TY - JOUR
T1 - Heart failure risk associated with rheumatoid arthritis–related chronic inflammation
AU - Ahlers, Michael J.
AU - Lowery, Brandon D.
AU - Farber-Eger, Eric
AU - Wang, Thomas J.
AU - Bradham, William
AU - Ormseth, Michelle J.
AU - Chung, Cecilia P.
AU - Stein, C. Michael
AU - Gupta, Deepak K.
N1 - Funding Information:
This work was supported by Clinical and Translational Science Awards (CTSA) award No. UL1 TR002243 from the National Center for Advancing Translational Sciences, K23 HL128928 (Gupta); Arthritis Foundation Innovative Research Grant (Stein), Veterans Administration CDA IK2CX001269 (Ormseth), Merit I01CX001741 (Chung), National Institutes of Health (NIH) grants: National Institute of Arthritis and Musculoskeletal and Skin Diseases P60 056116 (Stein), HL140145 (Stein), AR073764 (Chung) and GM126535 (Chung), and CTSA award UL1TR000445 from the National Center for Advancing Translational Sciences and the NIH Intramural Research Program. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the NIH.
Publisher Copyright:
© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2020/5/18
Y1 - 2020/5/18
N2 - BACKGROUND: Inflammation may contribute to incident heart failure (HF). Rheumatoid arthritis (RA), a prototypic inflammatcondition, may serve as a model for understanding inflammation-related HF risk. METHODS AND RESULTS: Using the Vanderbilt University Medical Center electronic health record, we retrospectively identified 9889 patients with RA and 9889 control patients without autoimmune disease matched for age, sex, and race. Prevalent HF at entry into the electronic health record or preceding RA diagnosis was excluded. Incident HF was ascertained using International Classification of Diseases, Ninth Revision (ICD-9), codes and medications. Over 177 566 person-years of follow-up, patients with RA were at 21% greater risk of HF (95% CI, 3–42%) independent of traditional cardiovascular risk factors. Among patients with RA, higher CRP (C-reactive protein) was associated with greater HF risk (P<0.001), while the anti-inflammatory drug methotrexate was associated with ≈25% lower HF risk (P=0.021). In a second cohort (n=115) of prospec-tively enrolled patients with and without RA, we performed proteomics and cardiac magnetic resonance imaging to discover circulating markers of inflammation associated with cardiac structure and function. Artemin levels were higher in patients with RA compared with controls (P=0.009), and higher artemin levels were associated with worse ventricular end-systolic elastance and ventricular-vascular coupling ratio (P=0.044 and P=0.031, respectively). CONCLUSIONS: RA, a prototypic chronic inflammatory condition, is associated with increased risk of HF. Among patients with higher levels of CRP were associated with greater HF risk, while methotrexate was associated with lower risk.
AB - BACKGROUND: Inflammation may contribute to incident heart failure (HF). Rheumatoid arthritis (RA), a prototypic inflammatcondition, may serve as a model for understanding inflammation-related HF risk. METHODS AND RESULTS: Using the Vanderbilt University Medical Center electronic health record, we retrospectively identified 9889 patients with RA and 9889 control patients without autoimmune disease matched for age, sex, and race. Prevalent HF at entry into the electronic health record or preceding RA diagnosis was excluded. Incident HF was ascertained using International Classification of Diseases, Ninth Revision (ICD-9), codes and medications. Over 177 566 person-years of follow-up, patients with RA were at 21% greater risk of HF (95% CI, 3–42%) independent of traditional cardiovascular risk factors. Among patients with RA, higher CRP (C-reactive protein) was associated with greater HF risk (P<0.001), while the anti-inflammatory drug methotrexate was associated with ≈25% lower HF risk (P=0.021). In a second cohort (n=115) of prospec-tively enrolled patients with and without RA, we performed proteomics and cardiac magnetic resonance imaging to discover circulating markers of inflammation associated with cardiac structure and function. Artemin levels were higher in patients with RA compared with controls (P=0.009), and higher artemin levels were associated with worse ventricular end-systolic elastance and ventricular-vascular coupling ratio (P=0.044 and P=0.031, respectively). CONCLUSIONS: RA, a prototypic chronic inflammatory condition, is associated with increased risk of HF. Among patients with higher levels of CRP were associated with greater HF risk, while methotrexate was associated with lower risk.
KW - Biomarker
KW - Cardiac magnetic resonance imaging
KW - Heart failure
KW - Inflammation
KW - Rheumatoid arthritis
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U2 - 10.1161/JAHA.119.014661
DO - 10.1161/JAHA.119.014661
M3 - Article
C2 - 32378457
AN - SCOPUS:85084939381
SN - 2047-9980
VL - 9
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 10
M1 - e014661
ER -