© MEDICAL GRAPHICS/MICHAEL HOFFMANN/SPL
September 2023
Does rheumatoid arthritis increase risk of aortic stenosis?
By Melanie Hinze
New research finds patients with rheumatoid arthritis (RA) are at increased risk of developing aortic stenosis (AS) and its complications, when compared with people without RA.
Published in JAMA Internal Medicine, the retrospective, matched cohort study used linked data from the Veterans Health Administration (VHA) and Centers for Medicare and Medicaid Services in the US, from 2000 to 2019.
A total of 73,070 patients with RA (87.6% male; mean age 63.0 years) were matched by age, sex and VHA enrolment year, with 639,268 patients without RA (86.7% male; mean age 61.9 years). The cohort was followed up until incident AS, aortic valve intervention or death.
The researchers identified 16,109 composite AS outcomes over 6,223,150 person-years. Of these, 2303 occurred in patients with RA.
Patients with RA were found to be at increased risk of developing AS compared with non-RA matched controls. The incidence of AS was 3.97 per 1000 person-years in patients with RA and 2.45 per 1000 person-years in control patients, equating to an absolute difference of 1.52 per 1000 person-years.
In addition, RA was associated with an increased risk of composite AS (adjusted hazard ratio [AHR], 1.48), aortic valve intervention (AHR, 1.34) and AS-related death (AHR, 1.26) compared with non-RA matched controls. Professor Ranjeny Thomas, Arthritis Queensland Chair of Rheumatology at the Frazer Institute, University of Queensland, Brisbane, and Consultant Rheumatologist at Princess Alexandra Hospital, Brisbane, said, ‘This study builds on evidence that cardiovascular events, including myocardial infarction, stroke and heart failure, are 1.5 to 2 times more frequent in RA, due to the compounding effects of inflammation on traditional risk factors.’
‘Histopathological studies suggest that inflammation may also accelerate valve dysfunction,’ she added.
Professor Thomas told Medicine Today that the take-home message was that in patients with RA, clinicians should be looking for, monitoring and proactively managing cardiovascular disease and AS, in addition to cardiovascular disease risk factors and RA inflammation.
The researchers called for future studies to confirm whether valvular heart disease might be an overlooked cardiovascular disease complication in RA.