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Rheumatoid arthritis (RA) is associated with elevated risks for myocardial infarction and cardiovascular mortality (for example, JW Womens Health May 20 2003). To assess whether people with RA are at excess risks for atrial fibrillation (AF) and stroke, researchers analyzed data from 4.2 million people (age >15 years) in Denmark who were free of RA, AF, and stroke before 1997 (baseline).
During a median follow-up of 4.8 years, roughly 18,000 people developed RA (mean age at onset, 59), 156,000 developed AF, and 165,000 experienced stroke. The risk for AF, adjusted for age and sex, was nearly 40% higher among people with RA than in the rest of the population (8.2 vs. 6.0 events per 1000 person-years). Adjusted risk for stroke was more than 30% higher among people with RA than in the rest of the population (7.6 vs. 5.7 events per 1000 person-years).
Lindhardsen J et al. Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study. BMJ 2012 Mar 8; 344:e1257. (http://dx.doi.org/10.1136/bmj.e1257)
Comment
In this population-based study, people who developed rheumatoid arthritis had significantly increased risks for atrial fibrillation and stroke. This finding is biologically plausible; for example, systemic inflammation is associated with both AF and stroke. The authors estimate that for every 12 patients followed for 10 years after RA diagnosis, 1 will develop AF. They therefore recommend closely monitoring RA patients for development of AF and adding RA as a factor in risk-stratification schemes for stroke.