Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease

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 (MAC E; 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 (IRR adj) 1.63, 95%CI 1.04 to 2.54), for patients with CAD alone (9.9%; IRR adj 3.35, 95%CI 3.10 to 3.62), and highest for patients with both RA and CAD (12.2%; IRR adj 4.53, 95%CI 3.66 to 5.59). Similar associations were observed for MAC E an all-cause mortality. Conclusions In patients undergoing CAG, RA is significantly associated with the 10-year risk of MI, MAC E 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