RA Characteristics May Contribute to Heart Failure

Several characteristics of rheumatoid arthritis (RA) are significant determinants of heart failure (HF) in patients with RA beyond traditional cardiovascular risk factors and coronary heart disease (CHD). Current use of corticosteroids is associated with an increased risk of HF; that of methotrexate (MTX) is associated with a decreased risk.

Myasoedova and colleagues monitored a population-based incidence cohort of patients who had RA with no history of HF until the onset of HF. Cardiovascular risk factors (eg, hypertension, dyslipidemia, obesity, diabetes mellitus, and personal history of CHD) were abstracted from patients' medical records at baseline and longitudinally throughout the follow-up. Information on RA characteristics included rheumatoid factor (RF) status, erythrocyte sedimentation rate (ESR) at RA incidence, and repeatedly high ESR.

HF developed in 92 of the 795 patients with RA during the mean follow-up of 9.7 years. HF was significantly associated with RF positivity, ESR at RA incidence, repeatedly high ESR, and severe extra-articular manifestations. Analysis of medications used at any time revealed no significant associations with HF. The probability of HF developing in MTX users was half that in nonusers.

The authors noted that their findings suggest an independent effect of RA on HF that may be further modified by antirheumatic treatment.