Aortic stenosis risk elevated in patients with rheumatoid arthritis, study finds
Future studies are needed to confirm whether aortic stenosis may be an overlooked cardiovascular disease complication of rheumatoid arthritis, the authors of a cohort study said.
Patients with rheumatoid arthritis (RA) had an increased risk of developing aortic stenosis (AS), undergoing aortic valve intervention, and dying of stenosis-related causes, a study found.
Researchers conducted a cohort study of linked data from the Veterans Health Administration and CMS from 2000 to 2019. Patients with RA were matched by age, sex, and enrollment year with up to 10 patients without RA. The cohort was followed until incident AS, aortic valve intervention, or death occurred. AS was defined using a composite of inpatient or outpatient diagnoses and diagnostic and procedural codes. Results were published by JAMA Internal Medicine on July 31.
The cohort included 73,070 patients with RA (64,008 [87.6%] men; mean [SD] age, 63.0 [11.9] years) matched with 639,268 patients without RA (554,182 [86.7%] men; mean [SD] age, 61.9 [11.7] years) and 16,109 composite AS outcomes that occurred over 6,223,150 person-years. The AS incidence rate was 3.97 (95% CI, 3.81 to 4.13) per 1,000 person-years in patients with RA and 2.45 (95% CI, 2.41 to 2.49) per 1,000 person-years in the control patients (absolute difference, 1.52 per 1,000 person-years). RA was associated with an increased risk of composite AS (adjusted hazard ratio [AHR], 1.48; 95% CI, 1.41 to 1.55), aortic valve intervention (AHR, 1.34; 95% CI, 1.22 to 1.48), and AS-related death (AHR, 1.26; 95% CI, 1.04 to 1.54).
The researchers noted that the results were limited by including mostly men when RA is more common in women and they wrote that future studies are needed to confirm whether valvular heart disease, specifically AS, may be an overlooked cardiovascular disease complication in RA.
“The findings from the present study emphasize that valvular heart disease may be an underrecognized contributor to the persistent [cardiovascular disease]-related mortality gap in RA, particularly given the lack of improvement in AS-specific risk over time,” the authors wrote.