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Rheumatoid arthritis and the heart

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Abstract

The risk of cardiovascular disease is increased in patients with rheumatoid arthritis (RA). Although the pathogenesis of cardiovascular disease in patients with RA is largely unknown, evidence to date indicates that it involves complex interactions between the traditional and nontraditional cardiovascular risk factors as well as various medications commonly used for the treatment of RA patients. This review provides an overview of the clinical studies that demonstrate increased risk of coronary heart disease and heart failure in patients with RA and also discusses the potential role of the various risk factors.

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References and Recommended Reading

  1. Frostegard J: Atherosclerosis in patients with autoimmune disorders. Arterioscler Thromb Vasc Biol 2005, 25:1776–1785. A comprehensive overview of potential mechanisms that may contribute to accelerated atherosclerosis in systemic lupus erythematosus and RA.

    Article  PubMed  CAS  Google Scholar 

  2. Hansson GK: Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med 2005, 352:1685–1695.

    Article  PubMed  CAS  Google Scholar 

  3. Diwan A, Tran T, Misra A, Mann DL: Inflammatory mediators and the failing heart: a translational approach. Curr Mol Med 2003, 3:161–182.

    Article  PubMed  CAS  Google Scholar 

  4. Maradit Kremers H, Gabriel SE: Epidemiology. In Rheumatoid Arthritis. Edited by St. Clair EW, Pisetsky DS, Haynes BF. Philadelphia: Lippincott Williams & Wilkins; 2004:1–10.

    Google Scholar 

  5. Gabriel SE, Crowson CS, O’Fallon WM: Mortality in rheumatoid arthritis: have we made an impact in 4 decades? J Rheumatol 1999, 26:2529–2533.

    PubMed  CAS  Google Scholar 

  6. Gonzalez A, Maradit Kremers H, Crowson CS, Gabriel SE: Survival trends and risk factors for mortality in rheumatoid arthritis. Int J Advances Rheum 2005, 3:38–46.

    Google Scholar 

  7. Gabriel SE, Crowson CS, O’Fallon WM: Comorbidity in Arthritis. J Rheumatol 1999, 26:2475–2479.

    PubMed  CAS  Google Scholar 

  8. del Rincon ID: High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum 2001, 44:2737–2745.

    Article  PubMed  Google Scholar 

  9. Solomon DH, Karlson EW, Rimm EB, et al.: Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation 2003, 107:1303–1307.

    Article  PubMed  Google Scholar 

  10. Maradit-Kremers H, Crowson CS, Nicola PJ, et al.: Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum 2005, 52:402–411. This comprehensive long-term study demonstrated for the first time that silent myocardial infarctions and sudden deaths are more common in RA patients compared with control subjects.

    Article  PubMed  Google Scholar 

  11. Nicola PJ, Maradit-Kremers H, Roger VL, et al.: The risk of congestive heart failure in rheumatoid arthritis: a population-based study over 46 years. Arthritis Rheum 2005, 52:412–420. A comprehensive long-term study that demonstrates that HF is more common in RA patients compared with control subjects and that RF positive patients have a much higher risk.

    Article  PubMed  Google Scholar 

  12. Kumeda Y, Inaba M, Goto H, et al.: Increased thickness of the arterial intima-media detected by ultrasonography in patients with rheumatoid arthritis. Arthritis Rheum 2002, 46:1489–1497.

    Article  PubMed  Google Scholar 

  13. Park YB, Ahn CW, Choi HK, et al.: Atherosclerosis in rheumatoid arthritis: morphologic evidence obtained by carotid ultrasound. Arthritis Rheum 2002, 46:1714–1719.

    Article  PubMed  Google Scholar 

  14. Del Rincon I, Williams K, Stern MP, et al.: Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects. Arthritis Rheum 2003, 48:1833–1840.

    Article  PubMed  Google Scholar 

  15. Roman MJ, Moeller E, Davis A, et al.: Preclinical Carotid Atherosclerosis in Patients with Rheumatoid Arthritis. Ann Intern Med 2006, 144:249–256.

    PubMed  Google Scholar 

  16. Aubry MC, Maradit-Kremers H, Reinalda MS, et al.: Differences in atherosclerotic coronary heart disease between patients with and without rheumatoid arthritis: an autopsy study of 123 cases [abstract]. Arthritis Rheum 2005, 52:S153.

    Google Scholar 

  17. Aubry MC, Riehle DL, Edwards WD, et al.: B-Lymphocytes in plaque and adventitia of coronary arteries in two patients with rheumatoid arthritis and coronary atherosclerosis: preliminary observations. Cardiovasc Pathol 2004, 13:233–236.

