Rheumatoid Arthritis Linked to Higher Risk of Heart Failure, Driven by Inflammation and HFpEF: Study Reveals

The analysis revealed that RA patients exhibited a higher overall rate of heart failure, driven primarily by heart failure with preserved ejection fraction (HFpEF). The findings emphasize the impact of chronic inflammation associated with RA on the heart, particularly in HFpEF development. HFpEF refers to a type of heart failure where the heart muscle maintains its ability to pump blood effectively but has difficulty relaxing, leading to reduced cardiac function.

Patients with rheumatoid arthritis (RA) have a higher risk of cardiovascular disease (CVD), including heart failure (HF). However, the relative risks of specific heart failure subtypes, such as heart failure with preserved ejection fraction (HFpEF) and heart failure with reduced ejection fraction (HFrEF), in RA patients compared to those without RA remain poorly understood.

To understand the relative risks of heart failure subtypes in rheumatoid arthritis patients, Yumeko Kawano, Brigham and Women's Hospital, Boston, MA, and colleagues identified RA patients and matched non-RA comparators from participants consenting to broad research at two large academic centers. They tracked incident HF and classified HF subtypes based on the ejection fraction (EF) value closest to the incident date. Factors such as age, sex, and established cardiovascular disease risk factors were considered as covariates. Cox proportional hazard models were employed to estimate the hazard ratios (HR) for incident heart failure and its subtypes.

The following were the key findings of the study:

• The study included 1,445 RA patients and 4,335 matched non-RA comparators, with mean ages of 51.4 and 51.7 years, respectively; 78.7% of participants were female.
• HFpEF was the most common subtype in both groups, occurring in 65% of RA patients compared to 59% of non-RA participants.
• RA patients had a hazard ratio (HR) of 1.79 for incident heart failure compared to non-RA participants after adjusting for cardiovascular disease (CVD) risk factors.
• The rate of HFpEF was higher in RA patients, with an HR of 1.99.
• There was no statistically significant difference in the rate of heart failure with reduced ejection fraction between the two groups, with an HR of 1.45.

According to the authors, rheumatoid arthritis was associated with a higher overall rate of heart failure compared to non-RA participants, even after adjusting for established cardiovascular disease risk factors.

"The increased risk was primarily driven by heart failure with preserved ejection fraction, supporting the role of inflammation in the development of HFpEF and underscoring potential opportunities to mitigate this elevated risk in RA through targeted interventions," they wrote.

Reference:

Kawano, Y., Weber, B. N., Weisenfeld, D., Jeffway, M. I., Cai, T., McDermott, G. C., Liu, Q., Sparks, J. A., Stuart, J., Joseph, J., Cai, T., & Liao, K. P. Risk of Incident Heart Failure and Heart Failure Subtypes in Patients with Rheumatoid Arthritis. Arthritis Care & Research. https://doi.org/10.1002/acr.25481