Rheumatoid Arthritis Patients Have Double The Risk Of Heart Failure

Mayo Clinic researchers have found that rheumatoid arthritis patients have twice the risk of heart failure, or a
weakening of the heart's ability to pump blood, as those without rheumatoid arthritis, according to a new study to be
published in the February edition of the journal Arthritis & Rheumatism???.rheumatology. About one-third of the rheumatoid arthritis patients studied developed heart failure
over 30 years of the disease.


"We decided to undertake this study because we knew that patients with rheumatoid arthritis die earlier than the general
population, and mostly from heart disease," says Paulo Nicola, M.D., Mayo Clinic research fellow in the Department of Health
Sciences Research and study author. "We thought heart failure could be a reason for early mortality in these patients.
However, we were not expecting that the incidence of heart failure would be so high."


The study found that patients with rheumatoid arthritis are at an increased risk for heart failure soon after the onset of
arthritis and that this elevated risk follows them throughout the course of the arthritis, a chronic disease. The researchers
also found that the factors putting them at this increased risk for heart failure seem to be unrelated to heart attacks and
to the traditional cardiovascular risk factors: diabetes; alcohol abuse; and elevated cholesterol, blood pressure and body
mass index. The source of the increased risk remains a mystery, however.


"We expected heart attacks and traditional cardiac risk factors to contribute to the increased risk of heart failure in
rheumatoid arthritis patients, but they did not," says Dr. Nicola. "This suggests another mechanism is at work. We suspect
that it has something to do with the underlying inflammation that occurs in people with rheumatoid arthritis. Another
possibility is that patients with rheumatoid arthritis are particularly vulnerable to develop heart disease through a
mechanism that we don't yet understand. These observations may also suggest the potential presence of a common susceptibility
for developing rheumatoid arthritis or cardiac heart failure, or a shared origination of these diseases."


The study's researchers also noted little difference between rates of heart failure in men and women with rheumatoid
arthritis.


"This is quite different from what you'd find in the general population, where rates of heart failure are significantly
higher among men than in women," says Dr. Nicola. "This suggests that whatever protects women from heart failure compared
with men in the general population is not the same in patients with rheumatoid arthritis."















Heart failure is a serious disease, according to Dr. Nicola, causing a survival as short as most cancers. He indicates that
in the general population, about one-half of heart failure patients die within three to five years.


At present, the study investigators cannot prescribe preventive measures for rheumatoid arthritis patients to take in order
to avoid heart failure; they suggest that this is a subject for further study. The Mayo researchers also are conducting
studies to find out which rheumatoid arthritis patients are at highest risk for heart failure and to identify whether
arthritis medications are protective or contributors to heart failure.


In the meantime, Dr. Nicola says, "Patients with rheumatoid arthritis should be vigilant regarding reducing their traditional
cardiac risk factors. Their physicians should have a high degree of suspicion of heart failure -- for example, they should be
suspicious when rheumatoid arthritis patients relate that they are more tired than normal."


The Mayo Clinic study utilized the resources of the Rochester Epidemiology Project, mayoresearch.mayo/mayo/research/rep, which
allowed the researchers to study a broad spectrum of individuals from the Rochester, Minn., area with all ranges of
rheumatoid arthritis severity. The arthritis patients' experiences were measured against other study subjects who did not
have rheumatoid arthritis but who matched the arthritis patients in age and gender. The arthritis patients were initially
diagnosed between 1955 and 1995, and all individuals in the study were followed until death, heart failure, moving from
Rochester, or Jan. 1, 2001. The researchers found that rheumatoid arthritis increased an individual's risk of heart failure
1.9 times the risk of those without the disease.


This study's senior investigator is Sherine Gabriel, M.D., Mayo Clinic rheumatologist, epidemiologist and chair of the
Department of Health Sciences Research. Other Mayo Clinic study collaborators include: Hilal Maradit Kremers, M.D.; Veronique
Roger, M.D., Steven Jacobsen, M.D., Ph.D.; Cynthia Crowson; and Karla Ballman, Ph.D.


The paper detailing these findings is entitled, "The Risk of Congestive Heart Failure in Rheumatoid Arthritis: A
Population-Based Study Over 46 Years."


Note for reporters: As the subjects in which the present analysis was conducted 1) have no direct patient relationship with
the investigators and 2) participated in this study under strict confidentiality agreements, the participants are not
available for news media interviews. The lead investigator, Dr. Gabriel, is available to speak to news media.


To obtain the latest news releases from Mayo Clinic, go to mayoclinic/news. MayoClinic (mayoclinic) is available as a resource for your health stories.


Lisa Lucier - newsbureaumayo

Mayo Clinic