased risk, the comparison that we have typically done when we compare RA patients against the general population is not the entire excess risk that we can remove by treating the inflammation. At the most, we can bring down the patient risk to the sibling risk, but the distance from the general population to the sibling probably depends on other factors — we need to think beyond inflammation control.”– by Bob Stott
Reference:
Westerlind H, et al. Abstract OP0136. Presented at: EULAR Annual Congress; June 13-16, 2018; Amsterdam.
Disclosure: Askling reports research support from AbbVie, BMS, MSD, Pfizer, Roche, Astra-Zeneca, Eli Lilly, Samsung Bioepis and UCB. Please see the study for all other authors’ relevant financial disclosures.