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Rose J. Autoimmune Connective Tissue Diseases: Systemic Lupus Erythematosus and Rheumatoid Arthritis. Rheum Dis Clin North Am 2025; 51:347-359. [PMID: 40246444 DOI: 10.1016/j.rdc.2025.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2025]
Abstract
Systemic lupus erythematosus and rheumatoid arthritis are just 2 of several autoimmune connective tissue diseases that are primarily chronic in nature but can present to the emergency department by virtue of an acute exacerbation of disease. Beyond an acute exacerbation of disease, their predilection for invading multiple organ systems lends itself to the potential for patients presenting to the emergency department with either a single or isolated symptom or a myriad of signs and/or symptoms indicative of a degree of disease complexity and severity that warrant timely recognition and resuscitation.
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Affiliation(s)
- Jonathan Rose
- Department of Emergency Medicine, Memorial Healthcare System, Memorial Hospital West, 703 N Flamingo Road, Pembroke Pines, FL 33028, USA.
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Yao H, Chen J, Li X, Zhang X. Relationship between epicardial adipose tissue volume and atrial fibrillation in patients with rheumatoid arthritis. Front Cardiovasc Med 2025; 12:1508025. [PMID: 40271125 PMCID: PMC12014581 DOI: 10.3389/fcvm.2025.1508025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2024] [Accepted: 03/19/2025] [Indexed: 04/25/2025] Open
Abstract
Introduction Epicardial adipose tissue (EAT) is involved in cardiac inflammatory responses and has been associated with both atrial fibrillation (AF) and rheumatoid arthritis (RA). However, the condition of EAT in patients with both RA and AF is still unclear. In addition, the risks of stroke and bleeding in patients with both RA and AF are unknown. Methods A retrospective analysis was conducted in patients with RA aged ≥18 years from August 2021 to May 2023, and compared with age- and gender-matched patients without RA. The volume of EAT was measured using chest computed tomography and the EAT/body mass index (BMI) ratio was used to correct for the possible impact of BMI differences. The stroke and bleeding risks of the patients were assessed using the CHA2DS2-VASc or HAS-BLED scores. Results A total of 145 patients with RA and 282 patients without RA were included. The volume of EAT or EAT/BMI ratio was similar between the patients with RA and no AF and those without both RA and AF. Compared to the patients without AF, those with AF had a larger EAT volume or EAT/BMI ratio, regardless of whether they had RA or not. EAT/BMI ratio was significantly associated with left atrial (LA) diameter among the patients with RA (RR = 2.23, P < 0.001) but not among the patients without RA (P < 0.954). The RA groups had larger LA-EAT volume (31.53 ± 11.02 mm3 vs. 22.56 ± 9.58 mm3, p < 0.001) and LA-EAT/Total EAT ratio (23.02% ± 3.62% vs. 18.74 ± 3.38 mm3, p < 0.001) than that in non-RA groups. In addition, the proportion of patients with high stroke risk scores was higher among the patients with both RA and AF compared to those without RA but with AF (90.90% vs. 72.00% in men; 84.78% vs. 71.11% in women), while the proportion of patients with high bleeding risk scores was lower (22.06% vs. 27.85%). Conclusion LA diameter correlates with the EAT/BMI ratio in patients with RA who exhibit larger LA-EAT volume and LA-EAT/total EAT ratios compared to individuals without RA.
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Affiliation(s)
- Hao Yao
- Heart Center, Department of Cardiovascular Medicine, Zhejiang Provincial People’s Hospital (Affiliated People’s Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China
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Di Napoli R, Richez C, Scavone C, Singier A, Demourgues M, Mascolo A, Capuano A, Salvo F. Major Adverse Cardiovascular Events Related to JAK Inhibitors: A Disproportionality Analysis Using the WHO Global Individual Case Safety Database. Drug Saf 2025:10.1007/s40264-025-01535-8. [PMID: 40121611 DOI: 10.1007/s40264-025-01535-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/17/2025] [Indexed: 03/25/2025]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is commonly treated with Janus kinase inhibitors (JAKis) and anti-tumor necrosis factor-α (anti-TNFα), but the cardiovascular safety profiles of these drugs remain unclear. OBJECTIVE The aim of this study was to describe the individual case safety reports of major adverse cardiac events (MACE) or stroke and to determine whether there was a difference in the frequency of reporting of cardiovascular events between JAKis and anti-TNFα used in RA. METHODS A case/non-case study was conducted using the WHO VigiBase® database. Descriptive analysis was performed, the time to onset (TTO) of MACE was calculated, and the reporting odds ratio (ROR) was used to estimate the frequency of MACE reports associated with JAKis versus anti-TNFα in RA. RESULTS A total of 18,099 cases of MACE were identified, of which 2543 (14%) were associated with JAKis, predominantly in women (65.4%) and in patients aged ≥65 years (49.9%). The median time to onset was 210 days (IQR 60-510) for JAKis and 690 days (210-1460) for anti-TNFα. JAKis were associated with higher odds of reporting MACE (ROR 1.38 [95% CI 1.32-1.44]), mainly due to non-fatal stroke (1.65 [1.55-1.75]). Stroke as a whole showed similar results (1.62 [1.53-1.72]). The ROR of MACE was also slightly increased in patients aged <65 years treated with JAKis (1.29 [1.21-1.39]). CONCLUSIONS Compared with anti-TNFα, JAKis were more associated with MACE, especially stroke, and with a shorter time to onset. These data support the hypothesis of a different cardiovascular reporting frequency between JAKis and anti-TNFα. In patients with identified cardiovascular risk, anti-TNFα should be preferred to JAKis until more definitive results are available.
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Affiliation(s)
- Raffaella Di Napoli
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy.
- Department of Experimental Medicine-Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy.
- Université de Bordeaux, INSERM, Bordeaux Population Health, U1219, AHeaD Team, 33000, Bordeaux, France.
| | - Christophe Richez
- Service de Rhumatologie, Centre de référence des maladies auto-immunes systémiques rares RESO, Hôpital Pellegrin, Centre Hospitalier Universitaire, Bordeaux, France
- CNRS-UMR 5164, ImmunoConcept, Université de Bordeaux, Bordeaux, France
| | - Cristina Scavone
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
- Department of Experimental Medicine-Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Life Science, Health, and Health Professions, Link Campus University, Rome, Italy
| | - Allison Singier
- Université de Bordeaux, INSERM, Bordeaux Population Health, U1219, AHeaD Team, 33000, Bordeaux, France
| | - Maxime Demourgues
- CHU de Bordeaux, Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance Bordeaux-DROM, 33000, Bordeaux, France
| | - Annamaria Mascolo
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
- Department of Experimental Medicine-Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
- Department of Life Science, Health, and Health Professions, Link Campus University, Rome, Italy
| | - Annalisa Capuano
- Campania Regional Centre for Pharmacovigilance and Pharmacoepidemiology, Department of Experimental Medicine, Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Via Costantinopoli 16, 80138, Naples, Italy
- Department of Experimental Medicine-Section of Pharmacology "L. Donatelli", University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Francesco Salvo
- Université de Bordeaux, INSERM, Bordeaux Population Health, U1219, AHeaD Team, 33000, Bordeaux, France
- CHU de Bordeaux, Service de Pharmacologie Médicale, Centre Régional de Pharmacovigilance Bordeaux-DROM, 33000, Bordeaux, France
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Xie X, Wei G, Tang Z, Chen H, Lin X, Huang C, Yu H, He Y, Li M, Zhang X, He C, He Y, Chen J. Investigating the causal relationship between rheumatoid arthritis and cardiovascular disease: A Mendelian randomization study. Clin Rheumatol 2025; 44:1057-1067. [PMID: 39909965 DOI: 10.1007/s10067-025-07357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 01/13/2025] [Accepted: 01/18/2025] [Indexed: 02/07/2025]
Abstract
OBJECTIVE Previous research has revealed a positive correlation between rheumatoid arthritis (RA) and cardiovascular diseases, but the causal relationship is unclear. This study applies Mendelian randomization to examine whether RA causally contributes to the likelihood of various cardiovascular diseases, such as heart failure, coronary artery disease, and atrial fibrillation. METHODS Using genome-wide association data, we conducted a univariable MR (UVMR) analysis to evaluate the causal impact of RA on CVD, primarily utilizing the inverse variance weighted method. Additional MR methods were used to test the robustness of the results. Multivariable MR (MVMR) was applied to explore potential confounders. RESULTS In the European population, genetically predicted RA had a harmful causal effect on HF, with the IVW analysis indicating an OR of 1.06 (95% CI: 1.02-1.10, P < 0.01) based on 23 SNPs. No causal relationships were found between RA and other CVDs. The MVMR analysis did not identify significant causal impact of rheumatoid arthritis on HF after controlling for traditional risk factors. In the Asian population, RA was associated with an adverse effect on AF, with the IVW method reporting an OR of 1.20 (95% CI: 1.01-1.41, P = 0.03) for 5 SNPs. No other CVD relationships were found. CONCLUSIONS Our MR analysis indicates that genetic susceptibility to rheumatoid arthritis increases the likelihood of heart failure in European populations and atrial fibrillation in East Asian populations. However, established CVD risk factors, such as smoking, overweight, and physical inactivity, remain critically important in the management of RA. Key Points • Multiple studies have highlighted a marked increase in the cardiovascular event risk among individuals with RA. However, additional RCTs are needed for confirmation. • We applied Mendelian randomization to explore the potential causal relationship between rheumatoid arthritis and cardiovascular conditions. The findings demonstrated a causal link between RA and heart failure among European populations, as well as an association between RA and atrial fibrillation in East Asian groups. • Further adjustments using multivariable Mendelian randomization to account for the influence of traditional cardiovascular risk factors revealed that the causal association between RA and heart failure disappeared.
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Affiliation(s)
- Xintong Xie
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Guangliang Wei
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Zhenboyang Tang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Huidong Chen
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Xiru Lin
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Chunyan Huang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Hao Yu
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Youxian He
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Mengxiang Li
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Xue Zhang
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Chengsong He
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China
| | - Yue He
- Department of Ophthalmology, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Jie Chen
- Department of Rheumatology and Immunology, The Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Jiangyang District, Luzhou, 646000, People's Republic of China.
- Stem Cell Immunity and Regeneration Key Laboratory of Luzhou, Luzhou, People's Republic of China.
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Alpizar-Rodriguez D, Martinez-Martinez MU. Rheumatoid arthritis and atrial fibrillation: bridging the gap in ischaemic stroke prevention. Rheumatology (Oxford) 2025; 64:391-392. [PMID: 39388248 DOI: 10.1093/rheumatology/keae548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2024] [Accepted: 09/25/2024] [Indexed: 10/15/2024] Open
Affiliation(s)
| | - Marco U Martinez-Martinez
- Internal Medicine, Hospital General de Subzona No. 9, Instituto Mexicano del Seguro Social, San Luis Potosi, Mexico
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Zheng E, Warchoł I, Mejza M, Możdżan M, Strzemińska M, Bajer A, Madura P, Żak J, Plewka M. Exploring Anti-Inflammatory Treatment as Upstream Therapy in the Management of Atrial Fibrillation. J Clin Med 2025; 14:882. [PMID: 39941553 PMCID: PMC11818443 DOI: 10.3390/jcm14030882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2024] [Revised: 01/05/2025] [Accepted: 01/14/2025] [Indexed: 02/16/2025] Open
Abstract
Inflammation has been widely recognized as one of the major pathophysiological drivers of the development of atrial fibrillation (AF), which works in tandem with other risk factors of AF including obesity, diabetes, hypertension, and heart failure (HF). Our current understanding of the role of inflammation in the natural history of AF remains elusive; however, several key players, including the NLRP3 (NLR family pyrin domain containing 3) inflammasome, have been acknowledged to be heavily influential on chronic inflammation in the atrial myocardium, which leads to fibrosis and eventual degradation of its electrical function. Nevertheless, our current methods of pharmacological modalities with reported immunomodulatory properties, including well-established classes of drugs e.g., drugs targeting the renin-angiotensin-aldosterone system (RAAS), statins, and vitamin D, have proven effective in reducing the overall risk of developing AF, the onset of postoperative atrial fibrillation (POAF), and reducing overall mortality among patients with AF. This might bring hope for further progress in developing new treatment modalities targeting cellular checkpoints of the NLRP3 inflammasome pathway, or revisiting other well-known anti-inflammatory drugs e.g., colchicine, vitamin C, nonsteroidal anti-inflammatory drugs (NSAIDs), glucocorticosteroids, and antimalarial drugs. In our review, we aim to find relevant upstream anti-inflammatory treatment methods for the management of AF and present the most current real-world evidence of their clinical utility.
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Hasan A, Zaidi SM, Zaveri S, Taklalsingh N, Zonnoor SL, Casillas-Gonzalez J, Chandrakumar H, Tadayoni A, Sharif S, Connelly C, Soleiman A, Sezhian T, Sreedhara K, Tsui CL, Prysyazhnyuk Y, Gruenstein D, Melamed A, Oleszak F, Axman R, Beltre D, Kazi A, Patwari F, Tsai A, Freilich M, Corominas A, Koci K, Siddique O, Marder R, Kirou R, McFarlane IM. Cardiovascular Risk Factors and Echocardiographic Findings in a Predominantly Black Population With Rheumatoid Arthritis and Heart Failure. Crit Pathw Cardiol 2024; 23:183-188. [PMID: 38843030 DOI: 10.1097/hpc.0000000000000365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2025]
Abstract
Among white rheumatoid arthritis (RA) cohorts, heart failure with preserved ejection fraction is the most prevalent type of heart failure (HF). We aimed to assess the type of HF affecting Black RA patients. A total of 64 patients with RA-HF were compared with age-, sex-, and race-matched RA patients without HF. Left ventricular ejection fraction, wall motion abnormalities, left ventricle (LV) mass, and wall thickness were reviewed. About 87.3% were Black and 84.4% were women, with a mean age of 69.6 ± 1.38 (± SEM) and body mass index (kg/m 2 ) of 29.6 ± 1.07. RA-HF patients had higher rates of hypertension (HTN), chronic kidney disease, and atrial fibrillation. However, 66.7% had ≥3 cardiovascular risk factors compared with RA patients without HF. 2D echocardiograms of RA-HF revealed that 62.3% had left ventricular ejection fraction ≥50%, 37% had diastolic dysfunction, and 43.1% had wall motion abnormalities. LV mass and relative wall thickness measurements indicated LV eccentric remodeling. The odds ratio for HF was 4.7 (CI, 1.5-14.53), P < 0.01, among the RA-HTN group and 3.5 (CI, 1.091-11.7) P < 0.01 among smokers. In our predominantly Black RA-HF patients, heart failure with preserved ejection fraction was the most common type of HF. HTN was associated with the highest OR for HF. Eccentric hypertrophic remodeling, a known poor prognostic indicator for cardiovascular events, was found. Further studies are required to confirm our findings.
