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The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years.
Arthritis Rheum. 2005 Feb; 52(2):412-20.AR

Abstract

OBJECTIVE

It is hypothesized that the systemic inflammation associated with rheumatoid arthritis (RA) promotes an increased risk of cardiovascular (CV) morbidity and mortality. We examined the risk and determinants of congestive heart failure (CHF) in patients with RA.

METHODS

We assembled a population-based, retrospective incidence cohort from among all individuals living in Rochester, Minnesota, in whom RA (defined according to the American College of Rheumatology 1987 criteria) was first diagnosed between 1955 and 1995, and an age- and sex-matched non-RA cohort. After excluding patients in whom CHF occurred before the RA index date, all subjects were followed up until either death, incident CHF (defined according to the Framingham Heart Study criteria), migration from the county, or until January 1, 2001. Detailed information from the complete medical records (including all inpatient and outpatient care provided by all local providers) regarding RA, ischemic heart disease, and traditional CV risk factors was collected. Cox models were used to estimate the effect of RA on the development of CHF, adjusting for CV risk factors and/or ischemic heart disease.

RESULTS

The study population included 575 patients with RA and 583 subjects without RA. The CHF incidence rates were 1.99 and 1.16 cases per 100 person-years in patients with RA and in non-RA subjects, respectively (rate ratio 1.7, 95% confidence interval [95% CI] 1.3-2.1). After 30 years of followup, the cumulative incidence of CHF was 34.0% in patients with RA and 25.2% in non-RA subjects (P< 0.001). RA conferred a significant excess risk of CHF (hazard ratio [HR] 1.87, 95% CI 1.47-2.39) after adjusting for demographics, ischemic heart disease, and CV risk factors. The risk was higher among patients with RA who were rheumatoid factor (RF) positive (HR 2.59, 95% CI 1.95-3.43) than among those who were RF negative (HR 1.28, 95% CI 0.93-1.78).

CONCLUSION

Compared with persons without RA, patients with RA have twice the risk of developing CHF. This excess risk is not explained by traditional CV risk factors and/or clinical ischemic heart disease.

Authors+Show Affiliations

Mayo Clinic, Rochester, Minnesota 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

15692992

Citation

Nicola, Paulo J., et al. "The Risk of Congestive Heart Failure in Rheumatoid Arthritis: a Population-based Study Over 46 Years." Arthritis and Rheumatism, vol. 52, no. 2, 2005, pp. 412-20.
Nicola PJ, Maradit-Kremers H, Roger VL, et al. The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis Rheum. 2005;52(2):412-20.
Nicola, P. J., Maradit-Kremers, H., Roger, V. L., Jacobsen, S. J., Crowson, C. S., Ballman, K. V., & Gabriel, S. E. (2005). The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis and Rheumatism, 52(2), 412-20.
Nicola PJ, et al. The Risk of Congestive Heart Failure in Rheumatoid Arthritis: a Population-based Study Over 46 Years. Arthritis Rheum. 2005;52(2):412-20. PubMed PMID: 15692992.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. AU - Nicola,Paulo J, AU - Maradit-Kremers,Hilal, AU - Roger,Véronique L, AU - Jacobsen,Steven J, AU - Crowson,Cynthia S, AU - Ballman,Karla V, AU - Gabriel,Sherine E, PY - 2005/2/5/pubmed PY - 2005/3/15/medline PY - 2005/2/5/entrez SP - 412 EP - 20 JF - Arthritis and rheumatism JO - Arthritis Rheum VL - 52 IS - 2 N2 - OBJECTIVE: It is hypothesized that the systemic inflammation associated with rheumatoid arthritis (RA) promotes an increased risk of cardiovascular (CV) morbidity and mortality. We examined the risk and determinants of congestive heart failure (CHF) in patients with RA. METHODS: We assembled a population-based, retrospective incidence cohort from among all individuals living in Rochester, Minnesota, in whom RA (defined according to the American College of Rheumatology 1987 criteria) was first diagnosed between 1955 and 1995, and an age- and sex-matched non-RA cohort. After excluding patients in whom CHF occurred before the RA index date, all subjects were followed up until either death, incident CHF (defined according to the Framingham Heart Study criteria), migration from the county, or until January 1, 2001. Detailed information from the complete medical records (including all inpatient and outpatient care provided by all local providers) regarding RA, ischemic heart disease, and traditional CV risk factors was collected. Cox models were used to estimate the effect of RA on the development of CHF, adjusting for CV risk factors and/or ischemic heart disease. RESULTS: The study population included 575 patients with RA and 583 subjects without RA. The CHF incidence rates were 1.99 and 1.16 cases per 100 person-years in patients with RA and in non-RA subjects, respectively (rate ratio 1.7, 95% confidence interval [95% CI] 1.3-2.1). After 30 years of followup, the cumulative incidence of CHF was 34.0% in patients with RA and 25.2% in non-RA subjects (P< 0.001). RA conferred a significant excess risk of CHF (hazard ratio [HR] 1.87, 95% CI 1.47-2.39) after adjusting for demographics, ischemic heart disease, and CV risk factors. The risk was higher among patients with RA who were rheumatoid factor (RF) positive (HR 2.59, 95% CI 1.95-3.43) than among those who were RF negative (HR 1.28, 95% CI 0.93-1.78). CONCLUSION: Compared with persons without RA, patients with RA have twice the risk of developing CHF. This excess risk is not explained by traditional CV risk factors and/or clinical ischemic heart disease. SN - 0004-3591 UR - https://www.unboundmedicine.com/medline/citation/15692992/The_risk_of_congestive_heart_failure_in_rheumatoid_arthritis:_a_population_based_study_over_46_years_ L2 - https://doi.org/10.1002/art.20855 DB - PRIME DP - Unbound Medicine ER -