The Influence of Rheumatoid Arthritis Disease Characteristics on Heart Failure

Abstract

Objective To examine the impact of rheumatoid arthritis (RA) characteristics and antirheumatic medications on the risk of heart failure (HF) in RA. Methods A population-based incidence cohort of RA patients aged ≥18 (1987 ACR criteria first met between 1/1/1980 and 1/1/2008) without a history of HF was followed until HF onset (defined by Framingham criteria), death, or 1/1/2008. We collected data on RA characteristics, antirheumatic medications and cardiovascular (CV) risk factors. Cox models adjusting for age, sex and calendar year were used to analyze the data. Results The study included 795 RA patients (mean age 55.3 years, 69% females, 66% rheumatoid factor [RF] positive). During the mean follow-up of 9.7 years, 92 patients developed HF. The risk of HF was associated with RF positivity (HR 1.6, 95%CI 1.0, 2.5), erythrocyte sedimentation rate (ESR) at RA incidence (HR 1.6, 95%CI 1.2, 2.0), repeatedly high ESR (HR 2.1, 95%CI 1.2, 3.5), severe extra-articular manifestations (HR 3.1, 95%CI 1.9, 5.1) and corticosteroid use (HR 2.0, 95%CI 1.3, 3.2), adjusting for CV risk factors and coronary heart disease (CHD). Methotrexate users were half as likely to have HF as non-users (HR 0.5, 95%CI 0.3, 0.9). Conclusion Several RA characteristics and the use of corticosteroids were associated with HF adjusting for CV risk factors and CHD. Methotrexate use appeared to be protective against HF. These findings suggest an independent impact of RA on HF which may be further modified by antirheumatic treatment.

Current Diagnostic and Treatment Strategies for Specific Dilated Cardiomyopathies: A Scientific Statement From the American Heart Association

“…Excess risk for mortality and HF occurs early after diagnosis, based on an inception cohort. 314 Limited data suggest that treatment of the RA with steroids can increase the risk of HF, 315 whereas in a large, nested case-control study, 316 treatment with methotrexate and other disease-modifying antirheumatic drugs reduced the risk of incident HF. However, etanercept and infliximab should probably not be used in patients with established HF, because prior trials found that these drugs can enhance the development of HF.…”

The Role of B-Cells in Heart Failure

“…There also appears to be a correlation between autoimmune illnesses and heart disease, since patients with rheumatoid arthritis have higher incidences of heart failure than the general population, and increased levels of c-reactive protein (CRP) are associated with heart failure progression. 42,43 In cases of nephritis, deposition of IgG is similar to that observed in end-stage Presence of Anti-Cardiac Antibodies in Cardiomyopathy heart failure, myocarditis, and dilated CMP. 44 Therapeutic strategies used in these disease settings have been used to treat CMP with the notion that it will have similar effects on this disease alone.…”

Impact of Antirheumatic Therapy on the Level of N-Terminal Pro-Brain Natriuretic Peptide in Patients With Early Rheumatoid Arthritis

“…В когортном ис-следовании Е. Myasoedova и соавт. [29] продемонстриро-вали снижение риска развития ХСН у больных РА, полу-чавших МТ, по сравнению с пациентами без терапии (от-носительный риск 0,5; 95% доверительный интервал 0,3-0,6). К. Gong и соавт.…”