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Differential Associations of Chronic Inflammatory Diseases With Incident Heart Failure

Author

ACC Heart Fail. 2020 Apr 6;S2213-1779(20)30014-7.doi: 10.1016/j.jchf.2019.11.013.Online ahead of print.

Sameer Prasada 1, Adovich Rivera 1, Arvind Nishtala 2, Anna E Pawlowski 3, Arjun Sinha 2, Joshua D Bundy 4, Simran A Chadha 1, Faraz S Ahmad 5, Sadiya S Khan 5, Chad Achenbach 6, Frank J Palella Jr 7, Rosalind Ramsey-Goldman 8, Yvonne C Lee 8, Jonathan I Silverberg 9, Babafemi O Taiwo 7, Sanjiv J Shah 2, Donald M Lloyd-Jones 5, Matthew J Feinstein 10

Author Information

1 Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

2 Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

3 Northwestern Medicine Enterprise Data Warehouse, Northwestern University, Chicago, Illinois.

4 Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.

5 Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

6 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

7 Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

8 Division of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

9 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Dermatology and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois.

10 Division of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois. Electronic address: matthewjfeinstein@northwestern.edu.

Abstract

Objectives: The purpose of this study was to compare the risks of incident heart failure (HF) among a variety of chronic inflammatory diseases (CIDs) and to determine whether risks varied by severity of inflammation within each CID.

Background: Individuals with CIDs are at elevated risk for cardiovascular diseases, but data are limited regarding risk for HF.

Methods: An electronic health records database from a large urban medical system was examined, comparing individuals with CIDs with frequency-matched controls without CIDs, all of whom were receiving regular outpatient care. Rates of incident HF were determined by using the Kaplan-Meier method and subsequently used multivariate-adjusted proportional hazards models to compare HF risks for each CID. Exploratory analyses determined HF risks by proxy measurement of CID severity.

Results: Of 37,636 patients (n = 18,278 patients with CIDs; and n = 19,358 controls without CIDs) there were 960 incident HF cases over a median of 3.6 years. Risks for incident HF were significantly or borderline significantly elevated for patients with systemic sclerosis (hazard ratio [HR]: 7.26; 95% confidence interval [CI]: 5.72 to 9.21; p < 0.01), systemic lupus erythematosus (HR: 3.15; 95% CI: 2.41 to 4.11; p < 0.01), rheumatoid arthritis (HR: 1.39; 95% CI: 1.13 to 1.71; p < 0.01), and human immunodeficiency virus (HR: 1.28; 95% CI: 0.99 to 1.66; p = 0.06). There was no association between psoriasis or inflammatory bowel disease and incident HF, although patients with those CIDs with higher levels of C-reactive protein had higher risks for HF than controls.

Conclusions: Systemic sclerosis and systemic lupus erythematosus were associated with the highest risks of HF, followed by rheumatoid arthritis and HIV. Measurements of inflammation were associated with HF risk across different CIDs.