    Article  PubMed  Google Scholar 

  18. Bergholm R, Leirisalo-Repo M, Vehkavaara S, et al.: Impaired responsiveness to NO in newly diagnosed patients with rheumatoid arthritis. Arterioscler Thromb Vasc Biol 2002, 22:1637–1641.

    Article  PubMed  CAS  Google Scholar 

  19. Hurlimann D, Forster A, Noll G, et al.: Anti-tumor necrosis factor-alpha treatment improves endothelial function in patients with rheumatoid arthritis. Circulation 2002, 106:2184–2187.

    Article  PubMed  Google Scholar 

  20. Hermann F, Forster A, Chenevard R, et al.: Simvastatin improves endothelial function in patients with rheumatoid arthritis. J Am Coll Cardiol 2005, 45:461–464.

    Article  PubMed  CAS  Google Scholar 

  21. Solomon DH, Curhan GC, Rimm EB, et al.: Cardiovascular risk factors in women with and without rheumatoid arthritis. Arthritis Rheum 2004, 50:3444–3449.

    Article  PubMed  Google Scholar 

  22. Gonzalez A, Maradit-Kremers H, Nicola PJ, et al.: The incidence of cardiovascular risk factors in rheumatoid arthritis [abstract]. Arthritis Rheum 2005, 52:S324.

    Google Scholar 

  23. Park YB, Choi HK, Kim MY, et al.: Effects of antirheumatic therapy on serum lipid levels in patients with rheumatoid arthritis: a prospective study. Am J Med 2002, 113:188–193.

    Article  PubMed  CAS  Google Scholar 

  24. Escalante A, Haas RW, del Rincon I: Paradoxical effect of body mass index on survival in rheumatoid arthritis: role of comorbidity and systemic inflammation. Arch Intern Med 2005, 165:1624–1629.

    Article  PubMed  Google Scholar 

  25. Kremers HM, Nicola PJ, Crowson CS, et al.: Prognostic importance of low body mass index in relation to cardiovascular mortality in rheumatoid arthritis. Arthritis Rheum 2004, 50:3450–3457.

    Article  PubMed  Google Scholar 

  26. Choi HK, Hern’an MA, Seeger JD, et al.: Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. Lancet 2002, 359:1173–1177. This well-designed database study is the first to demonstrate that methotrexate use is associated with a significantly lower risk of cardiovascular mortality in RA patients.

    Article  PubMed  CAS  Google Scholar 

  27. Davis JM 3rd, Maradit-Kremers H, Gabriel SE: Use of low-dose glucocorticoids and the risk of cardiovascular morbidity and mortality in rheumatoid arthritis: what is the true direction of effect? J Rheumatol 2005, 32:1856–1862.

    PubMed  Google Scholar 

  28. Bombardier C, Laine L, Reicin A, et al.: Comparison of upper gastrointestinal toxicity of rofecoxib and naproxen in patients with rheumatoid arthritis. VIGOR Study Group. N Engl J Med 2000, 343:1520–1528.

    Article  PubMed  CAS  Google Scholar 

  29. Silverstein FE, Faich G, Goldstein JL, et al.: Gastrointestinal toxicity with celecoxib vs nonsteroidal anti-inflammatory drugs for osteoarthritis and rheumatoid arthritis: the CLASS study: A randomized controlled trial. Celecoxib Long-term Arthritis Safety. JAMA 2000, 284:1247–1255.

    Article  PubMed  CAS  Google Scholar 

  30. Fitzgerald GA: Coxibs and cardiovascular disease. N Engl J Med 2004, 35:1709–1711. Review article that summarizes potential mechanisms for increased risk of cardiovascular disease with COX-2 inhibitors.

    Article  Google Scholar 

  31. Maradit-Kremers H, Nicola PJ, Crowson CS, et al.: Cardiovascular death in rheumatoid arthritis: a population- based study. Arthritis Rheum 2005, 52:722–732.

    Article  PubMed  Google Scholar 

  32. Danesh J, Collins R, Peto R, Lowe GD: Haematocrit, viscosity, erythrocyte sedimentation rate: meta-analyses of prospective studies of coronary heart disease. Eur Heart J 2000, 21:515–520.

    Article  PubMed  CAS  Google Scholar 

  33. Swanberg M, Lidman O, Padyukov L, et al.: MHC2TA is associated with differential MHC molecule expression and susceptibility to rheumatoid arthritis, multiple sclerosis and myocardial infarction. Nat Genet 2005, 37:486–494.

    Article  PubMed  CAS  Google Scholar 

  34. McCarey DW, McInnes IB, Madhok R, et al.: Trial of Atorvastatin in Rheumatoid Arthritis (TARA): doubleblind, randomised placebo-controlled trial. Lancet 2004, 363:2015–2021.

