The Influence of Rheumatoid Arthritis Disease Characteristics on Heart Failure

Elena Myasoedova, Cynthia Crowson, Paulo J. Nicola, Hilal D Maradit Kremers, John Manley III Davis, Veronique Lee Roger, Terry M Therneau, Sherine E. Gabriel

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Objective. To examine the influence of rheumatoid arthritis (RA) characteristics and antirheumatic medications on the risk of heart failure (HF) in patients with RA. Methods. A population-based incidence cohort of RA patients aged ≥ 18 years (1987 American College of Rheumatology criteria first met between January 1, 1980, and January 1, 2008) with no history of HF was followed until onset of HF (defined by Framingham criteria), death, or January 1, 2008. We collected data on RA characteristics, antirheumatic medications, and cardiovascular (CV) risk factors. Cox models adjusting for age, sex, and calendar year were used to analyze the data. Results. The study included 795 RA patients [mean age 55.3 yrs, 69% women, 66% rheumatoid factor (RF)-positive]. During the mean followup of 9.7 years, 92 patients developed HF. The risk of HF was associated with RF positivity (HR 1.6, 95% CI 1.0, 2.5), erythrocyte sedimentation rate (ESR) at RA incidence (HR 1.6, 95% CI 1.2, 2.0), repeatedly high ESR (HR 2.1, 95% CI 1.2, 3.5), severe extra - articular manifestations (HR 3.1, 95% CI 1.9, 5.1), and corticosteroid use (HR 2.0, 95% CI 1.3, 3.2), adjusting for CV risk factors and coronary heart disease (CHD). Methotrexate users were half as likely to have HF as nonusers (HR 0.5, 95% CI 0.3, 0.9). Conclusion. Several RA characteristics and the use of corticosteroids were associated with HF, with adjustment for CV risk factors and CHD. Methotrexate use appeared to be protective against HF. These findings suggest an independent effect of RA on HF that may be further modified by antirheumatic treatment. The Journal of Rheumatology

Original languageEnglish (US)
Pages (from-to)1601-1606
Number of pages6
JournalJournal of Rheumatology
Volume38
Issue number8
DOIs
StatePublished - Aug 2011

Fingerprint

Rheumatoid Arthritis
Heart Failure
Rheumatoid Factor
Blood Sedimentation
Methotrexate
Coronary Disease
Adrenal Cortex Hormones
Incidence
Rheumatology
Proportional Hazards Models
Joints
Population

Keywords

  • Determinants
  • Heart failure
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology
  • Immunology and Allergy

Cite this

The Influence of Rheumatoid Arthritis Disease Characteristics on Heart Failure. / Myasoedova, Elena; Crowson, Cynthia; Nicola, Paulo J.; Maradit Kremers, Hilal D; Davis, John Manley III; Roger, Veronique Lee; Therneau, Terry M; Gabriel, Sherine E.

In: Journal of Rheumatology, Vol. 38, No. 8, 08.2011, p. 1601-1606.

Research output: Contribution to journalArticle

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abstract = "Objective. To examine the influence of rheumatoid arthritis (RA) characteristics and antirheumatic medications on the risk of heart failure (HF) in patients with RA. Methods. A population-based incidence cohort of RA patients aged ≥ 18 years (1987 American College of Rheumatology criteria first met between January 1, 1980, and January 1, 2008) with no history of HF was followed until onset of HF (defined by Framingham criteria), death, or January 1, 2008. We collected data on RA characteristics, antirheumatic medications, and cardiovascular (CV) risk factors. Cox models adjusting for age, sex, and calendar year were used to analyze the data. Results. The study included 795 RA patients [mean age 55.3 yrs, 69{\%} women, 66{\%} rheumatoid factor (RF)-positive]. During the mean followup of 9.7 years, 92 patients developed HF. The risk of HF was associated with RF positivity (HR 1.6, 95{\%} CI 1.0, 2.5), erythrocyte sedimentation rate (ESR) at RA incidence (HR 1.6, 95{\%} CI 1.2, 2.0), repeatedly high ESR (HR 2.1, 95{\%} CI 1.2, 3.5), severe extra - articular manifestations (HR 3.1, 95{\%} CI 1.9, 5.1), and corticosteroid use (HR 2.0, 95{\%} CI 1.3, 3.2), adjusting for CV risk factors and coronary heart disease (CHD). Methotrexate users were half as likely to have HF as nonusers (HR 0.5, 95{\%} CI 0.3, 0.9). Conclusion. Several RA characteristics and the use of corticosteroids were associated with HF, with adjustment for CV risk factors and CHD. Methotrexate use appeared to be protective against HF. These findings suggest an independent effect of RA on HF that may be further modified by antirheumatic treatment. The Journal of Rheumatology",
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author = "Elena Myasoedova and Cynthia Crowson and Nicola, {Paulo J.} and {Maradit Kremers}, {Hilal D} and Davis, {John Manley III} and Roger, {Veronique Lee} and Therneau, {Terry M} and Gabriel, {Sherine E.}",
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AU - Crowson, Cynthia