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Affiliation(s)
- Abida Hasan
- From the Department of Rheumatology, UCSF at Fresno, Fresno, CA
| | - Seyed M Zaidi
- Department of Cardiology, UCSF at Fresno, Fresno, CA
| | - Sahil Zaveri
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Nicholas Taklalsingh
- Department of Cardiology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Seyedeh L Zonnoor
- Department of Rheumatology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | | | | | - Ashkan Tadayoni
- Department of Cardiology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Sara Sharif
- Department of Rheumatology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Courtney Connelly
- Department of Pathology, NYP Hospital-Columbia University Medical Center, New York, NY
| | - Aron Soleiman
- Department of Medicine, Montefiore Medical Center: Einstein Campus, Bronx, NY
| | - Thiagarajan Sezhian
- Department of Medicine, Montefiore Medical Center: Einstein Campus, Bronx, NY
| | - Karthik Sreedhara
- Division of Hospital Medicine, University of Pennsylvania, Philadelphia, PA
| | - Cindy L Tsui
- Department of Medicine, NYU Grossman New York, NY
| | | | | | - Adiell Melamed
- Department of Anesthesiology, Rutgers Robert Wood Johnson Medical Center, New Brunswick, NJ
| | - Filip Oleszak
- Division of Cardiology, Sanford School of Medicine University of South Dakota, Sioux Falls, SD
| | - Rachel Axman
- Department of Medicine, New York-Presbyterian/Weill Cornell Medical Center, New York, NY
| | - Daniel Beltre
- Department of Surgery, Brown University, Providence, RI
| | - Anan Kazi
- Department of Medicine, University of Rochester/Strong Memorial, Rochester, NY
| | - Fahmida Patwari
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrew Tsai
- Department of Medicine, Zucker Northwell NS/LIJ - NY Hempstead, NY
| | - Michael Freilich
- Department of Medicine, Montefiore Medical Center: Einstein Campus, Bronx, NY
| | - Anny Corominas
- Department of Rheumatology, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Kristaq Koci
- Department of Rheumatology, Icahn School of Medicine at Mount Sinai Morningside/Mount Sinai West, New York, NY
| | - Omar Siddique
- Department of Internal Medicine, NYC H+H/South Brooklyn Health, Brooklyn, NY
| | - Ryan Marder
- Department of Orthopedic Surgery, St. Joseph's University Medical Center, Paterson, NJ
| | - Raphael Kirou
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
| | - Isabel M McFarlane
- Department of Medicine, SUNY Downstate Health Sciences University, Brooklyn, NY
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Kerola AM, Ikdahl E, Engebretsen I, Bugge C, Semb AG. Rheumatoid arthritis and the risk of ischaemic stroke after diagnosis of atrial fibrillation: a Norwegian nationwide register study. Rheumatology (Oxford) 2024; 63:2997-3005. [PMID: 39171836 PMCID: PMC11534115 DOI: 10.1093/rheumatology/keae458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/03/2024] [Accepted: 07/26/2024] [Indexed: 08/23/2024] Open
Abstract
OBJECTIVES RA patients have an increased risk for cardiovascular diseases, including atrial fibrillation (AF), but the impact of RA on ischaemic stroke risk in the context of AF remains unknown. We explored whether the risk of ischaemic stroke after diagnosis of AF is further increased among patients with RA compared with non-RA patients. METHODS In the nationwide Norwegian Cardio-Rheuma Register, we evaluated cumulative incidence and hazard rate of ischaemic stroke after the first AF diagnosis (2750 individuals with RA and 158 879 without RA between 2010 and 2017) by using a competing risk model with a 3-month delayed entry. RESULTS The 5-year unadjusted cumulative incidence of ischaemic stroke was 7.3% (95% CI: 5.9-8.7%) for patients with RA and 5.0% (95% CI: 4.9-5.2%) for patients without RA. Unadjusted univariate analyses indicated that AF patients with RA had a HR of 1.36 (95% CI: 1.13, 1.62) for ischaemic stroke compared with those without RA. Sex- and age-adjusted HR for ischaemic stroke in RA patients with AF was 1.25 (95% CI: 1.05, 1.50), and the effect size remained unchanged after adjustment for diabetes, hypertension, atherosclerotic cardiovascular disease and oral anticoagulant (OAC) treatment. RA patients were less likely to receive OAC treatment than non-RA patients (adjusted odds ratio 0.88, 95% CI: 0.80, 0.97). CONCLUSION RA patients diagnosed with AF are at a further increased risk for stroke compared with non-RA patients with AF, and less likely to receive OAC treatment, emphasizing the need to improve stroke prevention in AF patients with RA.
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Affiliation(s)
- Anne M Kerola
- Department of Rheumatology, Inflammation Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Department of Internal Medicine, Päijät-Häme Central Hospital, Lahti, Finland
| | - Eirik Ikdahl
- Department of Rheumatology, REMEDY-Centre for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Section for Research and Innovation, REMEDY-Centre for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway
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Corrao S, Calvo L, Giardina A, Cangemi I, Falcone F, Argano C. Rheumatoid arthritis, cardiometabolic comorbidities, and related conditions: need to take action. Front Med (Lausanne) 2024; 11:1421328. [PMID: 39114820 PMCID: PMC11303151 DOI: 10.3389/fmed.2024.1421328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2024] [Accepted: 07/03/2024] [Indexed: 08/10/2024] Open
Abstract
Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease and mortality, however, traditional cardiovascular risk factors do not fully explain this relationship. This high risk of cardiovascular morbidity and mortality in RA has been increasingly acknowledged in past decades, with accumulating evidence that RA is an independent cardiovascular risk factor; RA is also associated with metabolic syndrome, which correlates with disease activity, contributing to the increased prevalence of coronary heart disease in RA patients. Moreover, multimorbidity, including the presence of long-term conditions, impacts adverse clinical outcomes in RA patients, emphasizing the need for holistic management that requires an understanding of shared pathophysiological mechanisms, such as systemic inflammation and immune dysregulation. For all these reasons, the management of RA patients with cardiometabolic comorbidities is a complex endeavor that requires a patient-centered, multidisciplinary approach. In this sense, there is a need to re-evaluate the approach toward a proactive model of care, moving away from a reactive medical paradigm to a multidimensional integrated management model, including aggressive screening, preventive strategies, and tailored therapeutic interventions. The aim of this review was to thoroughly review the literature on cardiometabolic comorbidities and related conditions linked to RA to enable us to identify the necessary actions required to effectively tackle the increasing burden of illness from a fully comprehensive perspective.
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Affiliation(s)
- Salvatore Corrao
- Department of Clinical Medicine, Internal Medicine Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties [PROMISE], University of Palermo, Palermo, Italy
| | - Luigi Calvo
- Department of Clinical Medicine, Internal Medicine Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Annarita Giardina
- Department of Clinical Medicine, Internal Medicine Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Ignazio Cangemi
- Department of Clinical Medicine, Internal Medicine Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
| | - Fabio Falcone
- Department of Clinical Medicine, Internal Medicine Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
- Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties [PROMISE], University of Palermo, Palermo, Italy
| | - Christiano Argano
- Department of Clinical Medicine, Internal Medicine Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy
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Luo W, Yv H, Yu X, Wu X. Investigating the Causal Link between Rheumatoid Arthritis and Atrial Fibrillation in East Asian Populations: A Mendelian Randomization Approach. Cardiol Res Pract 2024; 2024:3274074. [PMID: 39040846 PMCID: PMC11262875 DOI: 10.1155/2024/3274074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Revised: 06/08/2024] [Accepted: 07/10/2024] [Indexed: 07/24/2024] Open
Abstract
Background Rheumatoid arthritis (RA) has been associated with atrial fibrillation (AF) in observational studies, yet the causal relationship remains elusive. In this study, we employed Mendelian randomization (MR) to investigate the impact of RA on AF risk specifically in East Asian populations. Methods Utilizing genome-wide association study (GWAS) data on RA (n = 212,453) and AF (n = 36,792), we applied the following five MR methods: inverse variance weighted (IVW), MR-RAPS, maximum likelihood, weighted median (WM), and Bayesian weighted Mendelian randomization (BWMR). We evaluated heterogeneity, sensitivity, and pleiotropy. Results Five genetic instrumental variants for RA were identified. All MR methods consistently indicated a causal association between RA and AF (IVW: OR = 1.20, 95% CI: 1.01-1.41, p < 0.03; MR-RAPS: OR = 1.21, 95% CI: 1.03-1.42, p < 0.02; maximum likelihood: OR = 1.20, 95% CI: 1.04-1.39, p < 0.01; WM: OR = 1.25, 95% CI: 1.03-1.52, p < 0.03; and BWMR: OR = 1.20, 95% CI: 1.02-1.42, p < 0.03). Sensitivity and pleiotropy analyses confirmed the robustness and validity of the results. Conclusions This study establishes a causal link between RA and AF in East Asians. Our results underscore the need for in-depth mechanistic investigations to unravel the underlying pathways. Clinicians should consider AF risk in RA management, emphasizing collaborative care between rheumatologists and cardiologists. Moving forward, future research should explore therapeutic interventions and address the shared biological mechanisms.
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Affiliation(s)
- Weijun Luo
- Department of CardiologyLishui People's HospitalThe Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of CardiologyFirst Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
| | - Hui Yv
- Department of CardiologyLishui People's HospitalThe Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of CardiologyFirst Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
| | - Xiao Yu
- Department of CardiologyLishui People's HospitalThe Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of CardiologyFirst Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
| | - Xianjun Wu
- Department of CardiologyLishui People's HospitalThe Sixth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
- Department of CardiologyFirst Affiliated Hospital of Lishui University School of Medicine, Lishui, Zhejiang, China
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11
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AlGhalawin LS, Alomar M, Al Bassam S, AlHamdan AA, Anan H, Altaweel M, Alomran ZA, Al khamis R, Alqatri AI, Alamoudi MM, Alamer A. Incidence Rate of Cardiovascular Events in Rheumatoid Arthritis: An Observational Cohort Study in Saudi Arabia. J Multidiscip Healthc 2024; 17:3357-3370. [PMID: 39045492 PMCID: PMC11264283 DOI: 10.2147/jmdh.s459555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 06/12/2024] [Indexed: 07/25/2024] Open
Abstract
Purpose Rheumatoid arthritis (RA) doubles the morbidity of cardiovascular disease (CVD) and leads to a 50% increase in mortality compared to the general population. This study aims to estimate the CVD incidence among RA patients in Saudi Arabia (SA), vital for assessing CVD burdens within this group. Patients and Methods This retrospective study took place at two centers in the Eastern Province of SA, including all adult RA patients who visited the rheumatology clinic from 2016 to 2021 and were prescribed disease-modifying antirheumatic drugs (DMARDs). CVD incidence was determined by the diagnosis of ischemic heart disease (IHD), stroke/transient ischemic attack (TIA), venous thromboembolism (VTE), heart failure (HF), and arrhythmia post-RA diagnosis. Additional data collected included demographics, CVD risk factors, comorbidities, RA-related factors, and medication usage. Results The study comprised 651 patients, 80.5% of whom were females with an average age of 51. The overall CVD incidence was 11.2 per 1000 person-years, with males experiencing five times more incidents than females. The prevalence of CVD risk factors included 18.7% with hypertension, 7.8% with hyperlipidemia, 18.9% with diabetes, and 42.9% with obesity. Significant predictors of CVD were male gender and RA duration, with adjusted odds ratios (aOR) of 3.17 (95% CI 1.10 to 9.14, P=0.033) and 64.81 (95% CI 3.68 to 1140.6, P=0.004), respectively. Conclusion This unique study from SA examined the CVD incidence in RA patients, identifying long disease duration and male gender as significant predictors. Effective reduction of CVD risk in RA patients requires aggressive management of modifiable risk factors and regular risk assessments.
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Affiliation(s)
- Laila Saleh AlGhalawin
- Pharmaceutical Care Affairs, Dammam Medical Complex, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Mukhtar Alomar
- Pharmaceutical Care Affairs, Dammam Medical Complex, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Shahad Al Bassam
- Department of Pharmacy Practice, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | | | - Hadeel Anan
- Pharmaceutical Care and Formulary Management Affairs, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Marwah Altaweel
- Pharmaceutical Care Affairs, Saud AlBabtain Cardiac Center, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Zainab Abbas Alomran
- Department of Pharmacy Practice, College of Clinical Pharmacy, King Faisal University, Al-Ahsa, Saudi Arabia
| | | | | | - Marwan M Alamoudi
- Rheumatology Department, Dammam Medical Complex, Eastern Health Cluster, Dammam, Saudi Arabia
| | - Ahmad Alamer
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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12
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Xiong T, Krusche M. [Wearables in rheumatology]. Z Rheumatol 2024; 83:234-241. [PMID: 37289217 PMCID: PMC10973074 DOI: 10.1007/s00393-023-01377-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 06/09/2023]
Abstract
As a result of digitalization in medicine wearable computing devices (wearables) are becoming increasingly more important. Wearables are small portable electronic devices with which the user can record data relevant to health, such as number of steps, activity profile, electrocardiogram (ECG), heart and breathing frequency or oxygen saturation. Initial studies on the use of wearables in patients with rheumatological diseases show the opening up of new possibilities for prevention, disease monitoring and treatment. This study provides the current data situation and the implementation of wearables in the discipline of rheumatology. Additionally, future potential fields of application as well as challenges and limits of the implementation of wearables are illustrated.
