Rheumatoid Arthritis Doubles Heart Failure Risk
Jancin, Bruce, Clinical Psychiatry News
SNOWMASS, COLO. -- Heart failure is a major contributor to the excess mortality in patients with rheumatoid arthritis, Dr. Sherine E. Gabriel said at a symposium sponsored by the American College of Rheumatology.
Rheumatoid arthritis patients have twice the risk of developing heart failure (HF) compared with the general population--and its lethality is markedly greater, too, according to Dr. Gabriel, the William J. and Charles H. Mayo Professor of Medicine and Epidemiology at the Mayo Clinic, Rochester, Minn.
These are among the recent groundbreaking findings of the Rochester Epidemiology Project, an ongoing landmark, decades-long, primarily National Institutes of Health-funded longitudinal project drawing upon the complete inpatient and outpatient medical records of the entire populace of Olmsted County, Minn. Dr. Gabriel presented highlights from published and not-yet-published studies generated by the project.
In 575 Rochester patients with no history of HF at the time they were diagnosed with rheumatoid arthritis (RA) and 583 no-RA controls, the relative risk of new-onset HF during the subsequent 30 years was 1.9-fold greater in the RA group after adjustment in a multivariate analysis for age, gender, standard cardiovascular risk factors, and the presence of ischemic heart disease. In the subset of rheumatoid factor-positive RA patients, the relative risk climbed to 2.6 (Arthritis Rheum. 2005;52:412-20).
In another study, mortality was strikingly higher after the diagnosis of HF in 103 RA patients than in 852 non-RA controls with HF. In the first 30 days after diagnosis, 15.5% of the RA patients died, compared with 6.6% of controls. Six-month mortality was 25.2% in the RA cohort and 14% in controls.
Another distinguishing feature of HF in RA patients is that it is far more likely to involve diastolic dysfunction with preserved left ventricular ejection fraction. Indeed, Rochester patients with RA were an adjusted 2.6-fold more likely than were non-RA subjects to have a preserved ejection fraction at the time they developed HF. This is problematic because treatment options for isolated diastolic dysfunction are limited. …