Risk of Incident Heart Failure and Heart Failure Subtypes in Patients With Rheumatoid Arthritis

Area of Science:

• Cardiology
• Rheumatology
• Inflammation Research

Background:

• Patients with rheumatoid arthritis (RA) have an elevated risk of cardiovascular disease (CVD), including heart failure (HF).
• Limited data exist on the differential risks of HF subtypes, specifically HF with preserved ejection fraction (HFpEF) and HF with reduced ejection fraction (HFrEF), in RA patients compared to those without RA.

Purpose of the Study:

• To compare the incidence of overall HF and its subtypes (HFpEF and HFrEF) in patients with RA versus matched non-RA controls.
• To investigate the association between RA and HF risk after accounting for established cardiovascular risk factors.

Main Methods:

• Retrospective cohort study utilizing data from two academic centers.
• Inclusion of 1,445 RA patients and 4,335 matched non-RA comparators.
• Analysis of incident HF and HF subtypes using Cox proportional hazards models, adjusting for age, sex, and CVD risk factors.

Main Results:

• Patients with RA exhibited a significantly higher hazard ratio (HR) for incident HF (HR 1.79) compared to non-RA individuals.
• The increased HF risk in RA was primarily driven by HFpEF (HR 1.99), while the risk for HFrEF did not show a statistically significant difference (HR 1.45).
• HFpEF was the predominant HF subtype in both RA and non-RA groups.

Conclusions:

• Rheumatoid arthritis is associated with an increased overall risk of heart failure, even after adjusting for traditional CVD risk factors.
• The heightened HF risk in RA patients is largely attributable to HFpEF, suggesting a potential role for inflammation in its pathogenesis.
• These findings underscore the need for strategies to mitigate the excess cardiovascular risk, particularly HFpEF, in individuals with RA.