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Affiliation(s)
- Tingting Xiong
- Sektion für Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland.
| | - Martin Krusche
- Sektion für Rheumatologie und entzündliche Systemerkrankungen, III. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland
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13
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Jaiswal V, Roy P, Ang SP, Shama N, Deb N, Taha AM, Rajak K, Sharma A, Halder A, Wajid Z, Agrawal V, Khela H, Biswas M. Association between rheumatoid arthritis and atrial fibrillation: A systematic review and meta-analysis. J Arrhythm 2024; 40:203-213. [PMID: 38586849 PMCID: PMC10995606 DOI: 10.1002/joa3.12995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 12/26/2023] [Accepted: 01/09/2024] [Indexed: 04/09/2024] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune disorder with a varying range of organs involved leading to adverse outcomes. However, very little is known, with conflicting results about the association between RA and atrial fibrillation (AF). We aim to evaluate the association between RA and AF, and other clinical outcomes. We performed a systematic literature search using PubMed, Embase, and Scopus for relevant articles from inception until September 10, 2023. Primary clinical outcomes were AF. Secondary outcomes were acute coronary syndrome (ACS), stroke, and all-cause mortality (ACM). A total of 4 679 930 patients were included in the analysis, with 81 677 patients in the RA group and 4 493 993 patients in the nonrheumatoid arthritis (NRA) group. The mean age of the patients was 57.2 years. Pooled analysis of primary outcomes shows that RA groups of patients had a significantly higher risk of AF (odds ratios [OR], 1.53; 95% confidence interval [CI]: [1.16-2.03], p < .001) compared with NRA groups. Secondary Outcomes show that the RA group of patients had significantly higher odds of ACS (OR, 1.39; 95% CI: [1.26-1.52], p < .001), and ACM (OR, 1.19; 95% CI: [1.03-1.37], p = .02) compared with the NRA groups. However, the likelihood of stroke (OR, 1.02; 95% CI: [0.94-1.11], p = .61) was comparable between both groups of patients. Our study shows that RA groups of patients are at increased risk of having AF, ACS, and ACM.
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Affiliation(s)
- Vikash Jaiswal
- Department of Cardiovascular ResearchLarkin Community HospitalSouth MiamiFloridaUSA
| | - Poulami Roy
- Department of Internal MedicineNorth Bengal Medical College and HospitalSiliguriIndia
| | - Song Peng Ang
- Department of Internal MedicineRutgers Health/Community Medical CenterToms RiverNew JerseyUSA
| | - Nishat Shama
- Department of Internal MedicineBangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic DisordersDhakaBangladesh
| | - Novonil Deb
- Department of Internal MedicineNorth Bengal Medical College and HospitalSiliguriIndia
| | | | - Kripa Rajak
- Department of Internal MedicineUPMC HarrisburgHarrisburgPennsylvaniaUSA
| | - Akanksha Sharma
- Department of Internal MedicineUPMC MercyPittsburghPennsylvaniaUSA
| | - Anupam Halder
- Department of Internal MedicineUPMC HarrisburgHarrisburgPennsylvaniaUSA
| | - Zarghoona Wajid
- Department of Internal Medicine, School of MedicineWayne State UniversityDetroitMichiganUSA
| | - Vibhor Agrawal
- Department of MedicineKing George's Medical UniversityLucknowIndia
| | - Harpriya Khela
- Department of MedicineRoyal College of Surgeons in IrelandDublinIreland
| | - Monodeep Biswas
- Department of ElectrophysiologyUniversity of MarylandBaltimoreMarylandUSA
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14
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Aaramaa HK, Mars N, Helminen M, Kerola AM, Palomäki A, Eklund KK, Gracia-Tabuenca J, Sinisalo J, FinnGen, Isomäki P. Risk of cardiovascular comorbidities before and after the onset of rheumatic diseases. Semin Arthritis Rheum 2024; 65:152382. [PMID: 38308930 DOI: 10.1016/j.semarthrit.2024.152382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 12/27/2023] [Accepted: 01/09/2024] [Indexed: 02/05/2024]
Abstract
OBJECTIVES To elucidate the risk and temporal relationship of cardiovascular (CV) comorbidities in rheumatic diseases. METHODS Patients in the FinnGen study diagnosed between 2000 and 2014 with seropositive (n = 2368) or seronegative (n = 916) rheumatoid arthritis (RA), ankylosing spondylitis (AS, n = 715), psoriatic arthritis (PsA, n = 923), systemic lupus erythematosus (SLE, n = 190), primary Sjogren's syndrome (pSS, n = 412) or gout (n = 2034) were identified from healthcare registries. Each patient was matched based on age, sex, and birth region with twenty controls without any rheumatic conditions. Overall risk ratios (RR) were calculated by comparing the prevalence of seven CV diseases between patients and controls. Logistic regression models were used for estimating odds ratios (OR) for CV comorbidities before and after the onset of rheumatic diseases. RESULTS The RR for 'any CVD' varied from 1.14 (95 % confidence interval [CI] 1.02-1.26) in PsA to 2.05 (95 % CI 1.67-2.52) in SLE. Patients with SLE or gout demonstrated over two-fold risks for several CV comorbidities. Among CV comorbidities, venous thromboembolism (VTE) showed the highest effect sizes in several rheumatic diseases. The ORs for CV comorbidities were highest within one year before and/or after the onset of the rheumatic disease. However, in gout the excess risk of CV disease was especially high before gout diagnosis. CONCLUSIONS The risk of CV comorbidities was elevated in all studied rheumatic diseases, with highest risks observed in SLE and gout. The risk for CV diseases was highest immediately before and/or after rheumatic disease diagnosis, highlighting the increased risk for CV comorbidities across all rheumatic diseases very early on the disease course.
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Affiliation(s)
- Hanna-Kaisa Aaramaa
- Centre for Rheumatic Diseases, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland.
| | - Nina Mars
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland; Broad Institute of MIT and Harvard, 415 Main St, Cambridge, MA 02142, USA
| | - Mika Helminen
- Tays Research Services, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland; Faculty of Social Sciences, Health Sciences, Tampere University, Kalevantie 4, Tampere 33014, Tampere, Finland
| | - Anne M Kerola
- Inflammation Center, Rheumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland; Faculty of Medicine, University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland
| | - Antti Palomäki
- Centre for Rheumatology and Clinical Immunology, Turku University Hospital, Kiinamyllynkatu 4-8, 20521 Turku, Finland; Department of Medicine, Turku University, 20014 Turku University, Finland
| | - Kari K Eklund
- Inflammation Center, Rheumatology, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland
| | - Javier Gracia-Tabuenca
- Institute for Molecular Medicine Finland, FIMM, HiLIFE, University of Helsinki, Tukholmankatu 8, 00290 Helsinki, Finland
| | - Juha Sinisalo
- Heart and Lung Center, Helsinki University Hospital, Topeliuksenkatu 5, 00260 Helsinki, Finland
| | - FinnGen
- FinnGen consortium (see Supplementary Table S1)
| | - Pia Isomäki
- Centre for Rheumatic Diseases, Tampere University Hospital, Elämänaukio 2, 33521 Tampere, Finland; Molecular Immunology Group, Faculty of Medicine and Health Technology, Tampere University, Arvo Ylpön katu 34, 33520 Tampere, Finland
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15
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Kim HW, Han M, Jung I, Ahn SS. New-onset atrial fibrillation in seropositive rheumatoid arthritis: association with disease-modifying anti-rheumatic drugs treatment. Rheumatology (Oxford) 2024; 63:630-638. [PMID: 37421392 DOI: 10.1093/rheumatology/kead336] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 06/01/2023] [Accepted: 06/13/2023] [Indexed: 07/10/2023] Open
Abstract
OBJECTIVE Atrial fibrillation (AF) is a potentially lethal complication that leads to increased hospitalization, disability and mortality. Furthermore, the risk of cardiovascular disease is increased in RA. We evaluated whether DMARD treatment is associated with incident AF in patients with seropositive RA (SPRA). METHODS The South Korean Health Insurance Review and Assessment Service database was used to identify patients newly diagnosed with SPRA between 2010 and 2020. A nested case-control analysis was performed to match AF-affected patients to unaffected controls for age, sex, follow-up duration, and index year of SPRA diagnosis at a 1:4 ratio. Adjusted conditional logistic regression was used to identify the predictive factors for AF. RESULTS Of the 108 085 patients with SPRA, 2,629 (2.4%) developed new-onset AF, and the proportion of females was ∼67%. In the matched population, pre-existing comorbidities of hypertension, chronic kidney disease, and heart failure were associated with increased risk of AF. Meanwhile, the use of methotrexate (MTX) decreased the risk of incident AF [adjusted odds ratio (aOR), 0.89], whereas the use of leflunomide (LEF) increased AF (aOR, 1.21). In a subgroup of patients aged ≥50 years, LEF and adalimumab increased the occurrence of AF, while MTX decreased AF in males and LEF increased this risk in females. CONCLUSION Although the number of subjects developing new-onset AF was small, MTX decreased and LEF increased incident AF in patients with RA. Especially, a distinct pattern of AF risk with DMARDs usage was observed according to age and sex.
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Affiliation(s)
- Hyung Woo Kim
- Department of Internal Medicine, College of Medicine, Institute of Kidney Disease Research, Yonsei University, Seoul, Republic of Korea
| | - Minkyung Han
- Biostatistics Collaboration Unit, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Inkyung Jung
- Division of Biostatistics, Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Soo Ahn
- Division of Rheumatology, Department of Internal Medicine, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
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16
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Huang YC, Lai ECC, Liao TC, Weng MY. Evaluating the risk of ischemic stroke at a young age in patients with autoimmune inflammatory rheumatic diseases: a population-based cohort study in Taiwan. Front Immunol 2024; 15:1272557. [PMID: 38404587 PMCID: PMC10884215 DOI: 10.3389/fimmu.2024.1272557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background Recent studies have demonstrated an increased incidence of ischemic stroke among patients with certain autoimmune inflammatory rheumatic diseases (AIIRDs). However, the associations between young stroke and AIIRDs have not been fully investigated. This study aimed to evaluate the risk of ischemic stroke among young patients with AIIRDs. Methods The National Health Insurance Research Database in Taiwan was utilized to establish cohorts of patients with AIIRDs diagnosed between 2004 and 2015, who were compared with 1,000,000 control participants. Cox proportional hazards regression models were used to calculate the hazard ratio of ischemic stroke and young ischemic stroke for individual AIIRDs after adjustment for relative risk factors. Results During the study period, a total of 64,120 patients with AIIRDss and 1,000,000 control patients were identified. The overall mean follow-up time was 5.33 years. There were 223 (0.8%) and 1,923 (0.3%) young ischemic stroke-related hospitalizations among patients with AIIRDs and controls, respectively. The incidence rate of young ischemic stroke was 0.08 in patients with rheumatoid arthritis, 0.08 in patients with Sjögren's syndrome, 0.26 in patients with systemic lupus erythematosus, 0.17 in patients with idiopathic inflammatory myositis, 0.24 in patients with systemic sclerosis, 0.05 in patients with Behçet's disease, and 0.44 in patients with systemic vasculitis, versus 0.05 per 100 person-years in the general population. The adjusted hazard ratios for young ischemic stroke were 1.07 (95% CI 0.70-1.43) for rheumatoid arthritis, 1.39 (95% CI 0.94-2.06) for Sjögren's syndrome, 5.79 (95% CI 4.68-7.17) for systemic lupus erythematosus, 2.07 for idiopathic inflammatory myositis (95% CI 0.98-4.38), 2.79 for systemic sclerosis (95% CI 1.38-5.63), 0.82 for Behçet's disease (95% CI 0.26-2.55), and 4.15 (95% CI 1.96-8.82) for systemic vasculitis. Conclusions Patients younger than 50 years with systemic lupus erythematosus, systemic sclerosis, or systemic vasculitis have a significantly elevated risk of developing ischemic stroke. Further research is needed to elucidate the pathogenesis of accelerated atherosclerosis in these AIIRDs.
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Affiliation(s)
- Ya-Chun Huang
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Edward Chia-Cheng Lai
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Tzu-Chi Liao
- School of Pharmacy, Institute of Clinical Pharmacy and Pharmaceutical Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Meng-Yu Weng
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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17
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Al-Ewaidat OA, Naffaa MM. Stroke risk in rheumatoid arthritis patients: exploring connections and implications for patient care. Clin Exp Med 2024; 24:30. [PMID: 38294723 PMCID: PMC10830780 DOI: 10.1007/s10238-023-01288-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Accepted: 11/04/2023] [Indexed: 02/01/2024]
Abstract
Rheumatoid arthritis (RA) can independently increase the risk of stroke, affecting both young and adult RA patients. Recent attention has been drawn to the association between stroke and RA, supported by mounting evidence. Given that stroke is a significant and an urgent public health concern, this review aims to highlight the relationship between stroke and RA, covering mechanisms, underlying risk factors, early detection tools, and treatment implications. By uncovering the connection that links RA to stroke, we can pave the way for targeted healthcare practices and the development of preventive strategies for individuals with RA. Therefore, further research is imperative to deepen our understanding of this association and, ideally, guide treatment decisions for individuals at risk of both RA and stroke.
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Affiliation(s)
- Ola A Al-Ewaidat
- Department of Internal Medicine, Ascension Saint Francis Hospital, Evanston, IL, 60202, USA
| | - Moawiah M Naffaa
- Department of Psychology and Neuroscience, Duke University, Durham, NC, 27708, USA.
