Some Disease-Modifying Antirheumatic Drugs Raise Risk for Heart Failure

heart failure, doppler
heart failure, doppler
Researchers aimed to study the associations between heart failure medications and certain systemic autoimmune rheumatic diseases.

There may be an association between disease-modifying antirheumatic drugs and heart failure among some patients with rheumatic diseases. These findings were presented during the American College of Cardiology Annual Meeting, held virtually May 15 to 17, 2021.

Adult patients (N=86,491) treated at the Cleveland Clinic in Ohio for rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or systemic sclerosis (SSc) between 2000 and 2020 were retrospectively reviewed for evidence of drug exposures and diagnoses of heart failure.

Patients were treated for RA (n=60,229), SLE (n=20,704), and SSc (n=5558). Heart failure was diagnosed among 16.0%, 14.1%, and 20.3% of the RA, SLE, and SSc cohorts, respectively.

Heart failure was significantly associated with age, gender, race, diabetes, hypertension, and history of ischemic heart disease among all patient groups (all P <.001). Researchers also found that BMI was associated with heart failure among patients with RA (P <.001) and SLE (P <.001).

Use of mycophenolate was associated with increased risk for heart failure among patients with RA (odds ratio [OR], 1.96; 95% CI, 1.66-2.31; P <.001), SLE (OR, 1.38; 95% CI, 1.20-1.59; P <.001), and SSc (OR, 1.83; 95% CI, 1.52-2.21; P <.001). Among patients with RA, heart failure was increased among patients using anakinra (OR, 2.20; 95% CI, 1.27-3.74; P =.05) and decreased among patients who were exposed to methotrexate (OR, 0.81; 95% CI, 0.77-0.86; P <.001) or tumor necrosis factor inhibitor (OR, 0.77; 95% CI, 0.72-0.85; P <.001).

This study was a retrospective review of medical records from a single center. It remains unclear whether these findings may be generalizable.

The study authors concluded there was evidence that some disease-modifying antirheumatic drugs increased risk for heart failure among patients with RA, SLE, and SSc. Additional longer term studies, including a broader set of patients with rheumatic diseases, are needed to replicate these findings and to determine the biological mechanism for these associations.


Zagouras A, Chatterjee S, Tang WH. Association between disease modifying antirheumatic drugs and heart failure in patients with systemic autoimmune diseases. Presented at: American College of Cardiology (ACC) Annual Meeting; May 15-17, 2021. Abstract.

This article originally appeared on The Cardiology Advisor