Department of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland.
Rheumatology (Oxford). 2024 Nov 1;63(11):2997-3005. doi: 10.1093/rheumatology/keae458.
RA patients have an increased risk for cardiovascular diseases, including atrial fibrillation (AF), but the impact of RA on ischaemic stroke risk in the context of AF remains unknown. We explored whether the risk of ischaemic stroke after diagnosis of AF is further increased among patients with RA compared with non-RA patients.
In the nationwide Norwegian Cardio-Rheuma Register, we evaluated cumulative incidence and hazard rate of ischaemic stroke after the first AF diagnosis (2750 individuals with RA and 158 879 without RA between 2010 and 2017) by using a competing risk model with a 3-month delayed entry.
The 5-year unadjusted cumulative incidence of ischaemic stroke was 7.3% (95% CI: 5.9-8.7%) for patients with RA and 5.0% (95% CI: 4.9-5.2%) for patients without RA. Unadjusted univariate analyses indicated that AF patients with RA had a HR of 1.36 (95% CI: 1.13, 1.62) for ischaemic stroke compared with those without RA. Sex- and age-adjusted HR for ischaemic stroke in RA patients with AF was 1.25 (95% CI: 1.05, 1.50), and the effect size remained unchanged after adjustment for diabetes, hypertension, atherosclerotic cardiovascular disease and oral anticoagulant (OAC) treatment. RA patients were less likely to receive OAC treatment than non-RA patients (adjusted odds ratio 0.88, 95% CI: 0.80, 0.97).
RA patients diagnosed with AF are at a further increased risk for stroke compared with non-RA patients with AF, and less likely to receive OAC treatment, emphasizing the need to improve stroke prevention in AF patients with RA.
类风湿关节炎（RA）患者发生心血管疾病（包括心房颤动，AF）的风险增加，但 RA 对 AF 患者发生缺血性卒中风险的影响尚不清楚。我们探讨了与非 RA 患者相比，AF 诊断后 RA 患者发生缺血性卒中的风险是否进一步增加。
在全国性挪威心脏风湿病登记处中，我们使用竞争风险模型（3 个月延迟纳入）评估了首次 AF 诊断后（2010 年至 2017 年期间，2750 例 RA 患者和 158879 例非 RA 患者）缺血性卒中的累积发生率和危险率。
RA 患者的 5 年未调整累积缺血性卒中发生率为 7.3%（95%CI：5.9%-8.7%），而非 RA 患者为 5.0%（95%CI：4.9%-5.2%）。未调整的单因素分析表明，与非 RA 患者相比，AF 合并 RA 的患者发生缺血性卒中的 HR 为 1.36（95%CI：1.13，1.62）。在调整性别和年龄后，AF 合并 RA 的患者发生缺血性卒中的 HR 为 1.25（95%CI：1.05，1.50），且在调整糖尿病、高血压、动脉粥样硬化性心血管疾病和口服抗凝剂（OAC）治疗后，该效应大小保持不变。RA 患者接受 OAC 治疗的可能性低于非 RA 患者（调整后的比值比 0.88，95%CI：0.80，0.97）。
与 AF 合并非 RA 的患者相比，诊断为 AF 的 RA 患者发生卒中的风险进一步增加，且更不可能接受 OAC 治疗，这强调了需要改善 AF 合并 RA 患者的卒中预防。