- Department of Cell Biology, Duke University School of Medicine, Durham, NC, 27710, USA.
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18
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Rong JC, Chen XD, Jin NK, Hong J. Exploring the causal association of rheumatoid arthritis with atrial fibrillation: a Mendelian randomization study. Clin Rheumatol 2024; 43:29-40. [PMID: 37930596 DOI: 10.1007/s10067-023-06804-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 10/23/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023]
Abstract
BACKGROUND It has been proved that rheumatoid arthritis (RA) patients have high incidence of atrial fibrillation (AF). Nevertheless, whether they have causal relevance is uncertain. This study aimed to explore and verify the authenticity of causal relationship between RA and AF using Mendelian randomization (MR). METHODS The genome-wide association study (GWAS) summary data from Biobank Japan Project (BBJ) (RA, 4199 cases and 208,254 controls) were regarded as exposure data and the GWAS data from European Bio-informatics Institute database (EBI) (AF, 15,979 cases and 102,776 controls) as outcome data. The causal effect was appraised by the inverse variance weighted (IVW) method, MR-Egger regression, and weighted median estimator. MR-robust adjusted profile score (MR-RAPS) method was delivered to examine the robustness of causal relationship and MR Pleiotropy Residual Sum and Outlier (MR-PRESSO) method to control horizontal (directional) pleiotropy. RESULTS The results indicated that RA increased the risk of AF (IVW, the odds ratio (OR) = 1.060; 95% confidence interval (CI), 1.028 to 1.092; p = 1.411 × 10-4; weighted median, OR = 1.046, 95% CI, 1.002 to 1.093, p = 0.047). The MR analysis also showed this causal effect through all four IVW methods with various statistical algorithms. Both MR-RAPS and MR-PRESSO supported the causality of RA and AF. Also, the MR-PRESSO result indicated the absence of apparent pleiotropy. CONCLUSION There is a causal association between RA and AF. RA patients are genetically more vulnerable to AF. This study may contribute to further exploring early clinical prevention and fundamental mechanism of AF in patients with RA. Key Points • We provided some genetic evidence for the causal link between rheumatoid arthritis (RA) and atrial fibrillation (AF) with multiple Mendelian randomization (MR) methods. • RA patients were genetically more vulnerable to AF. • This study partly shed light on latent fundamental mechanisms underlying RA-induced AF and inspired future studies on RA-AF relationship.
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Affiliation(s)
- Jia-Cheng Rong
- Cardiovascular Department, Ningbo Hangzhou Bay Hospital, Hangzhou Bay New Area, Ningbo, Zhejiang, China
| | - Xu-Dong Chen
- Cardiovascular Department, Ningbo Hangzhou Bay Hospital, Hangzhou Bay New Area, Ningbo, Zhejiang, China
| | - Na-Ke Jin
- Cardiovascular Department, Ningbo Hangzhou Bay Hospital, Hangzhou Bay New Area, Ningbo, Zhejiang, China
| | - Jun Hong
- Cardiovascular Department, Ningbo Hangzhou Bay Hospital, Hangzhou Bay New Area, Ningbo, Zhejiang, China.
- Cardiovascular Department, Ningbo Hospital of Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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Schreiber T, Grune J, Landmesser U, Attanasio P. Detection and modification of biomarkers of inflammation determining successful rhythm control in patients with atrial fibrillation. Biomarkers 2023; 28:681-691. [PMID: 37962292 DOI: 10.1080/1354750x.2023.2284122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/12/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Multiple pathophysiological mechanisms are involved in the pathogenesis of atrial fibrillation (AF). Growing evidence suggests that both local and systemic inflammation plays a key role even in early stages and its progression towards persisting and permanent AF. Rhythm control therapy via pulmonary vein isolation or cardioversion is the cornerstone of AF therapy for most symptomatic patients, yet arrhythmia recurrence after treatment is still common, especially in patients with persistent AF. MATERIAL AND METHODS In this review, we summarize the current state of knowledge of biomarkers of inflammation with prognostic value in patients with atrial fibrillation as well as anti-inflammatory medication with potential benefits after rhythm control therapy. RESULTS AND DISCUSSION Both onset of AF, progression and arrhythmia recurrence after rhythm control therapy can be caused by local and systemic inflammation. Various inflammatory biomarkers have been established to predict treatment success. Furthermore, additional anti-inflammatory therapy may significantly improve success rates.
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Affiliation(s)
- Tobias Schreiber
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Jana Grune
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Philipp Attanasio
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
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20
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Rose J. Autoimmune Connective Tissue Diseases: Systemic Lupus Erythematosus and Rheumatoid Arthritis. Immunol Allergy Clin North Am 2023; 43:613-625. [PMID: 37394263 DOI: 10.1016/j.iac.2022.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Systemic lupus erythematosus and rheumatoid arthritis are just 2 of several autoimmune connective tissue diseases that are primarily chronic in nature but can present to the emergency department by virtue of an acute exacerbation of disease. Beyond an acute exacerbation of disease, their predilection for invading multiple organ systems lends itself to the potential for patients presenting to the emergency department with either a single or isolated symptom or a myriad of signs and/or symptoms indicative of a degree of disease complexity and severity that warrant timely recognition and resuscitation.
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Affiliation(s)
- Jonathan Rose
- Department of Emergency Medicine, Memorial Healthcare System, Memorial Hospital West, 703 N Flamingo Road, Pembroke Pines, FL 33028, USA.
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21
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Moysidis DV, Papazoglou AS, Kartas A. Autoimmunity-related atrial fibrillation incidence: an emerging conundrum meriting further investigation. Europace 2023; 25:euad076. [PMID: 36967235 PMCID: PMC10227760 DOI: 10.1093/europace/euad076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/28/2023] Open
Affiliation(s)
- Dimitrios V Moysidis
- Third Department of Cardiology, Hippokration General Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, Konstantinoupoleos 49, 54642 Thessaloniki, Greece
| | - Andreas S Papazoglou
- Department of Cardiology, Athens Naval Hospital, Dinokratous 70, 11521 Athens, Greece
| | - Anastasios Kartas
- First Department of Cardiology, AHEPA University Hospital, School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, St. Kyriakidi 1, 54636 Thessaloniki, Greece
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22
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McDowell B, Marr C, Holmes C, Edwards CJ, Cardwell C, McHenry M, Meenagh G, McGuinness B. Prevalence of cognitive impairment in patients with rheumatoid arthritis: a cross sectional study. BMC Psychiatry 2022; 22:777. [PMID: 36494656 PMCID: PMC9733399 DOI: 10.1186/s12888-022-04417-w] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 11/23/2022] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To explore the role of chronic inflammation in rheumatoid arthritis (RA) on cognition. METHODS AND ANALYSIS Six hundred sixty-one men and women aged ≥55 years who fulfilled the American College of Rheumatology/European League Against Rheumatism (ACR/EULAR) criteria for RA were recruited from three healthcare trusts in the United Kingdom (UK) between May 2018 and March 2020. Study participants took part in interviews which captured sociodemographic information, followed by an assessment of cognition. RA specific clinical characteristics were obtained from hospital medical records. Participants were cognitively assessed using the Montreal Cognitive Assessment (MoCA) and were classified as cognitively impaired if they scored ≤27/30 points. Linear regression analyses were conducted to identify which demographic and clinical variables were potential predictors of cognitive impairment. RESULTS The average age of participants was 67.6 years and 67% (444/661) were women. 72% (458/634; 95% CI 0.69 to 0.76) of participants were classified as cognitively impaired (MoCA≤27). Greater cognitive impairment was associated with older age (p = .006), being male (p = .041) and higher disease activity score (DAS28) (with moderate (DAS28 > 3.1) (p = 0.008) and high (DAS28 > 5.1) (p = 0.008)) compared to those in remission (DAS28 ≤ 2.6). There was no association between MoCA score and education, disease duration, RF status, anti-cyclic citrullinated peptide (anti-CCP) status, RA medication type or use of glucocorticoids or non-steroidal anti-inflammatory drugs (p > 0.05). CONCLUSION This study suggests that cognitive impairment is highly prevalent in older adults with RA. This impairment appears to be associated with higher RA disease activity and supports the concept that chronic systemic inflammation might accelerate cognitive decline. This underlines the importance of controlling the inflammatory response.
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Affiliation(s)
| | - Calum Marr
- Queen's University Belfast, Belfast, Northern Ireland
| | - Clive Holmes
- University of Southampton, Southampton, England
- Southern Health NHS Foundation Trust, Southampton, England
| | - Christopher J Edwards
- University of Southampton, Southampton, England
- NIHR Southampton Clinical Research Facility, Southampton, England
- University Hospital Southampton NHS Foundation Trust, Southampton, England
| | | | | | - Gary Meenagh
- Northern Health and Social Care Trust, Antrim, Northern Ireland
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23
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Wen P, Luo P, Zhang B, Wang Y, Hao L, Wang J, Guo J, Liu R, Zhang Y, Chen J. Hotspots and future directions in rheumatoid arthritis-related cardiovascular disease: A scientometric and visualization study from 2001 to 2021 based on Web of Science. Front Med (Lausanne) 2022; 9:931626. [PMID: 35966862 PMCID: PMC9372309 DOI: 10.3389/fmed.2022.931626] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/14/2022] [Indexed: 12/19/2022] Open
Abstract
Background The morbidity and mortality of cardiovascular diseases (CVD) in patients with rheumatoid arthritis (RA) is significantly higher than those in the general population, leading to RA-related CVD has attracted broad attention and numerous articles have been published. However, no study has systematically examined this area from a scientometric perspective. This study aimed to visualize the knowledge structure and identify emerging research trends and potential hotspots in this field. Materials and methods Articles and reviews on RA-CVD published from 2001 to 2021 were extracted from the Web of Science Core Collection database. CiteSpace and VOSviewer software were used to visualize the knowledge network of countries, institutions, authors, references and keywords in this field. SPSS and Microsoft Excel software were used for curve fitting and correlation analysis. Results A total of 2,618 articles and reviews were included. The number of publications about RA-related CVD significantly increased yearly. Publications were mainly concentrated in North America, Europe and East Asia. The United States contributed most with 699 publications, followed by the United Kingdom and Italy. Gross Domestic Product was an important factor affecting scientific output. University of Manchester and Professor Kitas George D. were the most prolific institutions and influential authors, respectively. Journal of Rheumatology was the most productive journal for RA-related CVD research. The research hotspots switched in the order of clinical features (cardiovascular events), mechanism exploration, anti-tumor necrosis factor therapy, risk factors, and antirheumatic drug safety, which can be observed from the keyword analysis and co-cited reference cluster analysis. Conclusions This study found that research on RA-related CVD is flourishing. The safety and cardiovascular pharmacological mechanisms of anti-rheumatoid drugs, especially targeted synthetic DMARDs, would be the focus of current research and developmental trends in future research.
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Affiliation(s)
- Pengfei Wen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Pan Luo
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Binfei Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Yakang Wang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Linjie Hao
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Jun Wang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Jianbin Guo
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Rui Liu
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Yumin Zhang
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
| | - Juan Chen
- Department of Joint Surgery, Honghui Hospital, Xi'an Jiaotong University, Shaanxi, China
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Chen Y, Fu L, Pu S, Xue Y. Systemic lupus erythematosus increases risk of incident atrial fibrillation: A systematic review and meta-analysis. Int J Rheum Dis 2022; 25:1097-1106. [PMID: 35906745 DOI: 10.1111/1756-185x.14403] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Patients with systemic lupus erythematosus (SLE) might have increased risk of atrial fibrillation (AF) as a result of initiating chronic and systematic inflammation. However, the prevalence of AF in patients with SLE have not been well quantified. The aim of this systematic review and meta-analysis was to collect and identify available clinical data to explore this possible correlation. METHODS Articles were searched based on electronic databases (PubMed, Scopus, ScienceDirect, Cochrane Library, Web of Science). Review Manager 5.4 was used to perform meta-analysis of all selected studies and subgroup analyses (pooled separately by geographical distribution). Pooled risk ratio (RR) and 95% confidence intervals (95% CI) were calculated by random-effect model or fix-effect model. RESULTS Six cohort studies were involved in this meta-analysis, including 311 844 participants, 78 134 cases of SLE and 347 883 non-SLE controls. Pooled studies indicated increased risk of AF development in patients with SLE compared to participants without SLE (I2 = 96%, RR = 1.85; 95% CI: 1.23-2.79; P = .003). Four clinical trials including only European/ American populations were analyzed in subgroups. Heterogeneity analysis showed that I2 = 9% and there was an increase in the risk of AF development in European/ American patients with SLE (RR = 1.79; 95% CI: 1.61-1.98; P < .001), while in 2 Korean studies, the heterogeneity was 98% and there was no correlation between AF and SLE (RR = 1.81, 95% CI: 0.39-8.43). Five clinical studies were involved in subgroup analysis after excluding the Beak study, with I2 = 96% and they suggested that SLE increased the risk of AF development (RR = 2.13, 95% CI: 1.42-3.21, P = .002). CONCLUSION This meta-analysis suggested that SLE may be a risk factor for AF development and the results may vary with geographic distribution.
