title: The influence of rheumatoid arthritis disease characteristics on heart failure.
abstract: OBJECTIVE
  To examine the influence of rheumatoid arthritis (RA) characteristics and antirheumatic medications on the risk of heart failure (HF) in patients with RA.
  
  
  METHODS
  A population-based incidence cohort of RA patients aged ≥ 18 years (1987 American College of Rheumatology criteria first met between January 1, 1980, and January 1, 2008) with no history of HF was followed until onset of HF (defined by Framingham criteria), death, or January 1, 2008. We collected data on RA characteristics, antirheumatic medications, and cardiovascular (CV) risk factors. Cox models adjusting for age, sex, and calendar year were used to analyze the data.
  
  
  RESULTS
  The study included 795 RA patients [mean age 55.3 yrs, 69% women, 66% rheumatoid factor (RF)-positive]. During the mean followup of 9.7 years, 92 patients developed HF. The risk of HF was associated with RF positivity (HR 1.6, 95% CI 1.0, 2.5), erythrocyte sedimentation rate (ESR) at RA incidence (HR 1.6, 95% CI 1.2, 2.0), repeatedly high ESR (HR 2.1, 95% CI 1.2, 3.5), severe extraarticular manifestations (HR 3.1, 95% CI 1.9, 5.1), and corticosteroid use (HR 2.0, 95% CI 1.3, 3.2), adjusting for CV risk factors and coronary heart disease (CHD). Methotrexate users were half as likely to have HF as nonusers (HR 0.5, 95% CI 0.3, 0.9).
  
  
  CONCLUSIONS
  Several RA characteristics and the use of corticosteroids were associated with HF, with adjustment for CV risk factors and CHD. Methotrexate use appeared to be protective against HF. These findings suggest an independent effect of RA on HF that may be further modified by antirheumatic treatment.
authors.affiliation: Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Elena
authors.initials: E
authors.lastname: Myasoedova
authors.forename: Cynthia S
authors.initials: CS
authors.lastname: Crowson
authors.forename: Paulo J
authors.initials: PJ
authors.lastname: Nicola
authors.forename: Hilal
authors.initials: H
authors.lastname: Maradit-Kremers
authors.forename: John M
authors.initials: JM
authors.lastname: Davis
authors.forename: Véronique L
authors.initials: VL
authors.lastname: Roger
authors.forename: Terry M
authors.initials: TM
authors.lastname: Therneau
authors.forename: Sherine E
authors.initials: SE
authors.lastname: Gabriel
mesh_terms: D000305:Adrenal Cortex Hormones / Q000009:adverse effects / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000009:adverse effects / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy*; D015331:Cohort Studies; D005260:Female; D006333:Heart Failure / Q000209:etiology*; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D018501:Antirheumatic Agents; D008727:Methotrexate