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Rheumatoid arthritis significantly increased recurrence risk after ischemic stroke/transient ischemic attack

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Abstract

The effect of RA on recurrent stroke is unknown. Therefore, we examined effects of rheumatoid arthritis (RA) on risk of stroke recurrence and investigated the interaction between RA and traditional cardiovascular risk factors on recurrence risk after ischemic stroke (IS) or transient ischemic attack (TIA). Of 3190 patients with IS or TIA recruited in this cohort study, 638 were comorbid with RA and 2552 without RA. Stroke recurrence, RA, lifestyle, lipid variables and other comorbidities were identified through linkage between a nationwide stroke database in Taiwan and the National Health Insurance claims database. Cox proportional hazard models with competing risk adjustment were used to evaluate the relationship between RA and recurrent stroke. Patients with RA showed a significantly increased risk of recurrent stroke, particular in recurrent IS/TIA. The increased risk of recurrent IS/TIA in RA patients may through the changes of triglycerides (TG)/high-density lipoprotein cholesterol (HDL-C) ratio. A positive additive interaction was observed between RA and current smoking on the risk of recurrent IS/TIA. Significantly increased risks for recurrent IS/TIA were observed among RA patients who smoked > 40 years or those who smoked > 20 cigarettes/day. This study provides the first evidence that RA significantly increased recurrence IS/TIA risk. The changes of TG/HDL-C ratio may play some roles in the recurrence IS/TIA risk in RA patients. In addition, our results suggest that smoking increases the risk of recurrent IS/TIA in RA patients and reinforces the need for aggressive smoking cessation efforts in RA patients.

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Acknowledgements

The data analyzed in this study were provided by the Health and Welfare Data Science Center (HWDC) and the Health Promotion Administration, Ministry of Health and Welfare, Taiwan.

Funding

This work was supported in part by Grants from the Ministry of Health and Welfare (MOHW105-TDU-B-212-133018); Ministry of Science and Technology (NSC 100-2811-B-038-018; NSC 101-2314-B-038-043-MY3; NSC 102-2314-B-038-041; MOST 104-2314-B-038-069); the Health Promotion Administration, Ministry of Health and Welfare; Dr. Chi-Chin Huang Stroke Research Center. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. School of Public Health, College of Public Health, Taipei Medical University, No. 250, Wuxing Street, Taipei City, 110, Taiwan

    Yih-Ru Chen, Fang-I Hsieh & Hung-Yi Chiou

  2. Department of Neurology, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan

    Li-Ming Lien

  3. School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Li-Ming Lien & Chaur-Jong Hu

  4. Department of Neurology, Shuang Ho Hospital, Taipei, Taiwan

    Chaur-Jong Hu & Nai-Fang Chi

  5. Stroke Center and Department of Neurology, National Taiwan University Hospital, Taipei, Taiwan

    Jiann-Shing Jeng & Sung-Chun Tang

  6. Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan

    Giia-Sheun Peng & Yueh-Feng Sung

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  1. Yih-Ru Chen
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Correspondence to Hung-Yi Chiou.

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None of the authors has any conflict of interest to disclose.

Ethical standards

This study was carried in accordance with ethical standard as set out in the Declaration of Helsinki and this study was confirmed exemption by Taipei Medical University Joint Institutional Review Board (approval no. 201411004).

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Chen, YR., Hsieh, FI., Lien, LM. et al. Rheumatoid arthritis significantly increased recurrence risk after ischemic stroke/transient ischemic attack. J Neurol 265, 1810–1818 (2018). https://doi.org/10.1007/s00415-018-8885-9

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  • DOI: https://doi.org/10.1007/s00415-018-8885-9

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