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Affiliation(s)
- Yanlin Chen
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Lu Fu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Sijia Pu
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yumei Xue
- Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
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25
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Conte M, Petraglia L, Cabaro S, Valerio V, Poggio P, Pilato E, Attena E, Russo V, Ferro A, Formisano P, Leosco D, Parisi V. Epicardial Adipose Tissue and Cardiac Arrhythmias: Focus on Atrial Fibrillation. Front Cardiovasc Med 2022; 9:932262. [PMID: 35845044 PMCID: PMC9280076 DOI: 10.3389/fcvm.2022.932262] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/13/2022] [Indexed: 01/02/2023] Open
Abstract
Atrial Fibrillation (AF) is the most frequent cardiac arrhythmia and its prevalence increases with age. AF is strongly associated with an increased risk of stroke, heart failure and cardiovascular mortality. Among the risk factors associated with AF onset and severity, obesity and inflammation play a prominent role. Numerous recent evidence suggested a role of epicardial adipose tissue (EAT), the visceral fat depot of the heart, in the development of AF. Several potential arrhythmogenic mechanisms have been attributed to EAT, including myocardial inflammation, fibrosis, oxidative stress, and fat infiltration. EAT is a local source of inflammatory mediators which potentially contribute to atrial collagen deposition and fibrosis, the anatomical substrate for AF. Moreover, the close proximity between EAT and myocardium allows the EAT to penetrate and generate atrial myocardium fat infiltrates that can alter atrial electrophysiological properties. These observations support the hypothesis of a strong implication of EAT in structural and electrical atrial remodeling, which underlies AF onset and burden. The measure of EAT, through different imaging methods, such as echocardiography, computed tomography and cardiac magnetic resonance, has been proposed as a useful prognostic tool to predict the presence, severity and recurrence of AF. Furthermore, EAT is increasingly emerging as a promising potential therapeutic target. This review aims to summarize the recent evidence exploring the potential role of EAT in the pathogenesis of AF, the main mechanisms by which EAT can promote structural and electrical atrial remodeling and the potential therapeutic strategies targeting the cardiac visceral fat.
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Affiliation(s)
- Maddalena Conte
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy.,Casa di Cura San Michele, Maddaloni, Italy
| | - Laura Petraglia
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Serena Cabaro
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | | | | | - Emanuele Pilato
- Department of Advanced Biomedical Science, University of Naples Federico II, Naples, Italy
| | - Emilio Attena
- Department of Cardiology, Monaldi Hospital, Naples, Italy
| | - Vincenzo Russo
- Chair of Cardiology, Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli" - Monaldi and Cotugno Hospital, Naples, Italy
| | - Adele Ferro
- Institute of Biostructure and Bioimaging, Consiglio Nazionale delle Ricerche, Naples, Italy
| | - Pietro Formisano
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Dario Leosco
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
| | - Valentina Parisi
- Department of Translational Medical Sciences, University of Naples Federico II, Naples, Italy
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Abstract
PURPOSE OF REVIEW The purpose of our review was to evaluate current standards in clinical practice in determining overall cardiac risk in female patients with chronic rheumatologic diseases. We hoped to not only summarize known cardiac manifestations of various chronic rheumatologic diseases but also determine the effectiveness of new risk scores in determining cardiac risk in this patient population. RECENT FINDINGS Chronic rheumatologic diseases have been associated with various cardiac manifestations for some time, with initial studies involving risk of coronary artery disease (CAD) in rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE). However, recent studies have shown numerous other cardiac manifestations associated with these and other chronic rheumatologic diseases. Risk scores have been used for several decades to help determine overall cardiac risk in the general population, but these risk scores have notoriously underestimated the risk of cardiac disease in woman and in patients with chronic rheumatologic diseases. These diseases, often with a female predominance, can impact long-term mortality and have devastating consequences if not monitored and treated appropriately. Thus, new risk scores have been developed over the last several years to help improve detection and awareness of cardiac disease in these patients. Novel modified risk scores have found some success at improving the detection of cardiac disease in patients with chronic rheumatologic diseases. Further studies looking at these risk scores need to determine the accuracy of these scores and where they fall short. With the advent of advanced imaging technologies, future risk scores may involve certain imaging-based markers to help guide accurate risk determination.
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Affiliation(s)
- Tyler Schmidt
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA
| | - Rekha Mankad
- Department of Cardiovascular Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN, 55905, USA.
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27
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Haq IU, Lodhi FK, Anan AR, Alzu’bi H, Agboola KM, Lee HC, Asirvatham SJ, Deshmukh AJ, DeSimone CV. Safety and Efficacy Outcomes of Atrial Fibrillation Ablation in Patients with Rheumatoid Arthritis. Heart Rhythm O2 2022; 3:261-268. [PMID: 35734296 PMCID: PMC9207736 DOI: 10.1016/j.hroo.2022.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Rheumatoid arthritis (RA) is an immune-mediated inflammatory disease associated with atrial fibrillation (AF) and stroke. Objective The purpose of this study was to evaluate the safety and efficacy of AF ablation in patients with RA. Methods All patients with RA undergoing AF ablation at our institution from 2010 to 2021 were propensity matched to patients without RA using 9 baseline characteristics. The primary outcome was procedural efficacy defined by clinical AF recurrence, the need for antiarrhythmic drugs (AADs), and repeat catheter ablation. Secondary outcome was safety. Results A total of 45 patients with RA (age 66.3 ± 7.7 years) were matched to 45 patients without a history of RA (age 68.0 ± 7.3 years). Both groups had similar procedural and periprocedural characteristics. Before ablation, RA patients had statistically higher C-reactive protein (CRP) levels (P ≤.01) and erythrocyte sedimentation rates (ESRs) (P <.05) compared to non-RA patients. After ablation, RA patients had statistically significant higher rates of AF recurrence (P = .006), were more likely to be taking AADs (P <.05), and more likely to undergo repeat ablations (P <.05). The use of immunosuppression or corticosteroids at the time of ablation did not influence the primary endpoint of AF recurrence, AADs, or repeat ablation. Multivariate regression analysis showed CRP and ESR were independent predictors of AF recurrence. CRP was an independent predictor of repeat ablation. Conclusion Patients with RA are at higher risk of clinical AF recurrence, and are more likely to be taking AADs and require repeat ablation. Preablation CRP and ESR are independent predictors of AF recurrence, and CRP is an independent predictor of repeat catheter ablation.
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28
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Konwerski M, Gąsecka A, Opolski G, Grabowski M, Mazurek T. Role of Epicardial Adipose Tissue in Cardiovascular Diseases: A Review. BIOLOGY 2022; 11:355. [PMID: 35336728 PMCID: PMC8945130 DOI: 10.3390/biology11030355] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 02/19/2022] [Accepted: 02/21/2022] [Indexed: 02/01/2023]
Abstract
Cardiovascular diseases (CVDs) are the leading causes of death worldwide. Epicardial adipose tissue (EAT) is defined as a fat depot localized between the myocardial surface and the visceral layer of the pericardium and is a type of visceral fat. EAT is one of the most important risk factors for atherosclerosis and cardiovascular events and a promising new therapeutic target in CVDs. In health conditions, EAT has a protective function, including protection against hypothermia or mechanical stress, providing myocardial energy supply from free fatty acid and release of adiponectin. In patients with obesity, metabolic syndrome, or diabetes mellitus, EAT becomes a deleterious tissue promoting the development of CVDs. Previously, we showed an adverse modulation of gene expression in pericoronary adipose tissue in patients with coronary artery disease (CAD). Here, we summarize the currently available evidence regarding the role of EAT in the development of CVDs, including CAD, heart failure, and atrial fibrillation. Due to the rapid development of the COVID-19 pandemic, we also discuss data regarding the association between EAT and the course of COVID-19. Finally, we present the potential therapeutic possibilities aiming at modifying EAT's function. The development of novel therapies specifically targeting EAT could revolutionize the prognosis in CVDs.
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Affiliation(s)
| | | | | | | | - Tomasz Mazurek
- 1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warszawa, Poland; (M.K.); (A.G.); (G.O.); (M.G.)
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29
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Soussi BG, Cordtz RL, Kristensen S, Bork CS, Christensen JH, Schmidt EB, Torp-Pedersen C, Prieto-Alhambra D, Dreyer L. Incidence and prevalence of rheumatoid arthritis in Denmark from 1998 to 2018: a nationwide register-based study. Scand J Rheumatol 2021; 51:481-489. [PMID: 34913402 DOI: 10.1080/03009742.2021.1957557] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Objective: To investigate the incidence and prevalence of rheumatoid arthritis (RA) in the adult Danish population.Method: In this nationwide register-based cohort study, patients with incident RA between 1998 and the end of 2018 were identified using Danish administrative registries. The age- and sex-standardized incidence rate (IR), incidence proportion (IP), lifetime risk (LR), and point prevalence (PP) of RA were calculated. RA was defined as a first-time RA diagnosis registered in the Danish National Patient Registry combined with a redeemed prescription of a conventional synthetic disease-modifying anti-rheumatic drug in the following year. In addition, three different case definitions of RA were explored.Results: The overall age- and sex-standardized IR of RA from 1998 to 2018 was 35.5 [95% confidence interval (CI) 35.1-35.9] per 100 000 person-years while the IP was 35.2 (95% CI 34.8-35.5) per 100 000 individuals. The IR was two-fold higher for women than for men. The LR of RA ranged from 2.3% to 3.4% for women and from 1.1% to 1.5% for men, depending on the RA case definition used. The overall PP of RA was 0.6% (95% CI 0.5-0.6%) in 2018: 0.8% (95% CI 0.7-0.8%) for women and 0.3% (95% CI 0.3-0.4%) for men. The prevalence increased about 1.5-fold from 2000 to 2018.Conclusion: The IR and PP were approximately two-fold higher for women than for men. The prevalence of RA in Denmark increased significantly from 2000 to 2018. The RA case definition had more impact on the results than the choice of denominator.
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Affiliation(s)
- B G Soussi
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - R L Cordtz
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark
| | - S Kristensen
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - C S Bork
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - J H Christensen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Nephrology, Aalborg University Hospital, Aalborg, Denmark
| | - E B Schmidt
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.,Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - C Torp-Pedersen
- Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Cardiology, Nordsjælland Hospital, Hillerød, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - D Prieto-Alhambra
- Musculoskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - L Dreyer
- Department of Rheumatology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
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Ariyaratnam JP, Elliott AD, Mishima RS, Gallagher C, Lau DH, Sanders P. Heart failure with preserved ejection fraction: An alternative paradigm to explain the clinical implications of atrial fibrillation. Heart Rhythm O2 2021; 2:771-783. [PMID: 34988529 PMCID: PMC8710629 DOI: 10.1016/j.hroo.2021.09.015] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Atrial fibrillation (AF) is associated with exercise intolerance, stroke, and all-cause mortality. However, whether this can be solely attributable to the arrhythmia itself or alternative mechanisms remains controversial. Heart failure with preserved ejection (HFpEF) commonly coexists with AF and may contribute to the poor outcomes associated with AF. Indeed, several invasive hemodynamic studies have confirmed that patients with AF are at increased risk of underlying HFpEF and that the presence of HFpEF may have important prognostic implications in these patients. Mechanistically, AF and HFpEF are closely linked. Both conditions are driven by the presence of common cardiovascular risk factors and are associated with left atrial (LA) myopathy, characterized by mechanical and electrical dysfunction. Progressive worsening of this left atrial (LA) myopathy is associated with both increased AF burden and worsening HFpEF. In addition, there is growing evidence to suggest that worsening LA myopathy is associated with poorer outcomes in both conditions and that reversal of the LA myopathy could improve outcomes. In this review article, we will present the epidemiologic and mechanistic evidence underlying the common coexistence of AF and HFpEF, discuss the importance of a progressive LA myopathy in the pathogenesis of both conditions, and review the evidence from important invasive hemodynamic studies. Finally, we will review the prognostic implications of HFpEF in patients with AF and discuss the relative merits of AF burden reduction vs HFpEF reduction in improving outcomes of patients with AF and HFpEF.
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Affiliation(s)
- Jonathan P Ariyaratnam
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Adrian D Elliott
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Ricardo S Mishima
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Celine Gallagher
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Dennis H Lau
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
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31
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Rose J. Autoimmune Connective Tissue Diseases: Systemic Lupus Erythematosus and Rheumatoid Arthritis. Emerg Med Clin North Am 2021; 40:179-191. [PMID: 34782087 DOI: 10.1016/j.emc.2021.09.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Systemic lupus erythematosus and rheumatoid arthritis are just 2 of several autoimmune connective tissue diseases that are primarily chronic in nature but can present to the emergency department by virtue of an acute exacerbation of disease. Beyond an acute exacerbation of disease, their predilection for invading multiple organ systems lends itself to the potential for patients presenting to the emergency department with either a single or isolated symptom or a myriad of signs and/or symptoms indicative of a degree of disease complexity and severity that warrant timely recognition and resuscitation.
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Affiliation(s)
- Jonathan Rose
- Department of Emergency Medicine, Memorial Healthcare System, Memorial Hospital West, 703 N Flamingo Road, Pembroke Pines, FL 33028, USA.
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32
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Wang X, Fan H, Wang Y, Yin X, Liu G, Gao C, Li X, Liang B. Elevated Peripheral T Helper Cells Are Associated With Atrial Fibrillation in Patients With Rheumatoid Arthritis. Front Immunol 2021; 12:744254. [PMID: 34721413 PMCID: PMC8554094 DOI: 10.3389/fimmu.2021.744254] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/29/2021] [Indexed: 11/23/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) have a significantly high risk of atrial fibrillation (AF). This study aimed to compare the absolute and relative changes in peripheral T cells in patients with RA who were also affected with and without AF. To help make an early diagnosis and prevent the initiation and progression of AF, the changes in the lymphocyte subsets were assessed in RA patients with and without AF. A propensity score matching (PSM) system (1:3) was used to perform a matched case-control study with 40 RA-AF cases and 120 RA controls. Changes in the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), anti-citrullinated peptide antibody (ACPA), and rheumatoid factor (RF) were examined. The percentage and absolute number of T, B, natural killer (NK), T helper (Th)1, Th2, Th17, and T-regulatory (Treg) cells in the peripheral blood of patients with and without RA-AF were determined using flow cytometry. Univariate and multivariate analyses were performed to determine the association between peripheral lymphocytes and RA-AF. Demographic data, ESR, CRP, ACPA, and the percentage, as well as the absolute value of B, NK, Th2, and Treg cells, showed no significant differences between the propensity score-matched groups of RA and RA-AF. Meanwhile, the absolute number and percentage of Th1 cells, the absolute number of Th17 cells, the ratio of Th1/Treg, Th17/Treg, and RF were significantly higher in patients with RA-AF than those in the control groups (P < 0.05). Univariate and multivariate logistic regression analyses also revealed that the percentage of Th1 cells, the absolute number of Th17 cells, and the ratio of Th1/Treg were associated with a significantly higher risk of AF. This PSM study demonstrated that the incidence of AF was higher in RA patients with Th cell immunological derangements.
