Rheumatoid Arthritis Heart Failure Risk Driven by Increased HFpEF Risk

People with rheumatoid arthritis (RA) had a higher risk of heart failure (HF) overall than people without RA, even adjusting for cardiovascular risk factors, with the elevated risk driven by HF with preserved (HFpEF) ejection fraction.1

"Patients with RA are at increased risk of cardiovascular disease (CVD) including HF. However, little is known regarding the relative risks of heart failure subtypes such as HFpEF or reduced ejection fraction (HFrEF) in RA compared to non-RA,” lead investigator Yumeko Kawano, MD, Brigham and Women's Hospital, and Harvard Medical School, and colleagues wrote.1

Kawano and colleagues included 1445 patients with RA and 4335 matched non-RA comparators in their study. Participants had a mean age of 51.4 and 51.7 years, respectively, and 78.7% were female. Among both groups, HFpEF was the most common HF subtype (65% in RA vs. 59% in non-RA).1

The investigators found that patients with RA had a hazard rate [HR] of 1.79 (95% CI, 1.38-2.32) for incident HF compared to those without RA after adjusting for CVD risk factors. Specifically, patients with RA had a higher rate of HFpEF (HR, 1.99 [95% CI, 1.43 - 2.77]), but there was no statistical difference in HFrEF rate (HR, 1.45 [95% CI, 0.81 - 2.60]).1

“RA was associated with higher rate of HF overall compared to non-RA, even after adjustment for established CVD risk factors. The elevated risk was driven by HFpEF, supporting a role for inflammation in HFpEF and highlighting potential opportunities to address this excess risk in RA,” Kawano and colleagues concluded.1

Other recent research elucidating CVD risk in people with RA centered on glucocorticosteroid (GC) use was presented during November’s American College of Rheumatology (ACR) Convergence 2024 meeting by Diane Lacaille, MDCM, MHSc, Scientific Director and Senior Scientist at Arthritis Research Canada and Professor, Department of Medicine, University of British Columbia, Vancouver.

Lacaille and colleagues found that GC use increases CVD and infection mortality risk in people with RA even after cessation. In data from 28,078 incident GC users, the investigators found that people who used GC for over 2 years and 3 years had elevated risks of CVD and infection-related mortality, respectively, that never returned to pre-GC use levels. In people who used GC for 6, 12, and 24 months, it took 1.5, 3.5 and 10 years after cessation for risk of CVD mortality to decrease to that of someone prior to starting GC. Similarly, it took 2.5, 3.5, and 5.5 years, respectively, after cessation for risk of deaths from infection to decrease accordingly.2

“They have risks and benefits, and those risks and benefits aren’t the same for every disease or every person. It’s important to have clear, ongoing conversations about steroids and to recognize that these risks include withdrawal symptoms when long-term steroids are tapered,” Wallace said in a statement.3

REFERENCES

1. Kawano Y, Weber BN, Weisenfeld D, et al. Risk of Incident Heart Failure and Heart Failure Subtypes in Patients with Rheumatoid Arthritis. Published online December 9, 2024. doi: 10.1002/acr.25481

2. Lacaille D, Danieli C, Moolooghy K, Abrahamowicz M. Changes in Mortality Risk After Stopping Glucocorticosteroids – a Population-based Study in Rheumatoid Arthritis. Presented at: ACR Convergence 2024; November 15-19; Washington, DC. Abstract 2673.

3. Corticosteroids: One Size Does Not Fit All. News release. ACR. November 14, 2024.