Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institutet, Stockholm, Sweden.
J Am Coll Cardiol. 2017 Mar 14;69(10):1275-1285. doi: 10.1016/j.jacc.2016.12.033.
It is unknown whether the increased risk of heart failure (HF) in rheumatoid arthritis (RA) is independent of ischemic heart disease (IHD).
This study sought to investigate the relative risk of HF overall and by subtype (ischemic and nonischemic HF) in patients with RA and to assess the impact of RA disease factors.
Two contemporary cohorts of RA subjects were identified from Swedish patient and rheumatology registries and matched 1:10 to general population comparator subjects. A first-ever HF diagnosis (classified as ischemic HF or nonischemic HF based on the presence of IHD) was assessed through registry linkages. Relative risks for a history of HF before RA onset were calculated through odds ratios. Relative risks of incident HF in RA were calculated as hazard ratios (HRs).
By the time of RA onset, a history of HF was not more common in RA. In the new-onset RA cohort, the overall HRs for subsequent HF (any type), ischemic HF, and nonischemic HF were between 1.22 and 1.27. The risk of nonischemic HF increased rapidly after RA onset, in contrast to the risk of ischemic HF. High disease activity was associated with all HF types but was most pronounced for nonischemic HF. In the cohort of patients with RA of any duration, the HRs were between 1.71 and 1.88 for the different HF subtypes.
Patients with RA are at increased risk of HF that cannot be explained by their increased risk of IHD. The increased risk of nonischemic HF occurred early and was associated with RA severity.
类风湿关节炎（RA）患者发生心力衰竭（HF）的风险增加是否独立于缺血性心脏病（IHD）尚不清楚。
本研究旨在探讨 RA 患者总体 HF 风险及其亚型（缺血性和非缺血性 HF）的相对风险，并评估 RA 疾病因素的影响。
从瑞典患者和风湿病登记处确定了两个当代 RA 患者队列，并以 1:10 的比例与普通人群对照者相匹配。通过登记处链接评估首次 HF 诊断（根据 IHD 的存在分类为缺血性 HF 或非缺血性 HF）。通过比值比计算 RA 发病前 HF 病史的相对风险。通过风险比（HR）计算 RA 中 HF 的发生率。
在 RA 发病时，RA 患者中 HF 病史并不更常见。在新发 RA 队列中，随后 HF（任何类型）、缺血性 HF 和非缺血性 HF 的总体 HR 介于 1.22 和 1.27 之间。与缺血性 HF 相比，RA 发病后非缺血性 HF 的风险迅速增加。高疾病活动与所有 HF 类型相关，但与非缺血性 HF 相关程度最强。在任何病程的 RA 患者队列中，不同 HF 亚型的 HR 介于 1.71 和 1.88 之间。
RA 患者 HF 的风险增加，不能用其 IHD 风险增加来解释。非缺血性 HF 的风险增加发生较早，与 RA 严重程度相关。