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Affiliation(s)
- Xin Wang
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Hongxuan Fan
- Department of Cardiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yongle Wang
- Department of Neurology, The First Hospital of Shanxi Medical University, Taiyuan, China
| | - Xufang Yin
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Guangying Liu
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Chong Gao
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Xiaofeng Li
- Department of Rheumatology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Bin Liang
- Department of Cardiology, The Second Hospital of Shanxi Medical University, Taiyuan, China
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Jiang Y, Damiris K, Suero-Abreu G, Xu B, Ahlawat S. Reflux esophagitis is associated with higher risks of acute stroke and transient ischemic attacks in patients hospitalized with atrial fibrillation: A nationwide inpatient sample analysis. Medicine (Baltimore) 2021; 100:e26502. [PMID: 34160467 PMCID: PMC8238265 DOI: 10.1097/md.0000000000026502] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Accepted: 06/01/2021] [Indexed: 01/04/2023] Open
Abstract
Reflux esophagitis (RE) is a subset of gastroesophageal reflux disease (GERD) with endoscopic evidence of esophageal inflammation, which has been linked to an increased incidence of atrial fibrillation (AF). However, data on the effect of RE on patient outcomes is limited. We sought to examine the potential association of RE with outcomes of patients with AF in a nationwide study.The National Inpatient Sample (NIS) database was queried to identify hospitalized adult patients with AF and RE between 2010 and 2014. Primary outcomes included inpatient mortality, length of stay (LOS), and total hospital charges. AF related complications such as acute stroke, transient ischemic attack (TIA) and acute heart failure were assessed as secondary outcomes. Propensity score matching and multivariate regression analysis were used.Six lakh sixty seven thousands five hundred twenty patients were admitted for primary diagnosis of AF out of which 5396 had a secondary diagnosis of RE. In the AF with RE cohort, the average age was 73.6 years, 41.5% were male, and 79.9% were Caucasian. There was a greater prevalence of concomitant dyslipidemia, chronic liver disease and chronic pulmonary disease (P < .01) when compared to the AF without RE cohort. Patients with AF and RE also had higher incidence of acute strokes and TIAs (P < .05), longer LOS (P < .001), and higher hospital charges (P < .05) with no difference in acute heart failure (P = .08), hospital mortality (P = .12), or CHA2DS2-VASc score (P = .67).In hospitalized patients with AF, RE was associated with a higher rate of acute stroke and TIAs, longer LOS, and greater hospital charges.
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Affiliation(s)
- Yi Jiang
- Department of Medicine, Rutgers New Jersey Medical School, Newark
| | | | | | - Binghong Xu
- Center for Asian Health, Saint Barnabas Medical Center, Livingston
| | - Sushil Ahlawat
- Division of Gastroenterology and Hepatology, Rutgers New Jersey Medical School, Newark, NJ
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Kessler J, Totoson P, Devaux S, Moretto J, Wendling D, Demougeot C. Animal models to study pathogenesis and treatments of cardiac disorders in rheumatoid arthritis: Advances and challenges for clinical translation. Pharmacol Res 2021; 170:105494. [PMID: 34139344 DOI: 10.1016/j.phrs.2021.105494] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 11/15/2022]
Abstract
Although cardiac diseases such as acute myocardial infarction, heart failure and arrhythmias are the leading cause of cardiovascular complications in rheumatoid arthritis (RA), their pathogenesis is far from being understood and optimal therapeutic options to treat specifically these disorders in RA are lacking. Preclinical studies on animal models of arthritis can help to decipher the complex link between arthritis and the heart, and to identify critical pathways and novel therapeutic targets. This review presented the available data on cardiac disorders in animal models of RA, as well as the current knowledge on pathophysiology and pharmacology of these disorders. Future directions for translational studies in a cardiorheumatic perspective are proposed.
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Affiliation(s)
- Julie Kessler
- PEPITE EA 4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25000 Besançon, France; Service de Rhumatologie, CHU Minjoz, 25000 Besançon, France
| | - Perle Totoson
- PEPITE EA 4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Sylvie Devaux
- PEPITE EA 4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Johnny Moretto
- PEPITE EA 4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Daniel Wendling
- Service de Rhumatologie, CHU Minjoz, 25000 Besançon, France; EA 4266 " Agents Pathogènes et Inflammation ", EPILAB, Univ. Bourgogne Franche-Comté, F-25000 Besançon, France
| | - Céline Demougeot
- PEPITE EA 4267, FHU INCREASE, Univ. Bourgogne Franche-Comté, F-25000 Besançon, France.
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Liou YT, Wei JCC, Hu KC, Hung YM, Chou MC, Chang R. Risk of subsequent atrial fibrillation in patients with myasthenia gravis: A population-based cohort study. Medicine (Baltimore) 2021; 100:e26008. [PMID: 34011098 PMCID: PMC8137031 DOI: 10.1097/md.0000000000026008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Accepted: 05/01/2021] [Indexed: 01/05/2023] Open
Abstract
The purpose of this study was to explore the association between myasthenia gravis (MG) and the risk of atrial fibrillation (AF) in an Asian population. The risk was analyzed in a cohort of 5528 patients with history of MG and 5528 individuals without MG using a hospitalization claim dataset. Both groups were matched by age, sex, index year and baseline comorbidities as an original analysis. A Cox proportional hazard model was used to estimate the hazard ratio and 95% confidence interval of AF after adjusting for demographic and relevant clinical covariates. The adjusted hazard ratio of the MG group compared with that of the non-MG group was 1.03 (95% confidence interval, 0.76-1.38) for AF. A stratified analysis showed that compared with the propensity score matched non-MG group, there was no increased risk of developing AF based on age categories, gender, or comorbidities. Different time follow-up periods results showed no increased risk of AF compared with the non-MG group. Overall, in the Taiwanese cohort, MG is not associated with an increased risk of AF.
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Affiliation(s)
- Yaw-Tzeng Liou
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital
- Institute of Medicine, Chung Shan Medical University
- Graduate Institute of Integrated Medicine, China Medical University
| | - Kai-Chieh Hu
- Management office for Health Data, China Medical University Hospital, Taichung
| | - Yao-Min Hung
- Department of Internal Medicine, Kaohsiung Municipal United Hospital, Kaohsiung
- College of Health and Nursing, Meiho University
| | - Mei-Chia Chou
- Department of Recreation and Sports Management, Tajen University
- Department of Physical Medicine and Rehabilitation, Kaohsiung Veterans General Hospital, Pingtung Branch, Pingtung County, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung
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Association between ischemic stroke and seropositive rheumatoid arthritis in Korea: A nationwide longitudinal cohort study. PLoS One 2021; 16:e0251851. [PMID: 33999944 PMCID: PMC8128246 DOI: 10.1371/journal.pone.0251851] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 05/05/2021] [Indexed: 01/06/2023] Open
Abstract
The purpose of this longitudinal follow-up study was to investigate the risk of ischemic stroke nationwide in patients with seropositive rheumatoid arthritis (RA) and controls who were matched in age and sex. Patient data were collected from the National Health Insurance Service (NHIS) Health Screening (HEALS) cohort. Using the International Classification of Diseases code M05 (seropositive RA), with a prescription of any disease-modifying anti-rheumatic drug (DMARD), RA was identified. A total of 2,765 patients and 13,825 control subjects were included in our study. The 12-year incidence of ischemic stroke in each group was calculated using the Kaplan–Meier method. The risk ratio of ischemic stroke was estimated using Cox proportional hazards regression. Sixty-four patients (2.31%) in the seropositive RA group and 512 (3.70%) in the control group experienced ischemic stroke (P < 0.001) during the follow-up period. The hazard ratio of ischemic stroke in the seropositive RA group was 1.32 (95% confidence interval (CI), 1.02–1.73) after adjusting for age and sex. The adjusted hazard ratio of ischemic stroke in the seropositive RA group was 1.40 (95% CI, 1.07–1.82) after adjusting for demographics and comorbid medical disorders. According to the subgroup analysis, the hazard ratios of ischemic stroke risks in the female and hypertensive subgroups were 1.44 (95% CI, 1.05–1.97) and 1.66 (95% CI, 1.16–2.38), respectively. In the non-diabetes and non-dyslipidemia subgroups, the corresponding hazard ratios of ischemic stroke were 1.47 (95% CI, 1.11–1.95) and 1.43 (95% CI, 1.07–1.91). Seropositive RA patients have an increased risk of ischemic stroke. In female, hypertension, non-diabetes, and non-dyslipidemia RA subgroups, even without the traditional risk factors for stroke (except for hypertension), increased the risk, which could be potentially attributed to RA.
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Khan MZ, Patel K, Patel KA, Doshi R, Shah V, Adalja D, Waqar Z, Franklin S, Gupta N, Gul MH, Jesani S, Kutalek S, Figueredo V. Burden of atrial fibrillation in patients with rheumatic diseases. World J Clin Cases 2021; 9:3252-3264. [PMID: 34002134 PMCID: PMC8107898 DOI: 10.12998/wjcc.v9.i14.3252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/06/2021] [Accepted: 03/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Studies have suggested that atrial fibrillation (AF) in patients with rheumatic diseases (RD) may be due to inflammation. AIM To determine the highest association of AF among hospitalized RD patients and to determine morbidity and mortality associated with AF in hospitalized patients with RD. METHODS The National inpatient sample database from October 2015 to December 2017 was analyzed to identify hospitalized patients with RD with and without AF. A subgroup analysis was performed comparing outcomes of AF among different RD. RESULTS The prevalence of AF was 23.9% among all patients with RD (n = 3949203). Among the RD subgroup, the prevalence of AF was highest in polymyalgia rheumatica (33.2%), gout (30.2%), and pseudogout (27.1%). After adjusting for comorbidities, the odds of having AF were increased with gout (1.25), vasculitis (1.19), polymyalgia rheumatica (1.15), dermatopolymyositis (1.14), psoriatic arthropathy (1.12), lupus (1.09), rheumatoid arthritis (1.05) and pseudogout (1.04). In contrast, enteropathic arthropathy (0.44), scleroderma (0.96), ankylosing spondylitis (0.96), and Sjorgen's syndrome (0.94) had a decreased association of AF. The mortality, length of stay, and hospitalization costs were higher in patients with RD having AF vs without AF. Among the RD subgroup, the highest mortality was found with scleroderma (4.8%), followed by vasculitis (4%) and dermatopolymyositis (3.5%). CONCLUSION A highest association of AF was found with gout followed by vasculitis, and polymyalgia rheumatica when compared to other RD. Mortality was two-fold higher in patients with RD with AF.
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Affiliation(s)
- Muhammad Zubair Khan
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Kirtenkumar Patel
- Division of Cardiology, North Shore University Hospital, Manhasset, NY 11030, United States
| | - Krunalkumar A Patel
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Rajkumar Doshi
- Department of Internal Medicine, University of Nevada Reno School of Medicine, Reno, NV 89502, United States
| | - Vraj Shah
- Division of Cardiology, Medical College of Baroda, Baroda 390001, India
| | - Devina Adalja
- Department of Internal Medicine, GMERS Gotri Medical College, Vadodara 390021, India
| | - Zainulabedin Waqar
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, OH 43608, United States
| | - Sona Franklin
- Department of Internal Medicine, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Neelesh Gupta
- Department of Internal Medicine, Nazareth Hospital, Philadelphia, PA 19115, United States
| | - Muhammad Hamdan Gul
- Department of Internal Medicine, Saint Joseph Hospital, Chicago, IL 60657, United States
| | - Shruti Jesani
- Department of Internal Medicine, Trinitas Regional Medical Center, Elizabeth, NJ 07202, United States
| | - Steven Kutalek
- Department of Cardiology, St. Mary Medical Center, Langhorne, PA 19047, United States
| | - Vincent Figueredo
- Department of Cardiology, St. Mary Medical Center, Langhorne, PA 19047, United States
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Liu W, Ma W, Liu H, Li C, Zhang Y, Liu J, Liang Y, Zhang S, Wu Z, Zang C, Guo J, Li L. Stroke risk in arthritis: A systematic review and meta-analysis of cohort studies. PLoS One 2021; 16:e0248564. [PMID: 33725018 PMCID: PMC7963101 DOI: 10.1371/journal.pone.0248564] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Accepted: 03/01/2021] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVE Stroke is a major contributor to the global burden of disease. Although numerous modifiable risk factors (RF) for stroke have been identified, some remain unexplained. Increasing studies have investigated stroke risk in arthritis, but their results are inconsistent. We aimed to synthesize, quantify, and compare the risk of stroke for the major types of arthritis in cohort studies by using a systematic review and meta-analysis approach. METHODS We searched Chinese and English databases to identify relevant studies from inception to April 30, 2020. Only studies adjusting at least for age and sex were included. We calculated pooled effect estimates for relative risk (RR) and 95% confidence interval (CI) and identified potential sources of heterogeneity and publication bias. RESULTS A total of 1,348 articles were retrieved, and after an preliminary screening of titles and abstracts, 69 were reviewed for full text, and finally, 32 met the criteria for meta-analysis. Stroke risk in arthritis was significantly increased in studies adjusting for age and sex (RR = 1.36, 95% CI: 1.27-1.46) and for at least one traditional risk factor (RR = 1.40, 95% CI: 1.28-1.54). The results of studies stratified by stroke subtype were consistent with the main finding (ischemic stroke: RR = 1.53, 95% CI: 1.32-1.78; hemorrhagic stroke: RR = 1.45, 95% CI: 1.15-1.84). In subgroup analysis by arthritis type, stroke risk was significantly increased in rheumatoid arthritis (RR = 1.38, 95% CI: 1.29-1.48), ankylosing spondylitis (RR = 1.49, 95% CI: 1.25-1.77), psoriatic arthritis (RR = 1.33, 95% CI: 1.22-1.45), and gout (RR = 1.40, 95% CI: 1.13-1.73) but not osteoarthritis (RR = 1.03, 95% CI: 0.91-1.16). Age and sex subgroup analyses indicated that stroke risk was similar by sex (women: RR = 1.47, 95% CI: 1.31-1.66; men: RR = 1.44, 95% CI: 1.28-1.61); risk was higher with younger age (<45 years) (RR = 1.46, 95% CI: 1.17-1.82) than older age (≥65 years) (RR = 1.17, 95% CI: 1.08-1.26). CONCLUSIONS Stroke risk was increased in multiple arthritis and similar between ischemic and hemorrhagic stroke. Young patients with arthritis had the highest risk.
