Nikiphorou E, de Lusignan S, Mallen CD, et al. - Researchers performed a retrospective case–control study using a large English primary care database to evaluate the burden of cardiovascular disease (CVD) at and prior to diagnosis in people with early rheumatoid arthritis (RA) and subsequent CVD in these patients. They distinguished a total of 6591 individuals with RA between 2004 and 2016 (inclusive) using a validated algorithm, matched 1:1 by age and gender to those without RA (n=6591) and followed for a median of 5.4 years. They evaluated variations in CVD at, before and after diagnosis, and the effect of traditional and RA-related risk factors (C reactive protein, RA-related autoantibodies and medication use) on incident CVD (a composite of myocardial infarction (MI), stroke or heart failure). The study found an excess of stroke and heart failure before diagnosis of RA. After diagnosis, there is excess risk for future cardiovascular events, which is not explained by variations in traditional CVD or RA-related risk factors at diagnosis.