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Heart Failure Risk in Patients With Systemic Autoimmune Inflammatory Diseases
Alexia A Zagouras1, Pieter Martens2, W H Wilson Tang3
1Department of Internal Medicine Stanford University School of Medicine Stanford CA USA.
Insights
Patients with systemic autoimmune inflammatory diseases (SAIDs) like systemic sclerosis, lupus, and rheumatoid arthritis face higher heart failure (HF) risks. Beta-blocker use may offer protection against HF in these patients.
Area of Science:
- Cardiology
- Rheumatology
- Immunology
Background:
- Systemic autoimmune inflammatory diseases (SAIDs) significantly increase morbidity and mortality due to cardiac disease, particularly heart failure (HF).
- Understanding HF risk in SAID patients and the impact of cardiovascular medications is crucial for improving patient outcomes.
Purpose of the Study:
- To assess the risk of incident heart failure (HF) in patients with various systemic autoimmune inflammatory diseases (SAIDs).
- To investigate the association between the use of cardiovascular drugs and the occurrence of incident HF among SAID patients.
Main Methods:
- A retrospective cohort study analyzed electronic health records of 182,795 adult patients with SAIDs (including systemic sclerosis, lupus, rheumatoid arthritis, psoriatic arthritis, inflammatory bowel disease, and HIV) from 2000 to 2020.
- Incident HF risk was tracked within a large healthcare system, comparing SAID patients to controls and analyzing medication effects.
Main Results:
- Systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis were significantly associated with increased incident HF risk compared to controls and inflammatory bowel disease patients.
- Beta-blocker use at baseline demonstrated an association with decreased incident HF in patients with systemic sclerosis, lupus, and rheumatoid arthritis.
Conclusions:
- Patients with systemic sclerosis, lupus, and rheumatoid arthritis exhibit an elevated HF risk, suggesting an autoimmune mechanism contributing to cardiac involvement.
- Beta-blocker use appears to have a cardioprotective effect, potentially reducing HF incidence in patients with SAIDs.
Background:
Cardiac disease, including heart failure (HF), is a significant cause of morbidity and mortality for patients with systemic autoimmune inflammatory diseases (SAIDs). We sought to describe HF risk among patients with SAIDs and to investigate associations between cardiovascular drug use and incident HF.
Methods:
We conducted a retrospective cohort study of electronic health records of 182 795 adult patients with SAIDs including systemic sclerosis, systemic lupus erythematosus, rheumatoid arthritis, psoriatic arthritis, inflammatory bowel disease, and HIV from 2000 to 2020 and track their risks of new-onset incident HF in a large multidisciplinary health care institution.
Results:
Systemic sclerosis (adjusted hazard ratio [aHR], 2.81 [95% CI, 2.57-3.08]; P<0.001), systemic lupus erythematosus (aHR, 1.64 [95% CI 1.56-1.74]; P<0.001), and rheumatoid arthritis (aHR, 1.54 [95% CI 1.47-1.61]; P<0.001), were significantly associated with incident HF compared both with a SAID-free control group and a large group with inflammatory bowel disease in adjusted Cox regression models. Beta-blocker use at baseline was associated with decreased incident HF in a combined group of systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis (aHR, 0.7 [95% CI 0.6-0.8]; P<0.001).
Conclusions:
Patients with systemic sclerosis, systemic lupus erythematosus, and rheumatoid arthritis had increased risk of incident HF independent of traditional risk factors, indicating an underlying autoimmune mechanism of cardiac involvement. Beta-blocker use was associated with decreased incident HF, indicating a potentially cardioprotective effect in SAIDs.
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