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Affiliation(s)
- Wei Liu
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Wei Ma
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Hua Liu
- Department of Neurology, The Third People’s Hospital of Chengdu & The Affiliated Hospital of Southwest Jiaotong University, Chengdu, Sichuan, China
| | - Chunyan Li
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Yangwei Zhang
- Department of Neurology, Nanchong Central Hospital & The Second Clinical Medical College, North Sichuan Medical College, Nanchong, Sichuan, China
| | - Jie Liu
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Yu Liang
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Sijia Zhang
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
| | - Zhen Wu
- Second Department of General Surgery, First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Chenghao Zang
- Second Department of General Surgery, First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Jianhui Guo
- Second Department of General Surgery, First People’s Hospital of Yunnan Province, Kunming, Yunnan, China
| | - Liyan Li
- Institute of Neuroscience, Kunming Medical University, Kunming, Yunnan, China
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Li S, Jiang Z, Chao X, Jiang C, Zhong G. Identification of key immune-related genes and immune infiltration in atrial fibrillation with valvular heart disease based on bioinformatics analysis. J Thorac Dis 2021; 13:1785-1798. [PMID: 33841968 PMCID: PMC8024788 DOI: 10.21037/jtd-21-168] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Atrial fibrillation (AF) is the most common persistent arrhythmia. Valvular heart disease (VHD) and AF frequently coexist. In our study, from performing bioinformatics analysis, we sought to identify immune-related genes (IRGs) and explore the role of immune cell infiltration in AF-VHD in depth, aiming at investigating the potential molecular mechanism and developing new therapeutic targets for AF, including AF-VHD. Methods The gene expression of the GSE41177 and GSE79768 datasets were downloaded from the Gene Expression Omnibus database. Differentially expressed genes (DEGs) were analyzed via the limma package in Bioconductor with R software. Differentially expressed immune-related genes (DEIRGs) were selected via combination ImmPort database with DEGs, and the enrichment function and pathway analysis were explored. A protein-protein interaction (PPI) network was built with a Search Tool for the Retrieval of Interacting Genes/Proteins plugin in Cytoscape. The CIBERSORT algorithm was used to evaluate immune infiltration in the left atrial (LA) tissues between AF-VHD and sinus rhythm (SR) patients. Finally, a correlation analysis between key DEIRGs and infiltrating immune cells was performed. Results A total of 130 DEIRGs were detected. Enrichment function of DEIRGs demonstrated that they are significant in immune and inflammatory responses. The key DEIRGs assessed by the PPI network and involved in both the immune and inflammatory responses were the C-X-C motif chemokine ligand (CXCL) 1, pro-platelet basic protein (PPBP), CXCL12, and C-C motif chemokine ligand 4 (CCL4). The immune infiltration findings indicated that, compared with the LA tissues from SR patients, the tissues from AF-VHD patients contained a higher proportion of gamma delta T cells, but a lower proportion of CD8 and regulatory T cells. The results of correlation analysis demonstrated that CXCL1 was positively correlated with activated mast cells and significantly negatively correlated with resting mast cells. PPBP, CXCL12, and CCL4 were positively correlated with the infiltration of various immune cells, such as neutrophils, plasma cells, and resting dendritic cells. Conclusions The key immune-related genes and the differences in immune infiltration in LA tissues play an essential role in the occurrence and progression of AF-VHD.
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Affiliation(s)
- Shuo Li
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Zhiyuan Jiang
- Department of Cardiology, Division of Hypertension, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Xiaoying Chao
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Chenyang Jiang
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
| | - Guoqiang Zhong
- Department of Cardiology, First Affiliated Hospital, Guangxi Medical University, Nanning, China
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40
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Ma Y, Pan Z, Fan D, Xu S, Pan F. The increased risk of atrial fibrillation in inflammatory arthritis: a systematic review and meta-analysis of cohort studies. Immunol Invest 2021; 51:1095-1107. [PMID: 33563055 DOI: 10.1080/08820139.2021.1884091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Atrial fibrillation (AF) is the most common cardiac arrhythmia contributing to stroke and sudden cardiac death. Numbers of studies indicated that patients with inflammatory arthritis have an increased risk of AF. The present study aims to assess the risk of AF in inflammatory arthritis patients.Methods: We systematically searched cohort studies regarding the risk of AF in patients with rheumatoid arthritis, or spondyloarthritis through PubMed, Web of Science, Cochrane Library, Clinical Trials Registry, and China National Knowledge from inception to August 1, 2019. Meta-analysis was performed using fixed effect model, estimating both crude and adjusted hazard ratios (HRs) with 95% confidence intervals (CIs). Subgroup analysis and meta-regression based on geographic characteristics, comorbidities, and medication use were conducted to explore the source of heterogeneity.Results: Literature search identified 388 potentially relevant studies, and five studies containing seven cohorts of rheumatoid arthritis or spondyloarthritis were included in the meta-analysis. The AF risk of inflammatory arthritis patients was significantly increased compared with health controls (HR = 1.42, 95% CI: 1.36 to 1.49, Z = 14.17, P < .001), and the pooled HR of studies adjusted factor, like demographic characteristics, medications use, and comorbidities, was 1.37 (95% CI: 1.29 to 1.46; Z = 9.82, P < .001).Conclusion: Patients with inflammatory arthritis have increased risk of AF, probably due to the underlying chronic inflammation. Although various confounders have been adjusted like medications use and comorbidities, the risk of AF is still significantly increased in inflammatory arthritis patients.Abbreviations: AF: Atrial fibrillation; AS: Ankylosing spondylitis; CI: Confidence interval; HR: Hazard ratio; NOS: Newcastle-Ottawa scale; NSAIDs: Non-steroid anti-inflammatory drugs; PsA: Psoriatic arthritis; RA: Rheumatoid arthritis; SpA: Spondyloarthritis; TNFi: Tumor necrosis factors inhibitor; uSpA: Undifferentiated spondyloarthritis.
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Affiliation(s)
- Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Zhipeng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Department of Medical Oncology, First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dazhi Fan
- Foshan Institute of Fetal Medicine, Southern Medical University Affiliated Maternal and Child Health Hospital of Foshan, Foshan, Guangdong, China
| | - Shanshan Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University, Hefei, Anhui, China
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41
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Mubasher M, Syed T, Hanafi A, Yu Z, Yusuf I, Abdullah AS, Mohamed MF, Alweis R, Rao M, Hoefen R, Danjuma MI. An Investigation into the Association Between Inflammatory Bowel Disease and Cardiac Arrhythmias: An Examination of the United States National Inpatient Sample Database. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2020; 14:1179546820955179. [PMID: 33192109 PMCID: PMC7604983 DOI: 10.1177/1179546820955179] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 08/12/2020] [Indexed: 01/28/2023]
Abstract
Background: Inflammatory bowel diseases (IBD) associated-chronic inflammation and
autonomic dysregulation may predispose to arrhythmias. However, its exact
prevalence is unknown. Thus, we aimed to ascertain the prevalence of
arrhythmias in patients with IBD. Methods: We queried the Nationwide Inpatient Sample (the largest publicly available
all-payer inpatient USA database) from 2012 to 2014. We used the
International Classification of Diseases, Ninth Revision, Clinical
Modification (ICD-9 CM) discharge codes to identify adult patients
(⩾18 years) with IBD and dysrhythmias (supraventricular tachycardia (SVT),
atrial fibrillation, atrial flutter, ventricular tachycardia (VT), or
ventricular fibrillation). Furthermore, we identified risk factors for
cardiovascular disease. We divided patients into 2 cohorts, IBD cohorts, and
non-IBD cohort. The independent effect of a diagnosis of IBD on the risk of
dysrhythmias was examined using a multivariable logistic regression model
controlling for multiple confounders. Results: We identified 847 235 and 84 757 349 weighted hospitalizations among patients
with IBD and non-IBD cohorts, respectively. Patients with IBD were less
likely to be hospitalized for dysrhythmias than the non-IBD (9.7% vs 14.2%,
P < .001). The hospitalization odds for dysrhythmias
among patients with IBD were less than the general population (OR 0.87; 95%
CI 0.85-0.88). However, the prevalence of SVT and VT was indifferent between
the 2 groups. Male sex, age of over 60, and white race were risk factors for
dysrhythmias. Conclusion: Despite prior reports of a higher prevalence of arrhythmias among patients
with IBD, in a nationwide inpatient database, we found lower rates of
hospitalization-related-arrhythmias in the IBD population compared to that
of the general population.
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Affiliation(s)
| | - Tausif Syed
- Department of Medicine, Unity Hospital, Rochester, NY, USA
| | - Amir Hanafi
- Department of Medicine, Unity Hospital, Rochester, NY, USA
| | - Zhao Yu
- Department of Medicine, Unity Hospital, Rochester, NY, USA
| | - Ibrahim Yusuf
- Department of Medicine, Unity Hospital, Rochester, NY, USA
| | | | | | - Richard Alweis
- Department of Medicine, Unity Hospital, Rochester, NY, USA.,Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY, USA.,School of Health Sciences, Rochester Institute of Technology, Rochester, NY, USA
| | - Mohan Rao
- Department of Cardiology, Rochester Regional Health, Rochester, NY, USA
| | - Ryan Hoefen
- Department of Medicine, Unity Hospital, Rochester, NY, USA.,Department of Cardiology, Rochester Regional Health, Rochester, NY, USA
| | - Mohammed I Danjuma
- Internal Medicine Department, Hamad Medical Corporation, Doha, Qatar.,College of Medicine, Qatar University (QU-Health), Doha, Qatar
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Rivington J, Twohig P. Quantifying Risk Factors for Atrial Fibrillation: Retrospective Review of a Large Electronic Patient Database. J Atr Fibrillation 2020; 13:2365. [PMID: 34950310 PMCID: PMC8691333 DOI: 10.4022/jafib.2365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Despite the numerous comorbidities associated with atrial fibrillation (AF), the relative risk has been varying and not well-documented. AIM To quantify the risk of diseases associated with AF. METHODS Population-based retrospective analysis in IBM Explorys (1999-2019), an electronic database with over 63 million patients in the United States. Odds ratios were calculated between AF and other diseases. AF patients were also stratified by age, gender, and race to assess trends of AF in different demographic groups. RESULTS 1,812,620 patients had AF in the database. Congestive heart failure had the highest association with AF (OR 42.95). Cardiomyopathy, coronary artery disease, hypertension, and myocardial infarction all had odds greater than 15. Anemia of chronic disease and chronic kidney disease had odds greater than 18, the highest for chronic inflammatory conditions. Other conditions commonly associated with AF were found to have odds less than 8, including hyperthyroidism, alcohol use, and sleep apnea. Helicobacter pylori infection had the lowest odds at 1.98. CONCLUSIONS Epidemiologic information could be integrated with current clinical algorithms to more rapidly identify patients at risk of AF.
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Affiliation(s)
- Jaclyn Rivington
- Department of Cardiology, University of Nebraska Medical Center, Omaha, NE, USA
| | - Patrick Twohig
- Department of Gastroenterology & Hepatology, University of Nebraska Medical Center, Omaha, NE, USA
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Løgstrup BB, Ellingsen T, Pedersen AB, Darvalics B, Olesen KKW, Bøtker HE, Maeng M. Cardiovascular risk and mortality in rheumatoid arthritis compared with diabetes mellitus and the general population. Rheumatology (Oxford) 2020; 60:1400-1409. [DOI: 10.1093/rheumatology/keaa374] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 06/01/2020] [Indexed: 12/25/2022] Open
Abstract
Abstract
Objectives
To compare risk of cardiovascular disease and mortality in patients with incident RA, diabetes mellitus (DM) and the general population (GP).
Methods
Patients diagnosed with incident RA were matched 1:5 by age, sex and year of RA diagnosis with the GP. In the same period, patients with incident DM were included. Outcomes were heart failure (HF), myocardial infarction (MI), coronary revascularization, stroke, major adverse cardiovascular events (MACE) and death up to 10 years after diagnosis.
Results
We included 15 032 patients with incident RA, 301 246 patients with DM and 75 160 persons from the GP. RA patients had an increased risk of HF [hazard ratio (HR) 1.51, 95% CI: 1.38, 1.64], MI (HR 1.58, 95% CI: 1.43, 1.74), percutaneous coronary intervention (PCI; HR 1.44, 95% CI: 1.27, 1.62), coronary artery bypass grafting (CABG; HR 1.30, 95% CI: 1.05, 1.62) and stroke (HR 1.22, 95% CI: 1.12–1.33) compared with the GP. However, the 10-year all-cause mortality was at the same level as observed in the GP. Cardiac death and MACE were increased in RA compared with the GP. When compared with patients with DM, RA patients had a lower adjusted risk of HF (HR 0.79, 95% CI: 0.73, 0.85), CABG (HR 0.62, 95% CI: 0.51, 0.76) and stroke (HR 0.82, 95% CI: 0.76, 0.89), and similar risk of MI and PCI. DM patients had the highest risk of 10-year mortality, cardiac death and MACE.
Conclusion
This study demonstrates that RA is associated with an increased risk of HF, MI, stroke and coronary revascularization than found in the GP but without reaching the risk levels observed in DM patients.
