Van Doornum S et al. (2006) Increased case fatality rates following a first acute cardiovascular event in patients with rheumatoid arthritis. Arthritis Rheum 54: 2061–2068

It is well known that patients with rheumatoid arthritis (RA) have a higher incidence of cardiovascular events than people without RA; however, the risk of death following a cardiovascular event in patients with RA, compared with the general population, has not previously been investigated. Van Doornum and colleagues have now shown that after a first cardiovascular event, patients with RA have a higher mortality rate than people without RA.

The data for this retrospective cohort study were obtained between July 2001 and December 2003 from The Victorian Linked Dataset, which includes information about all episodes of hospital patient care and deaths in Victoria, Australia. According to this dataset, 29,924 patients experienced a first cardiovascular event (myocardial infarction or stroke), of whom 359 had a diagnosis of RA. The 30-day cardiovascular mortality rate was 17.6% for patients with RA, compared with 10.9% for patients without RA; the excess mortality in RA patients was almost entirely attributable to an increased number of deaths from myocardial infarction, rather than from stroke. The higher fatality rate in RA patients did not change after adjustment for traditional cardiovascular risk factors, comorbidity and socioeconomic status.

The authors speculate that the increased cardiovascular mortality rate in patients with RA could be caused by the treatments for RA, systemic inflammation, delay in seeking medical attention and in diagnosis, and differences in treatments administered after cardiovascular events; however, the data obtained could not directly address these issues, and further research is required to identify the mechanisms responsible.