A recent study published in Frontiers in Immunology has unveiled a significant link between rheumatoid arthritis (RA) and an elevated risk of heart failure (HF), emphasizing the critical cardiovascular risks faced by individuals with this chronic autoimmune disease. The research, which combined epidemiological data from the U.S. with genetic analysis from European populations, found that RA patients are nearly twice as likely to develop heart failure compared to those without the condition.
The study involved a comprehensive analysis of data from 37,736 participants collected through the National Health and Nutrition Examination Survey (NHANES) from 1999 to 2020. The results revealed that the prevalence of heart failure among individuals with RA in the U.S. was 7.11%, with RA patients having an odds ratio (OR) of 1.93 for developing heart failure. This association was highly significant (P 0.0001). In the European population, the MR analysis confirmed a causal link between RA and an increased risk of heart failure, with an OR of 1.083 and a 95% CI of 1.028 to 1.141 (P = 0.003). However, this association was not observed in seronegative RA (SRA) cases, where the odds ratio was 1.028, and the confidence interval indicated no significant risk (95% CI: 0.992-1.065; P = 0.126).
Heart failure (HF) ranks as the second leading cause of cardiovascular mortality in patients with RA, with research indicating that RA doubles the incidence of HF compared to those without the condition. Faxén et al. found that RA was independently associated with an increased risk of developing heart failure (HF), particularly in those with a left ventricular ejection fraction (LVEF) of 40% or lower. While RA was not linked to worse cardiovascular outcomes after an HF diagnosis, it was associated with a higher risk of all-cause mortality in patients with HF and an LVEF below 40%.
Besides chronic inflammation, other factors such as the use of corticosteroids, comorbid conditions (e.g., diabetes, hypertension), and traditional cardiovascular risk factors (e.g., smoking, obesity) also contribute to the increased risk of HF in RA patients. The present study underscores the importance of vigilant cardiovascular health monitoring in RA patients, highlighting the need for early detection and proactive management of HF risk. The study also points to potential differences in risk between seropositive and seronegative RA, suggesting a need for further research into the specific mechanisms underlying this association. The study conclusion emphasizes that RA significantly increases the risk of heart failure, which may influence future clinical guidelines and patient care strategies. As the relationship between RA and heart failure becomes increasingly clear, it is crucial for healthcare providers to prioritize cardiovascular monitoring and develop tailored treatment plans for RA patients to reduce the risk of HF.
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Reference:
- Kadier K, Dilixiati D, Zhang X, Li H, Kuang L, Huang J et al. Rheumatoid arthritis increases the risk of heart failure: results from the cross-sectional study in the US population and mendelian randomization analysis in the European population. Front Immunol. 2024 May 28;15:1377432.
- Faxén J, Benson L, Mantel Ä, Savarese G, Hage C, Dahlström U et al. Associations between rheumatoid arthritis, incident heart failure, and left ventricular ejection fraction. Am Heart J. 2023 May;259:42-51.