Acute Coronary Syndrome Risk Elevated in Siblings of Patients With RA

Siblings of people with rheumatoid arthritis (RA) may have an increased risk for acute coronary syndrome (ACS), indicating a shared susceptibility between the 2 conditions, according to data presented at the European Congress of Rheumatology (EULAR) Congress 2018, held from June 13 to 16 in Amsterdam, The Netherlands.¹

The researchers used the Swedish Rheumatology Quality (SRQ) register to examine the possibility of shared susceptibility between the 2 conditions in full siblings of patients with vs without RA. The patients in the register were diagnosed with RA between 1996 and 2015, and through other population registries linked to the SRQ, the researchers sampled 5 general population comparator individuals to each patient with RA (matched by birth year and sex) and identified siblings of patients with RA for comparator individuals born within 5 years of their index case. Unique individuals were followed for ACS, which was defined as a first ever hospitalization.

A total of 7492 patients with RA who had 10,671 full siblings and 35,120 population comparator individuals with 47,137 siblings were identified. The hazard ratios (HRs) for ACS for patients with RA were 1.44 (95% CI, 1.25-1.66) and 1.23 (95% CI, 1.09-1.40) for their siblings, compared with the comparator individuals. The familial association between RA and ACS was confirmed using a direct comparison between the patients with RA and their siblings without RA (HR, 1.19; 95% CI, 1.02-1.38).

The researchers also published a report in 2017 which noted that, despite more efficient inflammation control in RA, the excess risk for ACS in patients with RA is still higher compared with that of the general population.²

They concluded that the increased risk for ACS in siblings of patients with RA suggests that to lower the cardiovascular risk in RA compared with the general population, “cardiopreventive measures must go beyond optimized RA disease control.”

Disclosures: Dr Askling has received grant/research support from Abbvie, Bristol-Myers Squibb, Merck Sharp & Dohme, Pfizer, Roche, AztraZeneca, Eli Lily, Samsung Bioepis, and UCB.

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References

1. Westerlind H, Holmqvist M, Ljung L, Frisell T, Askling J. Siblings of patients with rheumatoid arthritis are at increased risk of acute coronary syndrome. Presented at: European Congress of Rheumatology (EULAR) Congress 2018; June 13-16, 2018; Amsterdam, The Netherlands. Abstract OP0136.
2. Holmqvist M, Ljung L, Askling J. Acute coronary syndrome in new-onset rheumatoid arthritis: a population-based nationwide cohort study of time trends in risks and excess risks. Ann Rheum Dis. 2017;76(10):1642-1647.