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This editorial refers to ‘Rheumatoid arthritis is associated with a more severe presentation of acute coronary syndrome and worse short-term outcome’, by A. Mantel et al ., doi:10.1093/eurheartj/ehv461. Rheumatoid arthritis (RA) is a chronic inflammatory immune-mediated disease affecting the joints and several other organs. At a global prevalence of 0.24%, RA is ranked among the top 15% of diseases causing disability worldwide.1 RA is associated with an increased risk of cardiovascular mortality.2 Furthermore, post mortem3 and coronary CT angiography data4 indicate a higher prevalence of vulnerable coronary plaques in patients with RA compared with controls.The article by Mantel et al .5 in this issue of the journal adds an important piece to the puzzle, reporting their analysis of a large contemporary Swedish cohort study using national registries. The authors found an increased severity of disease at presentation with an incident acute coronary syndrome (ACS) and worse short-term all-cause mortality in patients with active RA compared with matched controls. Interestingly, worse outcome in patients with RA compared with matched controls persisted after adjustment for clinical covariates, including the type of ACS. …

Rheumatoid arthritis and coronary atherosclerosis: two cousins engaging in a dangerous liaison