Following a first time myocardial infarction (MI or heart attack) patients with rheumatoid arthritis (RA) were significantly less likely to have been prescribed standard post-MI treatments than healthy controls, according to data presented at the EULAR 2011 Annual Congress. The authors of the study hypothesize that clinicians may find that treatment of RA patients after a heart attack is more challenging than in healthy individuals.
Results of a study, involving 98,454 patients demonstrated that at 30 days following their first heart attack, RA patients were approximately 20% less likely to be prescribed standard MI treatments, such as statins and betablockers, compared to healthy patients. These finding remained relatively unchanged at 180 days, further highlighting differences between the two groups, with a high number being prescribed the current standards of care within the 180 day period (statins 80%, betablockers 82%, clopidogrel 70%, aspirin 79%) in general.
"Previous research has established that RA patients have an increased risk of cardiovascular disease (CVD). The results of our study suggest that CVD may be under treated in these patients, due to concerns regarding the use of multiple medications or patient compliance," said Dr. Jesper Lindhardsen of the Gentofte University Hospital in Copenhagen, Denmark. "Clinicians may find post-MI treatment in RA patients more complicated which would explain the lower propensity towards prescribing treatment; however this may be increasing the CVD burden seen in RA patients. Additional research is required in this area to establish whether further education is needed."
In the study, researchers identified 98,454 patients (39.4% female), who had suffered an MI for the first time, using the Danish National nationwide individual level registers, which included pharmacy records. Researchers examined 1,113 RA patient's prescriptions (62.5% female) between their first MI and 30 and 180 days following, allowing them to determine whether standard MI treatments had been prescribed or not. Odds ratios were calculated to determine the influence of RA, and were obtained using the statistical tool multivariate logistic regression modelling which included gender, age, co-morbidity and income.
Results of a separate study show that duration of RA doesn't further impact on CV risk over time
Results of one further study investigating the risk of CVD in RA patients, demonstrated that duration of RA did not increase the CVD risk over time. Previous studies have suggested that a number of factors may contribute to RA patients developing CVD such as chronic systemic inflammation or adverse effects associated with RA treatments. However the findings in this study showed no difference in the risk of CVD between patients who had suffered with RA for less or more than 10 years.
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