Common inflammatory disorder increases heart attack, stroke risk : New Study

Patients with polymyalgia rheumatica (PMR) are at 2.5 times the risk for a vascular event than matched control patients, with the greatest risk occurring in patients younger than 60 years, according to a study published online July 28 in CMAJ.

This research was conducted by Christian D. Mallen, PhD, of Keele University in Staffordshire, England, and colleagues.

The researchers used data from the General Practice Research Database in England, which includes electronic records of all patients with polymyalgia rheumatica in the United Kingdom and Wales. The people identified were seen in medical practices between January 1987 and December 31, 1999.

Each of 3,249 people with polymyalgia rheumatic was matched with as many as five controls—people born in the same year of the same gender and from the same practice, but not diagnosed with polymyalgia rheumatica. There were 12,735 controls.

Those with polymyalgia rheumatica were on at least two corticosteroid prescriptions—drugs that mimic the effect of hormones in our bodies but can reduce inflammation. The researchers wanted to be sure the patients had a correct diagnosis as polymyalgia rheumatica can sometimes resemble different conditions.

None of the patients had known vascular problems at the start of the study. They were all followed from their initiation into the study until their first vascular event, death, transfer out of the practice, or until May 2011, whichever was the earliest. The mid-range follow-up time was 7.8 years.

Vascular events were either cardiovascular (such as heart attack or angina), cerebrovascular (stroke or transient ischemic attack) or a peripheral vascular event (intermittent claudication/stop of blood flow in legs or ischemia/reduced blood flow to tissue).

Those with polymyalgia rheumatica experienced 36.1 vascular events per 1,000 person-years compared to controls, who only experienced 12.2.

The incidence was highest among people with polymyalgia rheumatica younger than 60, and among people within six months of diagnosis.

Even when the study authors looked at other factors contributing to vascular disease—such as smoking, having diabetes, having high cholesterol or high blood pressure—people aged 50 to 59 with polymyalgia rheumatica had a more than five times higher risk for a vascular event compared to those without the condition. Those 80 years of age and older with polymyalgia rheumatica had a three-fold increased risk compared to people without the condition.

The investigators suggested that other risk factors for vascular events should be treated particularly aggressively among those with polymyalgia rheumatica in order to reduce the risk as much as possible.

They concluded that “further research is needed to investigate the mechanisms of vascular disease in polymyalgia rheumatica, and specifically to assess the burden of risk conferred by traditional cardiovascular risk factors versus the risk conferred by inflammation or treatment with steroids.”

Agencies/Canadajournal