Declining risk of ischemic heart disease over time in rheumatoid arthritis: 1821 patients from 1972 to 2017.

Objectives: To evaluate trends of acute myocardial infarction (AMI) and ischemic heart disease (IHD) in rheumatoid arthritis (RA) patients compared with the general population over time. Methods: We performed a retrospective cohort study of 1821 RA patients diagnosed from 1972 to 2013. The total population of the same county (Hordaland, Norway) and time period was used for comparison. Information on AMI and IHD events was obtained from hospital patient administrative systems or cardiovascular registries. We estimated incidence rates and standardized event ratios (SER) compared with the general population by Poisson regression. Results: There was an average annual decline of 1.6% in age- and sex-adjusted AMI incidence rates from 1972 to 2017 (incidence rate ratio 0.984, 95% CI 0.971–0.998). Excess events in RA patients compared with the general population declined on average 1.3% per year for AMI and 2.3% for IHD from 1972 to 2014. The total RA cohort had 49% (SER 1.49, 95% CI 1.30–1.69) more AMI events and 63% (SER 1.63, 95% CI 1.52–1.74) more IHD events compared with the general population. There were no significant excess AMI and IHD events for RA patients diagnosed after 1998 compared with the general population. Conclusion: Incidence rates and excess events of AMI and IHD in RA patients declined from 1972 to 2017. There were no excess AMI or IHD events in RA patients diagnosed after 1998 compared with the general population.