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Affiliation(s)
- Brian B Løgstrup
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Torkell Ellingsen
- Clinic for Rational and Innovative Patient Pathways, Diagnostic Center, Regional Hospital Silkeborg, Silkeborg, Denmark
- Rheumatology Research Unit, Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Alma B Pedersen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Bianka Darvalics
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Kevin K W Olesen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Edigin E, Akuna E, Asemota I, Eseaton P, Ojemolon PE, Shaka H, Manadan A. Rheumatoid Arthritis Does Not Negatively Impact Outcomes of Patients Admitted for Atrial Fibrillation. Cureus 2020; 12:e10241. [PMID: 33042681 PMCID: PMC7535940 DOI: 10.7759/cureus.10241] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Objectives This study aimed to compare the outcomes of patients primarily admitted for atrial fibrillation (AF) with and without a secondary diagnosis of rheumatoid arthritis (RA). The primary outcome of interest was inpatient mortality. Hospital length of stay (LOS), total hospital charges, and odds of undergoing ablation and pharmacologic cardioversion were the secondary outcomes of interest. Methods Data were abstracted from the National Inpatient Sample (NIS) 2016 and 2017 databases. The NIS is the largest hospitalization database in the United States (US). The NIS was searched for hospitalizations for adult patients with AF as principal diagnosis with and without RA as secondary diagnosis using the International Classification of Diseases, 10th Revision (ICD-10) codes. Multivariate logistic and linear regression analysis was used accordingly to adjust for confounders. Results There were over 71 million discharges in the combined 2016 and 2017 NIS database. Out of 821,630 AF hospitalizations, 17,020 (2.1%) had RA. Hospitalizations for AF with RA had 0.18 days' decrease in adjusted mean LOS (p=0.014), and lower total hospital charges ($38,432 vs $39,175, p=0.018) compared to those without RA. AF hospitalizations with RA had similar inpatient mortality [1.1% vs 0.91%, adjusted odds ratio (AOR): 0.90, 95% CI: 0.63-1.27, p=0.540] and odds of undergoing ablation (3.5% vs 4.2%, AOR: 1.1, 95% CI: 0.87-1.30, p=0.549) and pharmacologic cardioversion (0.38% vs 0.38%, AOR: 1.00, 95% CI: 0.53-1.89, p=0.988) compared to those without RA. Conclusions Patients admitted for AF with coexisting RA were found to have lesser adjusted mean LOS and lower total hospital charges compared to those without RA. However, inpatient mortality and the odds of undergoing ablation and pharmacologic cardioversion were similar between both groups.
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Affiliation(s)
- Ehizogie Edigin
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Emmanuel Akuna
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Iriagbonse Asemota
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | | | - Pius E Ojemolon
- Anatomical Sciences, St. George's University, St. George, GRD
| | - Hafeez Shaka
- Internal Medicine, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
| | - Augustine Manadan
- Rheumatology, John H. Stroger, Jr. Hospital of Cook County, Chicago, USA
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Kornej J, Börschel CS, Benjamin EJ, Schnabel RB. Epidemiology of Atrial Fibrillation in the 21st Century: Novel Methods and New Insights. Circ Res 2020; 127:4-20. [PMID: 32716709 DOI: 10.1161/circresaha.120.316340] [Citation(s) in RCA: 839] [Impact Index Per Article: 167.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accompanying the aging of populations worldwide, and increased survival with chronic diseases, the incidence and prevalence of atrial fibrillation (AF) are rising, justifying the term global epidemic. This multifactorial arrhythmia is intertwined with common concomitant cardiovascular diseases, which share classical cardiovascular risk factors. Targeted prevention programs are largely missing. Prevention needs to start at an early age with primordial interventions at the population level. The public health dimension of AF motivates research in modifiable AF risk factors and improved precision in AF prediction and management. In this review, we summarize current knowledge in an attempt to untangle these multifaceted associations from an epidemiological perspective. We discuss disease trends, preventive opportunities offered by underlying risk factors and concomitant disorders, current developments in diagnosis and risk prediction, and prognostic implications of AF and its complications. Finally, we review current technological (eg, eHealth) and methodological (artificial intelligence) advances and their relevance for future prevention and disease management.
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Affiliation(s)
- Jelena Kornej
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
| | - Christin S Börschel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
| | - Emelia J Benjamin
- From the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts & Sections of Cardiovascular Medicine and Preventive Medicine, Boston Medical Center (J.K., E.J.B.), Boston University School of Medicine, MA
- Department of Epidemiology (E.J.B.), Boston University School of Medicine, MA
| | - Renate B Schnabel
- Department of General and Interventional Cardiology, University Heart & Vascular Center Hamburg Eppendorf, Hamburg, Germany (C.B., R.B.S.)
- German Center for Cardiovascular Research (DZHK) partner site Hamburg/Kiel/Lübeck (C.B., R.B.S.)
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Linking cellular energy state to atrial fibrillation pathogenesis: Potential role of adenosine monophosphate-activated protein kinase. Heart Rhythm 2020; 17:1398-1404. [PMID: 32268208 DOI: 10.1016/j.hrthm.2020.03.025] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Accepted: 03/28/2020] [Indexed: 01/01/2023]
Abstract
Adenosine monophosphate-activated protein kinase (AMPK) is the cellular stress-sensing molecule. Apart from maintaining cellular energy balance, AMPK controls expression and regulation of ion channels and ion transporters, including cytosolic Ca2+ handling proteins. Emerging evidence suggests that metabolic impairment plays a crucial role in the pathogenesis of atrial fibrillation. AMPK activation is thought to be protective by preventing metabolic stress, favorably modulating membrane electrophysiology including cytosolic Ca2+ dynamics; preventing cellular growth; and hypertrophic remodeling. This review considers current concepts and evidence from clinical and experimental studies regarding the role of AMPK in atrial fibrillation.
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Packer M. Characterization, Pathogenesis, and Clinical Implications of Inflammation-Related Atrial Myopathy as an Important Cause of Atrial Fibrillation. J Am Heart Assoc 2020; 9:e015343. [PMID: 32242478 PMCID: PMC7428644 DOI: 10.1161/jaha.119.015343] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Historically, atrial fibrillation has been observed in clinical settings of prolonged hemodynamic stress, eg, hypertension and valvular heart disease. However, recently, the most prominent precedents to atrial fibrillation are metabolic diseases that are associated with adipose tissue inflammation (ie, obesity and diabetes mellitus) and systemic inflammatory disorders (ie, rheumatoid arthritis and psoriasis). These patients typically have little evidence of left ventricular hypertrophy or dilatation; instead, imaging reveals abnormalities of the structure or function of the atria, particularly the left atrium, indicative of an atrial myopathy. The left atrium is enlarged, fibrotic and noncompliant, potentially because the predisposing disorder leads to an expansion of epicardial adipose tissue, which transmits proinflammatory mediators to the underlying left atrium. The development of an atrial myopathy not only leads to atrial fibrillation, but also contributes to pulmonary venous hypertension and systemic thromboembolism. These mechanisms explain why disorders of systemic or adipose tissue inflammation are accompanied an increased risk of atrial fibrillation, abnormalities of left atrium geometry and an enhanced risk of stroke. The risk of stroke exceeds that predicted by conventional cardiovascular risk factors or thromboembolism risk scores used to guide the use of anticoagulation, but it is strongly linked to clinical evidence and biomarkers of systemic inflammation.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute Baylor University Medical Center Dallas TX.,Imperial College London United Kingdom
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Shen HS, Chiang JH, Hsiung NH. Adjunctive Chinese Herbal Products Therapy Reduces the Risk of Ischemic Stroke Among Patients With Rheumatoid Arthritis. Front Pharmacol 2020; 11:169. [PMID: 32194408 PMCID: PMC7064546 DOI: 10.3389/fphar.2020.00169] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 02/07/2020] [Indexed: 12/11/2022] Open
Abstract
We performed a retrospective cohort study to investigate the association between the risk of ischemic stroke (IS) and the use of Chinese herbal products (CHP) in combination with western medicine (WM) among patients with rheumatoid arthritis (RA). The data were sourced from the registry for beneficiaries, inpatient and ambulatory care claims, and Registry for Catastrophic Illness from the National Health Insurance Research Database (NHIRD) in Taiwan between 1997 and 2011. Patients, who were newly diagnosed with RA between 1997 and 2010, were classified as the CHP group or non-CHP group depending on the presence of absence the adjunctive use of CHP following a diagnosis of RA. A total of 4,148 RA patients were in both the CHP and non-CHP groups after 1:1 matching. Patients in the CHP group had a significantly lower risk of IS compared to patients in the non-CHP group (adjusted hazard ratio [aHR], 0.67; 95% confidence interval [CI], 0.52-0.86). In the CHP group, patients who used CHP for more than 30 days had a lower risk of IS than their counterparts (aHR: 0.61, 95% CI: 0.40-0.91). Gui-Zhi-Shao-Yao-Zhi-Mu-Tang, Shu-Jin-Huo-Xie-Tang, and Du-Huo-Ji-Sheng-Tang might be associated with a lower risk of IS. Finally, the use of CHP in combination with WM was associated with a decreased risk of IS in patients with RA, especially among those who had used CHP for more than 30 days. A further randomized control trial is required to clarify the casual relationship between these results.
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Affiliation(s)
- Hsuan-Shu Shen
- Department of Chinese Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.,School of Post-Baccalaureate Chinese Medicine, Tzu Chi University, Hualien, Taiwan
| | - Jen-Huai Chiang
- Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.,College of Medicine, China Medical University, Taichung, Taiwan
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Tanemoto M, Hisahara S, Hirose B, Ikeda K, Matsushita T, Suzuki S, Manabe T, Imai T, Shimohama S. Severe Mononeuritis Multiplex due to Rheumatoid Vasculitis in Rheumatoid Arthritis in Sustained Clinical Remission for Decades. Intern Med 2020; 59:705-710. [PMID: 31735796 PMCID: PMC7086314 DOI: 10.2169/internalmedicine.3866-19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 09/29/2019] [Indexed: 12/28/2022] Open
Abstract
Rheumatoid vasculitis (RV) usually occurs in patients with refractory rheumatoid arthritis (RA). An 80-year-old woman was transferred to our hospital because of muscle weakness and paresthesia in all 4 limbs. She had been diagnosed with RA 30 years ago and achieved sustained clinical remission. At presentation, polyarthritis and drop foot were observed, and rheumatoid factor was prominently elevated. A peripheral nerve conduction test revealed mononeuritis multiplex in her limbs. We suspected that RV had developed rapidly despite RA having been stable for many years and started immunosuppression therapy with steroids combined with azathioprine. The treatment prevented worsening of muscle weakness and paresthesia.
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Affiliation(s)
- Masanobu Tanemoto
- Department of Neurology, Sapporo Medical University, School of Medicine, Japan
| | - Shin Hisahara
- Department of Neurology, Sapporo Medical University, School of Medicine, Japan
| | - Bungo Hirose
- Department of Neurology, Sapporo Medical University, School of Medicine, Japan
| | - Kazuna Ikeda
- Department of Neurology, Sapporo Medical University, School of Medicine, Japan
| | - Takashi Matsushita
- Department of Neurology, Sapporo Medical University, School of Medicine, Japan
| | - Shuichiro Suzuki
- Department of Neurology, Sapporo Medical University, School of Medicine, Japan
| | - Tatsuo Manabe
- Department of Neurology, Sapporo Medical University, School of Medicine, Japan
| | - Tomihiro Imai
- Department of Neurology, Sapporo Medical University, School of Medicine, Japan
- Sapporo Medical University, School of Health Sciences, Japan
| | - Shun Shimohama
- Department of Neurology, Sapporo Medical University, School of Medicine, Japan
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Gawałko M, Balsam P, Lodziński P, Grabowski M, Krzowski B, Opolski G, Kosiuk J. Cardiac Arrhythmias in Autoimmune Diseases. Circ J 2020; 84:685-694. [PMID: 32101812 DOI: 10.1253/circj.cj-19-0705] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Autoimmune diseases (ADs) affect approximately 10% of the world's population. Because ADs are frequently systemic disorders, cardiac involvement is common. In this review we focus on typical arrhythmias and their pathogenesis, arrhythmia-associated mortality, and possible treatment options among selected ADs (sarcoidosis, systemic lupus erythematosus, scleroderma, type 1 diabetes, Graves' disease, rheumatoid arthritis, ankylosing spondylitis [AS], psoriasis, celiac disease [CD], and inflammatory bowel disease [IBD]). Rhythm disorders have different underlying pathophysiologies; myocardial inflammation and fibrosis seem to be the most important factors. Inflammatory processes and oxidative stress lead to cardiomyocyte necrosis, with subsequent electrical and structural remodeling. Furthermore, chronic inflammation is the pathophysiological basis linking AD to autonomic dysfunction, including sympathetic overactivation and a decline in parasympathetic function. Autoantibody-mediated inhibitory effects of cellular events (i.e., potassium or L-type calcium currents, M2muscarinic cholinergic or β1-adrenergic receptor signaling) can also lead to cardiac arrhythmia. Drug-induced arrhythmias, caused, for example, by corticosteroids, methotrexate, chloroquine, are also observed among AD patients. The most common arrhythmia in most AD presentations is atrial arrhythmia (primarily atrial fibrillation), expect for sarcoidosis and scleroderma, which are characterized by a higher burden of ventricular arrhythmia. Arrhythmia-associated mortality is highest among patients with sarcoidosis and lowest among those with AS; there are scant data related to mortality in patients with psoriasis, CD, and IBD.
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Affiliation(s)
- Monika Gawałko
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Paweł Balsam
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Piotr Lodziński
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Marcin Grabowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Bartosz Krzowski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Grzegorz Opolski
- 1st Chair and Department of Cardiology, Medical University of Warsaw
| | - Jędrzej Kosiuk
- 1st Chair and Department of Cardiology, Medical University of Warsaw.,Department of Electrophysiology, Helios Klinikum Koethen
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