Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study

BMJ 2012; 344 doi: http://dx.doi.org/10.1136/bmj.e1257 (Published 8 March 2012)
Cite this as: BMJ 2012;344:e1257

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As rheumatoid arthritis is a chronic inflammatory condition it certainly increases the risk of atherosclerosis.Increased risk of atherosclerosis increases the risk of coronary artery disease and stroke.Thus rheumatoid arthritis patients have increased risk of atrial fibrillation and stroke.
But wheather theatment of rheumatoid arthritis reduces the risk of atrial fibrillation and stroke, is most important issue in now a day's practice
Or it has only symptomatic benifit with halting the process of inflammation without reducing the increased risk of death.

Competing interests: None declared

Gopal chandra Ghosh, Post Graduate Student

PGIMER & DR. RML HOSPITAL, BABA KHARAG SINGH MARG, NEW DELHI-110001

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Dear Editor

Lindhardsen and colleagues have recently reported a study which found increased risks of stroke and atrial fibrillation were associated with rheumatoid arthritis in the Danish population[1]. The incidence rate ratio of stroke for people with rheumatoid arthritis was 1.33 (1.22 to 1.46) for women and 1.34 (1.19 to 1.51) for men. The findings are very similar to the increased risk of cardiovascular disease in patients with rheumatoid arthritis reported in the QRISK2[2] study where the adjusted hazard ratio for women was 1.50 (1.39 to 1.61) with 1.38 (1.25 to 1.52) for men. The QRisk2 algorithms also include terms for atrial fibrillation which had overall adjusted hazard ratios of 3.06 (2.39 to 3.93) in women and 2.40 (2.07 to 2.79) in men in the QRisk2 study. These results support the inclusion of atrial fibrillation and rheumatoid arthritis in the calculation of cardiovascular risk.

References

1. Lindhardsen J, Ahlehoff O, Gislason GH, Madsen OR, Olesen JB, Svendsen JH, et al. Risk of atrial fibrillation and stroke in rheumatoid arthritis: Danish nationwide cohort study. BMJ 2012;344.
2. Hippisley-Cox J, Coupland C, Vinogradova Y, Robson J, Minhas R, Sheikh A, et al. Predicting cardiovascular risk in England and Wales: prospective derivation and validation of QRISK2. BMJ 2008:bmj.39609.449676.25.

Competing interests: JHC is professor of clinical epidemiology at the University of Nottingham and co-director of QResearch® – a not-for-profit organisation which is a joint partnership between the University of Nottingham and EMIS (leading commercial supplier of IT for 60% of general practices in the UK). JHC is also director of ClinRisk Ltd which produces open and closed source software to ensure the reliable and updatable implementation of clinical risk algorithms within clinical computer systems to help improve patient care. CC is associate professor of Medical Statistics at the University of Nottingham and a consultant statistician for ClinRisk Ltd. JR and PB have received no financial support for undertaking this work. JR and PB were previously members of the NICE Guideline Development Group for Lipid Modification of which JR was chair. This work and any views expressed within it are solely those of the co-authors and not of any affiliated bodies or organisations. There are no other relationships or activities that could appear to have influenced the submitted work.

Julia Hippisley-Cox, Professor and GP

Carol Coupland, John Robson, Peter Brindle

University of Nottingham/ClinRisk Ltd, Nottingham

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