Rheumatoid arthritis may be strong driver for incident HF
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Rheumatoid arthritis is independently associated with incident HF across the range of ejection fraction, with a stronger association among those with an EF of at least 40%, researchers reported.
“Major differences exist between the inflammation in rheumatoid arthritis and that in HF, both in terms of the signaling pattern and in its grade,” Jonas Faxen, MD, PhD, from the department of cardiology at Karolinska University Hospital, Stockholm, and colleagues wrote in the American Heart Journal. “Hence, given the instrumental nature of systemic inflammation in rheumatoid arthritis, investigating the association between rheumatoid arthritis and specific left ventricular EF categories in HF is of particular importance to guide further studies towards a better understanding of pathophysiological mechanisms and possible treatment targets.”
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Faxen and colleagues analyzed data from 20,916 patients with incident HF between 2003 and 2018 using data from the Swedish Heart Failure Registry, enriched with data from national health registers. Researchers assessed the associations between a prior diagnosis of rheumatoid arthritis (RA) and LVEF (< 40%; 40%-49%; and 50%) among patients with HF and compared data with 103,501 matched general population controls without HF.
Researchers also analyzed associations between HF with vs. without a prior diagnosis of RA, stratified by LVEF, and outcomes up to 5 years after a HF diagnosis.
Among the patients with incident HF, 1.6% had RA compared with 1% of controls without HF. Compared with controls without HF, the OR for RA was 1.4 (95% CI, 1.1-1.8) for adults with an LVEF less than 40% and 1.6 (95% CI, 1.3-2) for adults with an LVEF at least 40%.
Among patients with HF, RA was more common in HF with an LVEF of at least 40% (1.9%) vs. an LVEF less than 40% (1.3%), for an OR of 1.4 (95% CI, 1.1-1.7).
Across the range of LVEF, researchers did not observe any associations between RA and CV outcomes. However, researchers did observe an association between RA and all-cause mortality among patients with HF and an LVEF of less than 40%, with an HR of 1.4 (95% CI, 1.1-1.8).
“Although markers of inflammation could not be directly measured and we were only able to use RA as a possible proxy for systemic inflammation, our results are consistent with accumulating mechanistic and clinical data on inflammation as an important factor in HF pathogenesis,” the researchers wrote. “This, furthermore, links into the hypothesis of comorbidity-driven global inflammation in HF with preserved EF. Our data suggests that RA may be a strong driver of HF with LVEF 40%, independently of ischemic heart disease and additional cardiovascular comorbidities.”
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