Risk for heart failure is high in patients with early rheumatoid arthritis (RA) with increased levels of inflammation, according to study results published in Arthritis Care & Research.

Heart disease is associated with an increased risk for mortality and morbidity in patients with RA. However, studies on the association between heart failure subtypes (preserved ejection fraction [HFpEF] and reduced ejection fraction [HFrEF]) and RA are limited. Both HFrEF and HFpEF have a different pathophysiology; HFrEF has been associated with ischemic factors and HFpEF with inflammatory factors.

In the current study, Liao and colleagues sought to evaluate the association of inflammation with heart failure in RA. The researchers also evaluated the 5-year risk to determine the early onset of heart failure in patients with RA.


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Data were analyzed from the electronic health records of more than 15,000 patients with RA seen at 2 large academic hospitals in Boston from 1994 to 2017.

The study included 9087 patients with RA, with a mean age of 56±14.5 years; 76.5% were women. The median follow-up from RA diagnosis to last follow-up was 10.7 years. Approximately 55% of the patients were seropositive. The treatment regimen included corticosteroids (23.4%), methotrexate (15.0%), antimalarial drugs (9.7%), and tumor necrosis factor (TNF) inhibitors (5.0%). Median erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) at baseline was 24.7 mm/h and 5.9 mg/L, respectively. 

Older women were more likely to have elevated ESR and CRP levels, be seropositive, and receive corticosteroids at baseline, as well have cardiovascular comorbidities.

Incidence heart failure was diagnosed in 749 patients over a period of 10 years, of which 379 were within 5 years of RA onset. The incident rate was 11 per 1000 person-years.

Patients with RA with elevated inflammatory markers were found to be at higher risk for incident heart failure (P <.0001). A total of 127 patients developed HFrEF and 561 developed HFpEF. Overall, the rates of heart failure were significantly increased at 5 years (hazard ratio [HR], 1.72; 95% CI, 1.09-2.70) and 10 years (HR, 1.45; 95% CI, 1.07-1.94) in patients with elevated inflammation at baseline. A high inflammation at baseline was significantly associated with HFpEF, but not HFrEF, at 5 and 10 years.

In a secondary analysis, elevated inflammation was significantly associated with any heart failure and HFpEF at 5 and 10 years. No association was seen among patients with HFrEF.

Study limitations included the limited generalizability of the findings to patients with RA.

Researchers concluded, “Since inflammation is modifiable by RA treatments, these findings suggest an opportunity for mitigating risk of [heart failure], specifically HFpEF risk, early in the RA disease course.”

Disclosure: Some study authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

Reference

Huang S, Cai T, Weber BN, et al. The association between inflammation, incident heart failure, and heart failure subtypes in patients with rheumatoid arthritis. Arthritis Care & Res. Published online October 8, 2021. doi:10.1002/ACR.24804