Prevalence, risk factors and proteomic bioprofiles associated with heart failure in rheumatoid arthritis: The RA-HF study
2020; Elsevier BV; Volume: 85; Linguagem: Inglês
10.1016/j.ejim.2020.11.002
ISSN1879-0828
AutoresB Ferreira, Tomás Fonseca, Rita Quelhas Costa, António Marinhoc, Henrique Carvalho, José Carlos Oliveira, Faı̈ez Zannad, Patrick Rossignol, Jacques‐Eric Gottenberg, Francisca Saraiva, Patrícia Rodrigues, António S. Barros, João Pedro Ferreira,
Tópico(s)Heart Failure Treatment and Management
ResumoBackgroundRheumatoid arthritis (RA) patients have high risk of heart failure (HF).AimsIdentifying the risk factors and mechanistic pathways associated with HF in patients with RA.MethodsCohort study enrolling 355 RA patients. HF was defined according to the ESC criteria. 93 circulating protein-biomarkers (91CVDIIOlink®+troponin-T+c-reactive protein) were measured. Regression modeling (multivariate and multivariable) were built and network analyses were performed - based on the identified relevant protein biomarkers.Results115 (32.4%) patients fulfilled the ESC criteria for HF, but only 24 (6.8%) had a prior HF diagnosis. Patients with HF were older (67 vs. 55yr), had a longer RA duration (10 vs. 14yr), had more frequently diabetes, hypertension, obesity, dyslipidemia, atrial fibrillation, and ischemic arterial disease. Several protein-biomarkers remained independently associated with HF, the top (FDR1%) were adrenomedullin, placenta-growth-factor, TNF-receptor-11A, and angiotensin-converting-enzyme-2. The networks underlying the expression of these biomarkers pointed towards congestion, apoptosis, inflammation, immune system signaling and RAAS activation as central determinants of HF in RA. Similar HF-associated biomarker-pathways were externally found in patients without RA. Having RA plus HF increased the risk of cardiovascular events compared to RA patients without RF; adjusted-HR (95%CI)=2.37 (1.07-5.30), p=0.034ConclusionAge, cardiovascular risk factors, and RA duration increase the HF odds in patients with RA. Few RA patients had a correct prior HF diagnosis, but the presence of HF increased the patients` risk. RA patients with HF largely share the mechanistic pathways of HF patients without RA. Randomized HF trials should include patients with RA.ClinicalTrials.gov IDNCT03960515
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