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Rheumatoid Arthritis Linked To Cardiovascular Risk

Arthritis Rheumatoid 230px-Rheumatoid_Arthritis WIKIPEDIA
(The image "A hand affected by rheumatoid arthritis" by James Heilman, MD uploaded to wikipedia.)




People suffering from rheumatoid arthritis are also at risk for heart related problems, new research suggests. In a report published in the British Medical Journal, Danish researchers have evidence that rheumatoid arthritis is linked to increased risk for stroke and atrial fibrillation.

Jesper Lindhardsen from Department of Cardiology at Copenhagen University Hospital Gentofte and colleagues examined whether patients with rheumatoid arthritis (RA) had increased risk of atrial fibrillation and stroke. They recruited the entire Danish population over age 15 without RA, stroke or atrial fibrillation before 1997.

The cohort study collected data from 4,182,335 people of which 18,247 were diagnosed with RA during a five year follow up. During the course of the experiment, researchers learned startling new facts about the relationship between RA and cardiovascular disease.


Rheumatoid Arthritis Is Linked To Strokes And Atrial Fibrillation

Danish researchers observed that RA patients had a 30% higher risk of stroke than non RA patients; this broke down to stroke rates of 7.6 per 1000 among RA patients compared to 5.7 per 1000 among the general population.

Lindhardsen's team also discovered that 40% of RA patients had a higher risk of atrial fibrillation compared to the general population (8.2 events per 1000 in RA patients vs. 6.0 events per 1000 in the general population). Furthermore, they learned that women and the youngest age groups were most at risk for atrial fibrillation.

Overall the researchers showed that the absolute differences in rates of stroke and atrial fibrillation between people with RA and those without was greatest among the oldest patients.


Why Is Rheumatoid Arthritis Linked To Cardiovascular Problems?

Lindharden said the higher incidents of atrial fibrillation among RA patients could be related to previous research findings which show a relationship between increased risk of heart failure in people with RA.

Moreover, rheumatoid arthritis causes the arteries to stiffen which increases the risk of heart failure and atrial fibrillation. They also speculated that inflammation (symptomatic of rheumatoid arthritis) and C reactive proteins may contribute to atrial fibrillation.

They surmised that RA increases stroke risk through a "multifactorial process" involving inflammation and atherothrombosis. The development of arterial clots would cut off the brain's blood supply which, left untreated, could lead to a stroke. Lindhardsen's team did note increased prevalence of carotid plaques among diagnosed RA patients relative to people in the general population.

They determined that since inflammation plays such a significant role in stroke and atrial fibrillation their study "underlines the importance of rigorous control of inflammation with disease modifying antirheumatic drugs, not only for the management of joint symptoms but also to reduce the need for drugs with potential adverse cardiovascular effects and, ultimately, to diminish the inflammation driven atherthrombotic process."

Essentially, the Danish nationwide cohort study shows that inflammation is the binding tie between rheumatoid arthritis, stroke and atrial fibrillation.

The researchers involved in the study concluded that drug therapies that target inflammation could alleviate RA symptoms and reduce cardiovascular risk. It becomes difficult to dispute the results because the study encompassed such a large population.


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Article Reference

Lindhardsen, J., Ahlehoff, O., Gislason, G., Madsen, O., Olesen, J., Svendsen, J., Torp-Pedersen, C., & Hansen, P. (2012). Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study BMJ, 344 (mar08 2) DOI: 10.1136/bmj.e1257


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