类风湿关节炎增加心力衰竭风险：来自美国人群的横断面研究和欧洲人群的孟德尔随机分析结果。

Rheumatoid arthritis increases the risk of heart failure: results from the cross-sectional study in the US population and mendelian randomization analysis in the European population.

机构信息

Department of Cardiology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.

Department of Urology, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China.

出版信息

Front Immunol. 2024 May 28;15:1377432. doi: 10.3389/fimmu.2024.1377432. eCollection 2024.

DOI:10.3389/fimmu.2024.1377432

PMID:38863716

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11165030/

Abstract

OBJECTIVE

Rheumatoid arthritis (RA) is a chronic systemic autoimmune disease. Among its various complications, heart failure (HF) has been recognized as the second leading cause of cardiovascular death in RA patients. The objective of this study was to investigate the relationship between RA and HF using epidemiological and genetic approaches.

METHODS

The study included 37,736 participants from the 1999-2020 National Health and Nutrition Examination Survey. Associations between RA and HF in the US population were assessed with weighted multivariate logistic regression analysis. A two-sample Mendelian randomization (MR) analysis was employed to establish the causal relationship between the two variables. The primary analysis method utilized was inverse variance weighting (IVW). Additionally, horizontal pleiotropy and heterogeneity were assessed to account for potential confounding factors. In cases where multiple independent datasets were accessible during MR analysis, we combined the findings through a meta-analytical approach.

RESULTS

In observational studies, the prevalence of HF in combination with RA reached 7.11% (95%CI 5.83 to 8.39). RA was positively associated with an increased prevalence of HF in the US population [odds ratio (OR):1.93, 95% confidence interval (CI):1.47-2.54, P < 0.0001]. In a MR analysis utilizing a meta-analytical approach to amalgamate the results of the IVW method, we identified a significant causal link between genetically predicted RA and a heightened risk of HF (OR = 1.083, 95% CI: 1.028-1.141; P = 0.003). However, this association was not deemed significant for seronegative RA (SRA) (OR = 1.028, 95% CI: 0.992-1.065; P = 0.126). These findings were consistent across sensitivity analyses and did not indicate any horizontal pleiotropy.

CONCLUSION

RA correlates with an elevated prevalence of HF within the US population. Furthermore, genetic evidence derived from European populations underscores a causal link between RA and the risk of HF. However this association was not significant in SRA.

摘要

目的

类风湿关节炎（RA）是一种慢性全身性自身免疫性疾病。在其各种并发症中，心力衰竭（HF）已被认为是 RA 患者心血管死亡的第二大主要原因。本研究旨在通过流行病学和遗传学方法探讨 RA 与 HF 之间的关系。

方法

本研究纳入了 1999-2020 年全国健康和营养检查调查中的 37736 名参与者。采用加权多变量逻辑回归分析评估美国人群中 RA 与 HF 之间的关联。采用两样本 Mendelian 随机化（MR）分析来确定这两个变量之间的因果关系。主要分析方法为逆方差加权（IVW）。此外，还评估了水平多效性和异质性，以考虑潜在的混杂因素。在 MR 分析中可以获得多个独立数据集的情况下，我们通过 meta 分析方法对结果进行了合并。

结果

在观察性研究中，HF 合并 RA 的患病率达到 7.11%（95%CI 5.83-8.39）。RA 与美国人群中 HF 患病率升高呈正相关[比值比（OR）：1.93，95%置信区间（CI）：1.47-2.54，P<0.0001]。采用 IVW 方法的 meta 分析综合结果的 MR 分析中，我们发现遗传预测的 RA 与 HF 风险增加之间存在显著的因果关系（OR=1.083，95%CI：1.028-1.141；P=0.003）。然而，对于血清阴性 RA（SRA），这种关联并不显著（OR=1.028，95%CI：0.992-1.065；P=0.126）。这些发现在敏感性分析中是一致的，并且没有表明存在水平多效性。