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Aortic Stenosis Risk in Rheumatoid Arthritis
Quick Takes
- Patients with rheumatoid arthritis (RA) had an absolute risk increase of 1.52 composite aortic stenosis (AS) events/1,000 person-years compared with patients without RA.
- Patients with RA also had a higher risk for aortic valve replacement and AS-related death.
- A careful physical examination including cardiac auscultation should be part of a routine clinical assessment in patients with RA to identify AS.
Study Questions:
What is the risk of incident aortic stenosis (AS), aortic valve intervention, AS-related death, and risk factors for AS development in patients with rheumatoid arthritis (RA)?
Methods:
The investigators conducted a cohort study and linked data from the Veterans Health Administration (VHA) and Centers for Medicare & Medicaid Services from 2000 to 2019. Patients with RA were matched by age, sex, and VHA enrollment year with up to 10 patients without RA. The cohort was followed until incident AS, aortic valve intervention, or death. Data were analyzed from August 23, 2022, to March 3, 2023. The primary outcome was incident AS, defined as a composite of inpatient or outpatient AS diagnosis, aortic valve intervention, or AS-related death. Secondary outcomes were the individual aortic valve interventions and AS-related death outcomes. Risk of AS development was assessed with multivariable Cox proportional hazards models adjusted for race, ethnicity, smoking status, body mass index, rurality, comorbidities, and health care use.
Results:
The cohort included 73,070 patients with RA (64,008 [87.6%] males; mean [SD] age, 63.0 [11.9] years) matched with 639,268 patients without RA (554,182 [86.7%] males; 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% confidence interval [CI], 3.81-4.13) per 1,000 person-years in patients with RA and 2.45 (95% CI, 2.41-2.49) 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, 1.41-1.55), aortic valve intervention (AHR, 1.34; 95% CI, 1.22-1.48), and AS-related death (AHR, 1.26; 95% CI, 1.04-1.54).
Conclusions:
The authors report that RA was associated with a higher risk of developing AS and the subsequent risks of undergoing aortic valve intervention and suffering from AS-related death.
Perspective:
This large, national cohort study reports that patients with RA had an absolute risk increase of 1.52 composite AS events/1,000 person-years compared with patients without RA. Furthermore, patients with RA also had a higher risk for aortic valve replacement and AS-related death. Overall, these data suggest that valvular heart disease, specifically AS, may be a cardiovascular disease complication in RA. A careful physical examination including cardiac auscultation should be part of a routine clinical assessment in patients with RA to identify AS.
Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Prevention, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and Arrhythmias, Cardiac Surgery and VHD, Interventions and Structural Heart Disease
Keywords: Aortic Valve Stenosis, Arthritis, Rheumatoid, Auscultation, Heart Auscultation, Heart Valve Diseases, Inpatients, Outpatients, Rheumatology, Risk Factors, Secondary Prevention, Transcatheter Aortic Valve Replacement, Veterans
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