Rheumatoid arthritis associated with greater risk of HF, especially when CRP levels are high

Rheumatoid arthritis (RA) is associated with a greater risk of heart failure (HF), according to new findings published in the Journal of the American Heart Association. The risk increases even more when patients have higher levels of C-reactive protein (CRP), a telltale sign of severe inflammation.  

“Inflammation has been proposed as an important mechanism for the development of HF, particularly heart failure with preserved ejection fraction (HFpEF),” wrote lead author Michael J. Ahlers, MD, Vanderbilt University School of Medicine in Nashville, and colleagues. “Understanding whether and how inflammation influences cardiovascular structure and function and HF risk is of biologic, preventive, and therapeutic importance. RA is a prototypic chronic inflammatory disorder that has been associated with an increased risk for HF independent of traditional cardiovascular risk factors, including coronary artery disease. Therefore, patients with RA may represent a human model for studying how chronic inflammation contributes to HF, and possibly HFpEF.”

Ahlers et al. explored deidentified data from 9,889 adult RA patients and 9,889 control patients treated at a single facility from 1993 to 2017. Overall, RA was associated with a 21% greater risk of HF. Higher CRP levels were linked to an even greater risk of HF.

Also, the team observed, use of the anti-inflammatory drug methotrexate was associated with a significant drop in HF risk. Antimalarial medications such as hydroxychloroquine, on the other hand, were significantly associated with an increased risk of HFpEF—but not HF with reduced ejection fraction (HFrEF).

“Collectively, the body of literature suggests that specific anti‐inflammatory therapies may differentially affect the risk of HFpEF or HFrEF, the mechanisms for which warrant further investigation,” the authors wrote.