AU - Nicola, Paulo J.

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AU - Davis, John Manley III

AU - Roger, Veronique Lee

AU - Therneau, Terry M

AU - Gabriel, Sherine E.

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N2 - Objective. To examine the influence of rheumatoid arthritis (RA) characteristics and antirheumatic medications on the risk of heart failure (HF) in patients with RA. Methods. A population-based incidence cohort of RA patients aged ≥ 18 years (1987 American College of Rheumatology criteria first met between January 1, 1980, and January 1, 2008) with no history of HF was followed until onset of HF (defined by Framingham criteria), death, or January 1, 2008. We collected data on RA characteristics, antirheumatic medications, and cardiovascular (CV) risk factors. Cox models adjusting for age, sex, and calendar year were used to analyze the data. Results. The study included 795 RA patients [mean age 55.3 yrs, 69% women, 66% rheumatoid factor (RF)-positive]. During the mean followup of 9.7 years, 92 patients developed HF. The risk of HF was associated with RF positivity (HR 1.6, 95% CI 1.0, 2.5), erythrocyte sedimentation rate (ESR) at RA incidence (HR 1.6, 95% CI 1.2, 2.0), repeatedly high ESR (HR 2.1, 95% CI 1.2, 3.5), severe extra - articular manifestations (HR 3.1, 95% CI 1.9, 5.1), and corticosteroid use (HR 2.0, 95% CI 1.3, 3.2), adjusting for CV risk factors and coronary heart disease (CHD). Methotrexate users were half as likely to have HF as nonusers (HR 0.5, 95% CI 0.3, 0.9). Conclusion. Several RA characteristics and the use of corticosteroids were associated with HF, with adjustment for CV risk factors and CHD. Methotrexate use appeared to be protective against HF. These findings suggest an independent effect of RA on HF that may be further modified by antirheumatic treatment. The Journal of Rheumatology

AB - Objective. To examine the influence of rheumatoid arthritis (RA) characteristics and antirheumatic medications on the risk of heart failure (HF) in patients with RA. Methods. A population-based incidence cohort of RA patients aged ≥ 18 years (1987 American College of Rheumatology criteria first met between January 1, 1980, and January 1, 2008) with no history of HF was followed until onset of HF (defined by Framingham criteria), death, or January 1, 2008. We collected data on RA characteristics, antirheumatic medications, and cardiovascular (CV) risk factors. Cox models adjusting for age, sex, and calendar year were used to analyze the data. Results. The study included 795 RA patients [mean age 55.3 yrs, 69% women, 66% rheumatoid factor (RF)-positive]. During the mean followup of 9.7 years, 92 patients developed HF. The risk of HF was associated with RF positivity (HR 1.6, 95% CI 1.0, 2.5), erythrocyte sedimentation rate (ESR) at RA incidence (HR 1.6, 95% CI 1.2, 2.0), repeatedly high ESR (HR 2.1, 95% CI 1.2, 3.5), severe extra - articular manifestations (HR 3.1, 95% CI 1.9, 5.1), and corticosteroid use (HR 2.0, 95% CI 1.3, 3.2), adjusting for CV risk factors and coronary heart disease (CHD). Methotrexate users were half as likely to have HF as nonusers (HR 0.5, 95% CI 0.3, 0.9). Conclusion. Several RA characteristics and the use of corticosteroids were associated with HF, with adjustment for CV risk factors and CHD. Methotrexate use appeared to be protective against HF. These findings suggest an independent effect of RA on HF that may be further modified by antirheumatic treatment. The Journal of Rheumatology

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