“We found that patients with rheumatoid arthritis were at 21% (95% CI, 3–42%) increased risk for heart failure compared with patients without rheumatologic conditions, which was independent of traditional cardiovascular risk factors, including prevalent coronary artery disease,” researchers wrote.
The findings stem from a retrospective analysis of electronic health record data for 9889 patients with rheumatoid arthritis and 9889 matched control patients without the autoimmune disease at Vanderbilt University Medical Center.
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Among patients with rheumatoid arthritis and heart failure, heart failure with preserved ejection fraction was most common. The analysis also revealed that greater inflammation, as measured by C-reactive protein levels, among patients with rheumatoid arthritis was linked with higher risk of heart failure. Meanwhile, the anti-inflammatory medication methotrexate was associated with lower risk.
In a second cohort of 115 prospectively enrolled patients with and without rheumatoid arthritis, researchers used proteomics and cardiac magnetic resonance imaging to explore associations between circulating markers of inflammation and cardiac structure and function. Artemin levels, they found, were higher in patients with rheumatoid arthritis, compared with patients without rheumatoid arthritis, and were associated with worse ventricular end‐systolic elastance and ventricular‐vascular coupling ratio.
“Our results, in concert with existing literature, may suggest that artemin could be a promising circulating biomarker for cardiovascular risk and heart failure,” researchers wrote, “although future validation studies are needed.”
Ahlers MJ, Lowery BD, Farber-Eger E, et al. Heart failure risk associated with rheumatoid arthritis-related chronic inflammation [published online May 7, 2020]. J Am Heart Assoc. doi:10.1161/JAHA.119.014661