Heart failure (HF) is a multifactorial clinical syndrome that usually presents at the end of cardiovascular disease. Studies have shown that patients with rheumatoid arthritis (RA) are at twice the risk of heart failure.
RA appears to have a unique mechanism of influence on HF. In addition, it has also been shown that some RA drugs, such as methotrexate
MTX), have a preventive effect on HF. Thus, Elena Myasoedova et al. of the Mayo Clinic in the United States investigated the impact of RA signs on risk factors for HF in RA patients. An Yang, Department of Rheumatology and Immunology, Second Affiliated Hospital of Guiyang Traditional Chinese Medicine
A total of 795 patients with RA (mean age 55.3 years, no history of HF) between 1980 and 2008 were included in the study. After a mean follow-up of 9.7 years, 92 patients developed HF. 31 of these HF patients had an ejection
Of these HF patients, 31 showed a decrease in ejection fraction (EF), 36 had stable EF values, and no valid data could be collected for the other 25. The results showed that the following cardiovascular risk factors were significantly associated with the risk of HF: coronary heart disease (CHD)
heart
disease (CHD) (HR=1.6), personal history of CHD (HR=3.1), angina pectoris (HR=2.3), vascular regeneration (HR=2.3), and alcohol abuse (HR=2.4).
Sixty-six percent of the patients showed positive rheumatoid factor (RF).
HF risk was correlated with positive RP (HR=1.6), RA erythrocyte sedimentation rate (ESR) (HR=1.6), recurrent high ESR (HR=2.1), severe extra-articular disease (HR=3.1), and corticosteroid use (HR=2.0), after correction for RA and CHD risk factors.) In addition, patients with a history of RA for more than 1 year had 2 times the risk of HF than patients with a history of RA for less than 1 year (HR=2). After correcting for CV and CHD risk factors, the results did not change significantly.
The study also found that the risk of developing HF in RA patients using MTX was only half that of non-users (HR=0.5). Patients using biologics or other DMARD drugs also had a lower risk of developing HF than non-users, but it was not statistically different. Hydroxychloroquine use was not associated with HF risk. In contrast, the use of corticosteroids doubled the risk of HF (HR=2.0.) The combination of MTX and corticosteroids did not have a synergistic effect on HF risk and did not differ from single use. In addition, men who showed decreased EF were more likely to develop HF than women (HR=3.7), while there was no gender difference in patients with stable EF. This study confirms that RA and corticosteroid use can affect the risk of HF. MTX appears to protect patients with RA and reduce the risk of HF.