Wang Zuoxiang, Lv Junxing, Qian Xifeng, Li Ziang, Yin Zheng, Wang Can, Zhao Sheng, Gao Xiaojin, Wu Yongjian
Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College No. 167 Beilishi Road, Xicheng District Beijing 100037 China.
J Am Heart Assoc. 2025 Aug 19;14(16):e042025. doi: 10.1161/JAHA.125.042025. Epub 2025 Aug 12.
Accumulating evidence indicates that degenerative valvular heart disease (VHD) and rheumatoid arthritis (RA) share overlapping risk factors and intersecting inflammatory processes; however, their interrelationship remains insufficiently explored.
Among 492 745 UK Biobank participants without VHD at baseline, Cox proportional hazards models were conducted to assess the association between prevalent RA and new-onset degenerative VHD, with sequential adjustments for demographic factors, lifestyle variables, and comorbidities. The end points of degenerative VHD in this study included 8 subtypes: aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation, tricuspid stenosis, tricuspid regurgitation, pulmonary stenosis, and pulmonary regurgitation.
Among participants with RA (n=6673), 359 cases of degenerative VHD were recorded over a median follow-up of 13.71 (interquartile range, 12.71-14.55) years, compared with 13 518 cases in those without RA (n=486 072) over a median follow-up of 13.78 (interquartile range, 12.96-14.51) years. After full adjustment, RA was significantly associated with a higher risk of 3 types of new-onset degenerative VHD: aortic stenosis (hazard ratio [HR], 1.64 [95% CI, 1.40-1.92]), aortic regurgitation (HR, 1.69 [95% CI, 1.34-2.13]), and mitral regurgitation (HR, 1.54 [95% CI, 1.32-1.81]), while no significant association was observed between RA and other degenerative VHD subtypes. Moreover, sex subgroup analyses revealed an interaction between sex and RA in the occurrence of aortic stenosis ( for interaction=0.02) and mitral regurgitation ( for interaction=0.04), indicating a higher risk in women.
The presence of RA indicated an elevated risk of new-onset degenerative aortic stenosis, aortic regurgitation, and mitral regurgitation, which required further investigation and better disease management.
越来越多的证据表明，退行性心脏瓣膜病（VHD）和类风湿关节炎（RA）有重叠的危险因素和交叉的炎症过程；然而，它们之间的相互关系仍未得到充分探索。
在492745名基线时无VHD的英国生物银行参与者中，采用Cox比例风险模型评估患RA与新发退行性VHD之间的关联，并对人口统计学因素、生活方式变量和合并症进行序贯调整。本研究中退行性VHD的终点包括8种亚型：主动脉瓣狭窄、主动脉瓣反流、二尖瓣狭窄、二尖瓣反流、三尖瓣狭窄、三尖瓣反流、肺动脉狭窄和肺动脉反流。
在患有RA的参与者（n = 6673）中，在中位随访13.71年（四分位间距，12.71 - 14.55年）期间记录到359例退行性VHD，而在无RA的参与者（n = 486072）中，在中位随访13.78年（四分位间距，12.96 - 14.51年）期间记录到13518例。经过全面调整后，RA与3种新发退行性VHD的较高风险显著相关：主动脉瓣狭窄（风险比[HR]，1.64[95%CI，1.40 - 1.92]）、主动脉瓣反流（HR，1.69[95%CI，1.34 - 2.13]）和二尖瓣反流（HR，1.54[95%CI，1.32 - 1.81]），而未观察到RA与其他退行性VHD亚型之间存在显著关联。此外，性别亚组分析显示，在主动脉瓣狭窄（交互作用P = 0.
