How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease?

Abstract

Objective. To compare the proportion of the risk for the development of heart failure (HF) that is attributable to traditional cardiovascular (CV) risk factors, ischemic heart disease (IHD), and alcohol abuse between subjects with and subjects without rheumatoid arthritis (RA).Methods. A population-based inception cohort of RA patients was assembled along with a similar cohort of subjects without RA. All individuals were followed up through their complete medical records, until HF incidence, death, migration, or January 1, 2001. The attributable risk of HF was estimated as the difference between the observed cumulative incidence of HF in each cohort (estimated from multivariable Cox models and adjusted for the competing risk of death) and the predicted cumulative incidence of HF in the absence of risk factors, with results expressed as a percentage of the observed cumulative incidence.Results. A total of 575 RA subjects and 583 non-RA subjects (mean age 57 years, 73% women) without HF at incidence/index date had a mean followup of 15.1 and 17.0 years, respectively. During that period, 165 RA and 115 non-RA subjects had a first episode of HF, with a cumulative incidence of 36.3% and 20.4%, respectively, at age 80 years. Among non-RA subjects, 77% of the HF at age 80 years was attributable to CV risk factors, IHD, and alcohol abuse combined, whereas among RA subjects, only 54% of the HF at age 80 years was attributable to these factors (P < 0.01). Conclusion. The excess risk of HF among RA patients is not explained by an increased frequency or effect of CV risk factors and IHD.Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease of unknown etiology, affecting ϳ1% of the adult general population (1,2). Patients with RA have twice the risk of heart failure (HF) when compared with individuals of the same age and sex without RA (3). The mechanism behind this increased risk is unknown. The etiology of HF can be multifactorial, with several clinical risk factors coexisting and interacting to produce this clinical syndrome (4,5). Ischemic heart disease (IHD) and hypertension have long been recognized as major risk factors for HF in the general population (6-9). Therefore, elimination of traditional cardiovascular (CV) risk factors and IHD is a recognized approach to prevent HF (9).However, we previously reported that the increased risk of HF in subjects with RA appears to be independent of the presence or effect of IHD and CV risk factors (3). Consequently, IHD and CV risk factors may play a different role with respect to the development and prevention of HF in RA subjects, compared with non-RA subjects. The aim of the present study was to compare the proportion of the risk for the development of HF that is attributable to traditional CV risk factors, IHD, and alcohol abuse between subjects with and subjects without RA.

Hydroxychloroquine cardiotoxicity presenting as a rapidly evolving biventricular cardiomyopathy: key diagnostic features and literature review

“…[36][37][38] Meanwhile, RA is associated with a higher prevalence of symptomatic heart failure compared with individuals without RA which is not explained by traditional risk factors or clinical ischaemic disease, suggesting that chronic rheumatoid inflammation may account for the increased susceptibility. 39,40 Impairment in renal function has been proposed as a mechanism for toxicity given that these drugs undergo renal as well as hepatic excretion. 32 Of note, many of the more recently described HCQ-induced cardiotoxicity cases occurred in patients with lupus nephritis.…”

No increased occurrence of ischemic heart disease prior to the onset of rheumatoid arthritis: Results from two Swedish population‐based rheumatoid arthritis cohorts

“…This increased risk cannot be fully attributed to traditional risk factors for IHD such as smoking, hypertension, diabetes mellitus, and hyperlipidemia (4)(5)(6). These observations point to the presence and importance of other risk factors for IHD in patients with RA but do not define what risk factors these are or whether the risk that cannot be attributed to traditional risk factors could be a consequence of RA.…”

Artrite reumatóide e doença cardiovascular na atualidade: o que sabemos sobre essa associação e o que podemos fazer pelo paciente?

“…Assim como na DAC, pacientes com AR possuem risco elevado de desenvolvimento de insuficiência cardíaca em comparação à população em geral 7,19,25 . A incidência cumulativa de insuficiência cardíaca em 30 anos de seguimento chega a 34% em pacientes com AR em comparação à 25% no restante da população (p < 0,001), mesmo após ajuste para diferentes fatores de risco cardiovasculares 7,13,15,19,25 .…”

“…A incidência cumulativa de insuficiência cardíaca em 30 anos de seguimento chega a 34% em pacientes com AR em comparação à 25% no restante da população (p < 0,001), mesmo após ajuste para diferentes fatores de risco cardiovasculares 7,13,15,19,25 . No entanto, o risco de insuficiência cardíaca parece estar diretamente relacionado à presença de fator reumatóide positivo (OR = 2,59, IC 95%, 1,95-3,43) quando comparado a pacientes com fator reumatóide negativo (OR = 2,57, IC 95%, 1,20-5,49) 7,15,19 .…”