There may be no increased risk for heart failure (HF) in patients with rheumatoid arthritis (RA) receiving hydroxychloroquine (HCQ), according to study results published in The Journal of Rheumatology.
In a population-based, nested case-control study, the researchers sought to evaluate the relationship between HCQ use and risk for development of HF.
Study participants included a group of residents (aged ≥18 years) in Olmsted County, Minnesota, with incident RA, according to the 1987 American College of Rheumatology (ACR) criteria, between 1980 and 2013. Cases were defined as patients with RA who developed HF after RA incidence (HF cases); control participants were defined as patients with RA who did not develop HF (non-HF control participants). Cases and control participants were matched in a 1:1 ratio, based on year of birth, sex, and year of RA incidence. Each of the non-HF control participants was assigned an index date that corresponded to the HF diagnosis date of the case, which occurred between 1983 and 2018. Framingham Heart Study criteria were used to define HF. Data on HCQ use, including start and stop dates, as well as dose changes, were reviewed and used to calculate HCQ duration and cumulative dose.
A total of 143 patients with RA diagnosed with HF (mean age, 65.8 years; 62% women) and 143 control participants with RA without HF (mean age, 64.5 years; 62% women) were included in the study. Researchers noted that the cumulative dose of HCQ was not associated with HF (odds ratio [OR], 0.96 per 100-g increase in cumulative dose; 95% CI, 0.90-1.03). Similarly, they did not observe an association between HCQ and HF in patients receiving a cumulative HCQ dose of 300 g or greater (OR, 0.92; 95% CI, 0.41-2.08). Further, the duration of HCQ intake in the years prior to the index date was not linked to the development of HF (OR, 0.98; 95% CI, 0.91-1.05).
Study limitations included the fact that only information from medical records was used to determine outcomes, the lack of follow-up after patients’ discontinued HCQ, and the small cohort size.
Researchers concluded, “Larger prospective studies are needed to define the safety of higher cumulative doses of HCQ with regards to HF development, as well as to identify the incidence of HCQ-related cardiotoxicity in patients [with RA] in order to define the subgroups of high-risk patients and the need for cardiovascular screening.”
Sorour AA, Kurmann RD, Shahin YE, et al. Use of hydroxychloroquine and risk of heart failure in patients with rheumatoid arthritis. J Rheumatol. Published online January 15, 2021. doi:10.3899/jrheum.201180