Rheumatoid arthritis increases the risk of aortic stenosis: U.S. study

U.S. veterans with rheumatoid arthritis (RA) have a 50% increased risk of developing aortic stenosis, compared to the rest of this population, says a study published in JAMA Internal Medicine.“This is a significant difference,” said Dr. Tate Johnson, rheumatologist and assistant professor at the University of Nebraska Medical Center and co-author of the study.Stenosis is the narrowing of the aortic valves that allows blood to pass from the left ventricle into the aorta. “It becomes more difficult for the heart to pump blood through this barrier, and when that happens, patients develop shortness of breath, chest pain, and exercise intolerance,” said Dr. Johnson. The most severe stages of stenosis can lead to death, especially when the disease becomes symptomatic, he noted.Read: 'It drives me nuts!' Women undertreated for aortic stenosisIn total, the health history of 73,070 patients living with rheumatoid arthritis between 2000 and 2019 was compared to that of 639,268 unaffected people. The study data came from the United States Veterans Affairs health system and was cross-referenced with that of the Medicaid program.The Department of Veterans Affairs and the Department of Defense funded the study. The authors also reported ties to pharmaceutical companies and medical device manufacturers.A neglected riskOther cardiovascular disorders have already been associated with RA, such as stroke, heart attacks or arterial atherosclerosis, but aortic stenosis had flown under the radar of researchers. According to Dr. Johnson, valvular heart disease hasn't received enough attention. This could be explained by the lower frequency of aortic stenosis in patients living with rheumatoid arthritis, compared to heart attacks and strokes.The presence of inflammatory lesions around the aortic valves or even nodules at this location in patients living with rheumatoid arthritis had already been observed, recalls the researcher. “Our hypothesis is that aortic stenosis has been more neglected and therefore not studied significantly, at least in the context of a large-scale epidemiological study,” said Dr. Johnson.Despite the presence of a statistical association, the research team was nevertheless unable to precisely determine the causal mechanisms behind this higher risk of aortic stenosis. Further research will be necessary, but Dr. Johnson nevertheless offers some possible explanations.“Patients with a higher degree of systemic inflammation . . . were at higher risk of developing aortic stenosis, as were patients requiring more aggressive immunosuppressive therapy,” he said.The importance of preventionAortic stenosis constitutes a burden, both for society because of the cost of replacing aortic valves, and for patients, who can suffer from major disabilities, said Dr. Johnson.The researcher is convinced that it is only by targeting all avenues for improvement that it will be possible to extend the life expectancy of people living with rheumatoid arthritis. Patients and doctors must therefore be aware of the cardiovascular risks linked to this disease, including aortic stenosis, to adapt treatments accordingly.When a patient with RA also has cardiorespiratory symptoms, or a weakened health condition, it would be wise for healthcare professionals to consider the risk of aortic stenosis. In these situations, careful cardiac auscultation is necessary to determine whether an echocardiogram is appropriate, said Dr. Johnson, who hopes that future research will establish methods to detect aortic stenoses as early as possible.The researcher also noted that it would be beneficial if these results were validated among populations other than veterans, because this includes a disproportionate number of men, while rheumatoid arthritis affects women up to 70% to 80% more often.Read: Could initiating bridging therapy for early rheumatoid arthritis be worth it?

Rheumatoid arthritis increases the risk of aortic stenosis: U.S. study

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