Ängla Mantel1, Marie Holmqvist2, Daniel C Andersson3, Lars H Lund4, Johan Askling5. 1. Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden. Electronic address: angla.mantel@ki.se. 2. Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden. 3. Department of Medicine Solna, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden. 4. Department of Medicine Solna, Unit of Cardiology, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden. 5. Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden; Department of Rheumatology, Karolinska University Hospital, Stockholm, Sweden.
Abstract
BACKGROUND: It is unknown whether the increased risk of heart failure (HF) in rheumatoid arthritis (RA) is independent of ischemic heart disease (IHD). OBJECTIVES: This study sought to investigate the relative risk of HF overall and by subtype (ischemic and nonischemic HF) in patients with RA and to assess the impact of RA disease factors. METHODS: Two contemporary cohorts of RA subjects were identified from Swedish patient and rheumatology registries and matched 1:10 to general population comparator subjects. A first-ever HF diagnosis (classified as ischemic HF or nonischemic HF based on the presence of IHD) was assessed through registry linkages. Relative risks for a history of HF before RA onset were calculated through odds ratios. Relative risks of incident HF in RA were calculated as hazard ratios (HRs). RESULTS: By the time of RA onset, a history of HF was not more common in RA. In the new-onset RA cohort, the overall HRs for subsequent HF (any type), ischemic HF, and nonischemic HF were between 1.22 and 1.27. The risk of nonischemic HF increased rapidly after RA onset, in contrast to the risk of ischemic HF. High disease activity was associated with all HF types but was most pronounced for nonischemic HF. In the cohort of patients with RA of any duration, the HRs were between 1.71 and 1.88 for the different HF subtypes. CONCLUSIONS: Patients with RA are at increased risk of HF that cannot be explained by their increased risk of IHD. The increased risk of nonischemic HF occurred early and was associated with RA severity.
BACKGROUND: It is unknown whether the increased risk of heart failure (HF) in rheumatoid arthritis (RA) is independent of ischemic heart disease (IHD). OBJECTIVES: This study sought to investigate the relative risk of HF overall and by subtype (ischemic and nonischemic HF) in patients with RA and to assess the impact of RA disease factors. METHODS: Two contemporary cohorts of RA subjects were identified from Swedish patient and rheumatology registries and matched 1:10 to general population comparator subjects. A first-ever HF diagnosis (classified as ischemic HF or nonischemic HF based on the presence of IHD) was assessed through registry linkages. Relative risks for a history of HF before RA onset were calculated through odds ratios. Relative risks of incident HF in RA were calculated as hazard ratios (HRs). RESULTS: By the time of RA onset, a history of HF was not more common in RA. In the new-onset RA cohort, the overall HRs for subsequent HF (any type), ischemic HF, and nonischemic HF were between 1.22 and 1.27. The risk of nonischemic HF increased rapidly after RA onset, in contrast to the risk of ischemic HF. High disease activity was associated with all HF types but was most pronounced for nonischemic HF. In the cohort of patients with RA of any duration, the HRs were between 1.71 and 1.88 for the different HF subtypes. CONCLUSIONS:Patients with RA are at increased risk of HF that cannot be explained by their increased risk of IHD. The increased risk of nonischemic HF occurred early and was associated with RA severity.
Authors: Sameer Prasada; Adovich Rivera; Arvind Nishtala; Anna E Pawlowski; Arjun Sinha; Joshua D Bundy; Simran A Chadha; Faraz S Ahmad; Sadiya S Khan; Chad Achenbach; Frank J Palella; Rosalind Ramsey-Goldman; Yvonne C Lee; Jonathan I Silverberg; Babafemi O Taiwo; Sanjiv J Shah; Donald M Lloyd-Jones; Matthew J Feinstein Journal: JACC Heart Fail Date: 2020-04-08 Impact factor: 12.035
Authors: Sicong Huang; Tianrun Cai; Brittany N Weber; Zeling He; Kumar P Dahal; Chuan Hong; Jue Hou; Thany Seyok; Andrew Cagan; Marcelo F DiCarli; Jacob Joseph; Seoyoung C Kim; Daniel H Solomon; Tianxi Cai; Katherine P Liao Journal: Arthritis Care Res (Hoboken) Date: 2021-10-08 Impact factor: 4.794
Authors: Arjun Sinha; Deepak K Gupta; Clyde W Yancy; Sanjiv J Shah; Laura J Rasmussen-Torvik; Elizabeth M McNally; Philip Greenland; Donald M Lloyd-Jones; Sadiya S Khan Journal: Circ Heart Fail Date: 2021-02-04 Impact factor: 8.790