Men With Rheumatoid Arthritis Face Higher Risk of Heart Failure: Study
Written By : Medha Baranwal
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2026-06-30 14:45 GMT | Update On 2026-06-30 14:45 GMT
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Germany: A study published in Clinical Rheumatology has found that men with rheumatoid arthritis (RA) have significantly higher odds of developing heart failure (HF) than women with RA. The sex-based difference appears to be driven largely by ischemic heart disease, suggesting that cardiovascular complications may contribute more substantially to HF risk in men.
These findings highlight the importance of vigilant cardiovascular risk assessment and management in patients with RA, particularly among men who may be at greater risk for heart failure.
The study was conducted by Vera Zietemann from the Epidemiology and Health Services Research unit at the German Rheumatology Research Center, Berlin, Germany, and colleagues.
Rheumatoid arthritis is associated with an increased risk of cardiovascular complications, including heart failure. However, it remains unclear whether heart failure risk factors differ between men and women with RA. To investigate this, researchers examined sex-specific predictors of incident heart failure in a large RA cohort.
The study analyzed data from the German biologics register RABBIT, including patients without heart failure at enrollment between 2007 and 2022. Participants were followed for up to 10 years, and researchers used multivariable analyses to evaluate the associations of sex, traditional cardiovascular risk factors, and RA-related factors with the development of heart failure.
The study revealed the following findings:
- The study analyzed 15,807 patients with rheumatoid arthritis, including 4,022 men and 11,785 women.
- Heart failure occurred in 3.9% of men and 2.6% of women during follow-up.
- Men had a 48% higher risk of developing heart failure than women.
- Men with coronary heart disease had more than double the risk of heart failure compared with women with coronary heart disease.
- Men remained at higher risk of heart failure even in the absence of coronary heart disease.
- Older age was strongly associated with increased heart failure risk in both sexes.
- Coronary heart disease was a major predictor of heart failure in both men and women.
- Higher RA disease activity (DAS28-ESR) increased the risk of heart failure in both sexes.
- Diabetes had a stronger impact on heart failure risk in women than in men.
- Hypertension was more strongly associated with heart failure in women than in men.
- Longer RA duration appeared to increase heart failure risk more in women.
- Elevated inflammatory markers were linked to a greater increase in heart failure risk among women.
The findings suggest that heart failure may be underrecognized in women with rheumatoid arthritis, particularly older women, potentially leading to an underestimation of its true burden.
As the first large registry-based study to examine sex-specific heart failure risk factors in RA, the research found that men—especially those with coronary heart disease—have a higher risk of heart failure, while diabetes and hypertension appear to exert a greater effect in women.
The authors stressed the need for effective cardiovascular risk management in RA and called for further research to determine whether sex-specific approaches to heart failure prevention, diagnosis, and treatment are needed.
Reference:
Zietemann, V., Rudi, T., Bestler, D. et al. Sex-specific traditional and disease-related risk factors for incident heart failure in patients with rheumatoid arthritis: a registry-based cohort study. Clin Rheumatol 45, 3143–3154 (2026). https://doi.org/10.1007/s10067-026-08078-y
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