JIA Women at Risk of Heart Disease Save

Women with a history of juvenile idiopathic arthritis (JIA) are more than twice as likely as those without this condition to be diagnosed with heart disease, according to the results of a new study.

After adjusting for maternal age and education, the adjusted odds ratio for any type of heart disease among women who had been diagnosed with JIA was 2.44 (95% CI 1.15-5.15), according to Debbie E. Feldman, PhD, École de réadaptation, Université de Montréal, Quebec, Canada, and her colleagues.

"This is an important finding and signifies the importance of prevention strategies for young adult women with JIA," the authors wrote in Arthritis Care & Research.

The analysis also suggests women with JIA may be at higher risk for hypertension. Adults with rheumatoid arthritis are at increased risk for heart disease, and among women, pregnancy complications such as preeclampsia occur more frequently than in healthy women. However, little is known about heart disease and pregnancy outcomes among women with persistent, active JIA.

To explore these concerns, researchers conducted a retrospective nested case-control study using physician billing and hospitalization databases from Quebec. They identified all women who were diagnosed with juvenile arthritis at age 16 or younger, and followed them to detect those who gave birth for the first time. They matched each woman with JIA to a control woman without JIA.

The team identified 403 cases of heart disease, matched with 1,209 controls. These included acute rheumatic fever in 1.7%, chronic rheumatic heart disease in 4%, diseases of the pulmonary circulation in 7.4%, ischemic heart disease in 38.2%, and other forms of heart disease such as valvular disease and heart failure in 48.6%.

The researchers also identified 66 cases of pre-pregnancy hypertension, defined as occurring at least 1 year before giving birth, matched with 198 controls. All cases with pre-pregnancy hypertension had juvenile arthritis.

The authors noted that they used maternal education as a proxy for socioeconomic status, which is related to certain adverse maternal outcomes. It's unclear whether JIA itself is associated with socioeconomic status, they said.

Among women giving birth, the researchers identified 561 cases of maternal hypertension (1,683 controls), 285 cases of gestational diabetes (855 controls), and 236 cases of preeclampsia/eclampsia (708 controls).

They were unable to determine an association between JIA and maternal hypertension, gestational diabetes, or preeclampsia. However, the study found that having pre-pregnancy hypertension was strongly associated with preeclampsia/eclampsia (OR 8.05, 95% CI 2.69-24.07).

Other associations included higher maternal age and heart disease (OR 1.64, 95% CI 1.25-2.16), and higher maternal age and gestational hypertension (OR 1.48, 95% CI 1.19-1.84).

According to the authors, possible explanations for the link between JIA and heart disease in women include lower physical activity, inflammation, and medications.

The findings of this study differed from those in an earlier report, which found a three-fold increase in preeclampsia among women with JIA. However, in that study there was no adjustment for pre-pregnancy hypertension, and the patients represented a sicker cohort.

"Monitoring and treating high blood pressure in young adults with JIA may be important," the authors wrote. "Other prevention strategies may also be warranted, including advice on diet, promotion of physical activity, and discouraging smoking."

Asked to comment, Hemalatha Srinivasalu, MD, of George Washington University School of Medicine in Washington, D.C., noted that information on important confounders such as clinical characteristics, medication, obesity, and lifestyle factors "could not be accounted for" in the study.  "This study emphasizes incorporation of prevention strategies for heart disease in young adults with JIA," said Srinivasalu. "Future prospective studies are needed to validate the findings seen in this study and assess risk stratification based on JIA subclassification, medication exposure, and obesity and lifestyle factors." 

Factors typically associated with use of administrative data, such as the validity of the diagnoses and lack of information on severity of the condition and other clinical data, were a limitation of the study. In addition, although this is the largest study of JIA and pregnancy, the numbers of specific outcomes such as pre-pregnancy hypertension were small.

The study was supported by a grant from CIORA (Canadian Initiative for Outcomes in Rheumatology Care).