Heart Failure Risk Associated With Rheumatoid Arthritis–Related Chronic Inflammation

Background Inflammation may contribute to incident heart failure (HF ). Rheumatoid arthritis (RA ), a prototypic inflammatory condition, may serve as a model for understanding inflammation‐relatedHF risk.Methods and Results Using the Vanderbilt University Medical Center electronic health record, we retrospectively identified 9889 patients with RA and 9889 control patients without autoimmune disease matched for age, sex, and race. PrevalentHF at entry into the electronic health record or precedingRA diagnosis was excluded. IncidentHF was ascertained usingInternational Classification of Diseases, Ninth Revision (ICD‐9), codes and medications. Over 177 566 person‐years of follow‐up, patients withRA were at 21% greater risk ofHF (95% CI, 3–42%) independent of traditional cardiovascular risk factors. Among patients withRA , higher CRP (C‐reactive protein) was associated with greaterHF risk (P <0.001), while the anti‐inflammatory drug methotrexate was associated with ≈25% lowerHF risk (P =0.021). In a second cohort (n=115) of prospectively enrolled patients with and withoutRA , we performed proteomics and cardiac magnetic resonance imaging to discover circulating markers of inflammation associated with cardiac structure and function. Artemin levels were higher in patients with RA compared with controls (P =0.009), and higher artemin levels were associated with worse ventricular end‐systolic elastance and ventricular‐vascular coupling ratio (P =0.044 andP =0.031, respectively).Conclusions RA , a prototypic chronic inflammatory condition, is associated with increased risk ofHF . Among patients withRA , higher levels of CRP were associated with greaterHF risk, while methotrexate was associated with lower risk.