Recent research has uncovered alarming findings regarding the risks associated with rheumatoid arthritis (RA), indicating that individuals suffering from this autoimmune disorder face a considerably heightened risk of heart failure (HF) compared to those without the condition. This heightened risk persists even after accounting for various cardiovascular risk factors, with the most affected being those with heart failure with preserved ejection fraction (HFpEF).

Lead investigator Dr. Yumeko Kawano from Brigham and Women’s Hospital and Harvard Medical School stated, 'Patients with RA are indeed at an increased risk for cardiovascular disease (CVD), including heart failure. However, the finer details concerning the different subtypes of heart failure, particularly HFpEF versus heart failure with reduced ejection fraction (HFrEF), remain largely underexplored.'

In this study, a cohort of 1,445 RA patients was evaluated alongside a matched group of 4,335 individuals without RA. Both groups had a mean age ranging from 51 to 52 years, with a significant majority—approximately 78.7%—being female. Notably, HFpEF emerged as the most prevalent heart failure subtype among participants, occurring in 65% of RA patients compared to 59% of those without the condition.

The statistical analysis revealed that the hazard rate (HR) for heart failure in RA patients was a striking 1.79 (95% CI, 1.38-2.32) after adjustment for established cardiovascular risk factors. The data highlighted an even more alarming rate concerning HFpEF, showing a hazard rate of 1.99 (95% CI, 1.43 - 2.77). Conversely, no significant difference was noted for HFrEF rates (HR, 1.45 [95% CI, 0.81 - 2.60]).

Dr. Kawano and colleagues concluded, 'Our findings underscore that RA correlates with a higher overall incidence of heart failure, notably driven by HFpEF. This suggests that inflammation may play a critical role in the development of HFpEF, revealing new avenues for intervention and management strategies to mitigate this elevated risk in RA patients.'

In addition to this focus on heart failure, recent discussions at the American College of Rheumatology (ACR) Convergence 2024 meeting by Dr. Diane Lacaille also shed light on the increased cardiovascular and infection-related mortality risks associated with glucocorticosteroid (GC) use in RA patients, even long after their cessation. Data from over 28,000 GC users indicated heightened risks persist for CVD and infection-related mortality, delaying their return to pre-GC levels for several years.

Dr. Lacaille emphasized, 'Discussion about the risks and benefits of steroid use must be ongoing and tailored to individual patient needs, ensuring patients are fully informed about potential withdrawal symptoms and long-term implications.'

These revelations present a wake-up call, urging RA patients and healthcare providers to stay vigilant about cardiovascular health and the lasting impacts of medication usage. It is imperative for patients to discuss their treatment plans and heart health proactively as they manage their RA and associated risks.