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Aortic Stenosis Risk in Rheumatoid Arthritis
Tate M Johnson1,2, Chetaj A Mahabir3, Yangyuna Yang2
1Medicine & Research Service, VA Nebraska-Western Iowa Health Care System, Omaha.
JAMA Internal Medicine
|July 31, 2023
Summary
Rheumatoid arthritis (RA) significantly increases the risk of developing aortic stenosis (AS), leading to a higher likelihood of aortic valve intervention and AS-related death. This highlights AS as a potential complication in RA patients.
Area of Science:
- Cardiology
- Rheumatology
- Epidemiology
Background:
- Rheumatoid arthritis (RA) is linked to increased ischemic cardiovascular disease risk.
- The association between RA and aortic stenosis (AS) risk remains unclear.
Purpose of the Study:
- To investigate the risk of incident AS in patients with RA.
- To assess the risk of aortic valve intervention and AS-related death in RA patients.
- To identify risk factors for AS development in the context of RA.
Main Methods:
- A large cohort study linked Veterans Health Administration and Medicare data (2000-2019).
- Patients with RA were matched with up to 10 controls without RA.
- Aortic stenosis was defined by diagnoses, valve replacement, or AS-related death; Cox models were used for risk assessment.
Main Results:
- The study included over 73,000 RA patients and over 639,000 controls.
- RA patients exhibited a higher incidence rate of AS (3.97 vs 2.45 per 1000 person-years).
- RA was associated with significantly increased risks of composite AS (AHR, 1.48), aortic valve intervention (AHR, 1.34), and AS-related death (AHR, 1.26).
Conclusions:
- Rheumatoid arthritis is associated with a substantially higher risk of developing aortic stenosis.
- Patients with RA face increased risks for aortic valve intervention and AS-related mortality.
- Aortic stenosis may be an under-recognized cardiovascular complication in rheumatoid arthritis, warranting further investigation.
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