Association Between Rheumatoid Arthritis and the Risk of Incident Degenerative Valvular Heart Disease: Evidence From a Prospective Cohort Study.

BACKGROUND

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.

METHODS

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.

RESULTS

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.

CONCLUSIONS

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.