    Article  PubMed  CAS  Google Scholar 

  35. Mutru O, Laakso M, Isomaki H, Koota K: Cardiovascular mortality in patients with rheumatoid arthritis. Cardiology 1989, 76:71–77.

    Article  PubMed  CAS  Google Scholar 

  36. Wolfe F, Freundlich B, Straus WL: Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 2003, 30:36–40.

    PubMed  Google Scholar 

  37. Gonzalez-Juanatey C, Testa A, Garcia-Castelo A, et al.: Echocardiographic and Doppler findings in long-term treated rheumatoid arthritis patients without clinically evident cardiovascular disease. Semin Arthritis Rheum 2004, 33:231–238.

    Article  PubMed  Google Scholar 

  38. Suskin N, Sheth T, Negassa A, Yusuf S: Relationship of current and past smoking to mortality and morbidity in patients with left ventricular dysfunction. J Am Coll Cardiol 2001, 37:1677–1682.

    Article  PubMed  CAS  Google Scholar 

  39. Dessein PH, Stanwix AE, Joffe BI: Cardiovascular risk in rheumatoid arthritis versus osteoarthritis: acute phase response related decreased insulin sensitivity and high-density lipoprotein cholesterol as well as clustering of metabolic syndrome features in rheumatoid arthritis. Arthritis Res 2002, 4:R5.

    Article  PubMed  Google Scholar 

  40. Crowson CS, Nicola PJ, Kremers HM, et al.: How much of the increased incidence of heart failure in rheumatoid arthritis is attributable to traditional cardiovascular risk factors and ischemic heart disease? Arthritis Rheum 2005, 52:3039–3044. The authors use attributable risk statistics and demonstrate that the risk of HF attributable to traditional risk factors is less in RA patients compared with non-RA patients.

    Article  PubMed  Google Scholar 

  41. Davis JM 3rd, Maradit-Kremers H, Crowson CS, et al.: Cumulative glucocorticoid exposure and the risk of cardiovascular events in a population-based cohort of rheumatoid arthritis subjects [abstract]. Paper submitted to the ACR 2005 Annual Meeting. San Diego, CA November 13–17, 2005.

  42. Mann DL: Mechanisms and models in heart failure: A combinatorial approach. Circulation 1999, 100:999–1008.

    PubMed  CAS  Google Scholar 

  43. Khanna D, McMahon M, Furst DE: Anti-tumor necrosis factor alpha therapy and heart failure: what have we learned and where do we go from here? Arthritis Rheum 2004, 50:1040–1050.

    Article  PubMed  CAS  Google Scholar 

  44. Wolfe F, Michaud K: Heart failure in rheumatoid arthritis: rates, predictors, and the effect of anti-tumor necrosis factor therapy. Am Med 2004, 116:305–311.

    Article  Google Scholar 

  45. Heerdink ER, Leufkens HG, Herings RM, et al.: NSAIDs associated with increased risk of congestive heart failure in elderly patients taking diuretics. Arch Intern Med 1998, 158:1108–1112.

    Article  PubMed  CAS  Google Scholar 

  46. Garcia Rodriguez LA, Hernandez-Diaz S: Nonsteroidal antiinflammatory drugs as a trigger of clinical heart failure. Epidemiology 2003, 14:240–246.

    Article  Google Scholar 

  47. Mamdani M, Juurlink DN, Lee DS, et al.: Cyclo-oxygenase- 2 inhibitors versus non-selective non-steroidal anti-inflammatory drugs and congestive heart failure outcomes in elderly patients: a population-based cohort study. Lancet 2004, 363:1751–1756.

    Article  PubMed  CAS  Google Scholar 

  48. Maradit Kremers H, Crowson CS, Nicola PJ, et al.: Erythrocyte sedimentation rate (ESR) and congestive heart failure (CHF) in rheumatoid arthritis (RA) [abstract]. Arthritis Rheum 2004, 50:S557-S558.

    Google Scholar 

  49. Nicola P, Maradit Kremers H, Crowson C, et al.: Systemic lupus erythematosus (SLE) characteristics in rheumatoid arthritis subjects are associated with the risk of congestive heart failure (CHF). Arthritis Rheum 2004, 50:S551.

    Google Scholar 

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Authors and Affiliations

  1. Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Sherine E. Gabriel MD, MSc

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  1. Hilal Maradit Kremers MD, MSc
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  2. Sherine E. Gabriel MD, MSc
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Correspondence to Sherine E. Gabriel MD, MSc.

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Kremers, H.M., Gabriel, S.E. Rheumatoid arthritis and the heart. Curr Heart Fail Rep 3, 57–63 (2006). https://doi.org/10.1007/s11897-006-0003-0

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  • DOI: https://doi.org/10.1007/s11897-006-0003-0

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