Rheumatoid Arthritis associated with Aortic Stenosis and related mortality: JAMA

A recent study by Tate Johnson and colleagues linked data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services to investigate the association between rheumatoid arthritis (RA) and aortic stenosis (AS). Although RA has been previously linked to an increased risk of ischemic cardiovascular disease, its potential association with AS was unknown. The findings, analyzed from August 23, 2022, to March 3, 2023, revealed significant implications for patients with RA.

The study included a cohort of 73,070 patients with RA, matched by age, sex, and VHA enrollment year, with up to 10 patients without RA, resulting in a total of 639,268 control patients. The cohort was followed over a period of 6,223,150 person-years until incident AS, aortic valve intervention, or death occurred.

The results showed that patients with RA had a higher incidence rate of AS compared to the control group. The AS incidence rate was 3.97 per 1000 person-years in patients with RA, while it was 2.45 per 1000 person-years in the control patients, indicating an absolute difference of 1.52 per 1000 person-years.

Furthermore, the presence of RA was associated with an increased risk of several outcomes related to AS. These included:

Composite AS: The study found that RA was linked to a 48% higher risk of developing AS (adjusted hazard ratio [AHR], 1.48; 95% CI, 1.41-1.55).

Aortic Valve Intervention: Patients with RA faced a 34% higher risk of requiring aortic valve intervention (AHR, 1.34; 95% CI, 1.22-1.48).

AS-Related Death: Rheumatoid arthritis was associated with a 26% higher risk of death related to AS (AHR, 1.26; 95% CI, 1.04-1.54).

These findings indicate that RA may be a significant risk factor for the development of AS and subsequent complications requiring medical intervention or even leading to fatal outcomes.

While the study provides crucial insights into the link between RA and AS, the authors emphasize the need for further research to fully understand the relationship between valvular heart disease, particularly AS, and rheumatoid arthritis. They suggest that valvular heart disease may be an under-recognized complication of RA and that greater awareness and monitoring of AS risk in RA patients could potentially lead to better management and improved outcomes.

Reference:

Johnson, T. M., Mahabir, C. A., Yang, Y., Roul, P., Goldsweig, A. M., Binstadt, B. A., Baker, J. F., Sauer, B. C., Cannon, G. W., Mikuls, T. R., & England, B. R. (2023). Aortic Stenosis Risk in Rheumatoid Arthritis. In JAMA Internal Medicine. American Medical Association (AMA). https://doi.org/10.1001/jamainternmed.2023.3087