Non-Ischemic Heart Failure in Rheumatoid Arthritis Save

The current issue of the Journal of the American College of Cardiology reports on the relative risk of heart failure (HF) in rheumatoid arthritis (RA) and its relation to ischemic heart disease (IHD).

Investigators analyzed 2 cohorts of RA subjects identified from Swedish patient and rheumatology registries and matched these 1:10 to general population as comparators.

A first-ever HF diagnosis (classified as ischemic HF or nonischemic HF based on the presence of IHD) was assessed through registry linkages. Relative risks for a history of HF before RA onset were calculated through odds ratios. Relative risks of incident HF in RA were calculated as hazard ratios (HRs).

They found that at time of RA onset, a history of HF was not more common in RA than the general population.

In those with new-onset RA, the overall HRs for subsequent HF (any type), ischemic HF, and nonischemic HF were between 1.22 and 1.27.

Compared to ischemic HF, the risk of nonischemic HF increased rapidly after RA onset. High disease activity was associated with all HF types but was most pronounced for nonischemic HF. 

RA is associated with an increased risk of HF that cannot be explained by IHD alone. The increased risk of nonischemic HF occurred early and was associated with RA severity, suggesting that inflammations effects extend beyond that experienced by the coronary vasculature.