Author + information
- Received October 23, 2019
- Revision received November 26, 2019
- Accepted November 29, 2019
- Published online May 25, 2020.
- Sameer Prasada, MDa,
- Adovich Rivera, MDa,
- Arvind Nishtala, MD, MPHb,
- Anna E. Pawlowski, MBAc,
- Arjun Sinha, MDb,
- Joshua D. Bundy, PhD, MPHd,
- Simran A. Chadha, BSe,
- Faraz S. Ahmad, MD, MSb,f,
- Sadiya S. Khan, MD, MSb,f,
- Chad Achenbach, MD, MPHf,g,
- Frank J. Palella Jr., MDg,
- Rosalind Ramsey-Goldman, MD, DrPHh,
- Yvonne C. Lee, MD, MMSch,
- Jonathan I. Silverberg, MD, PhD, MPHf,i,
- Babafemi O. Taiwo, MBBSg,
- Sanjiv J. Shah, MDb,
- Donald M. Lloyd-Jones, MD, ScMb,f and
- Matthew J. Feinstein, MD, MScb,f,∗ ()
- aFeinberg School of Medicine, Northwestern University, Chicago, Illinois
- bDivision of Cardiology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- cNorthwestern Medicine Enterprise Data Warehouse, Northwestern University, Chicago, Illinois
- dDepartment of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana
- eFeinberg School of Medicine, Northwestern University, Chicago, Illinois
- fDepartment of Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- gDivision of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- hDivision of Rheumatology, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- iDepartment of Dermatology and Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- ↵∗Address for correspondence:
Dr. Matthew J. Feinstein, Division of Cardiology, Department of Medicine, and Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 North Lake Shore Drive, Suite 1400, Chicago, Illinois 60611.
Objectives The purpose of this study was to compare the risks of incident heart failure (HF) among a variety of chronic inflammatory diseases (CIDs) and to determine whether risks varied by severity of inflammation within each CID.
Background Individuals with CIDs are at elevated risk for cardiovascular diseases, but data are limited regarding risk for HF.
Methods An electronic health records database from a large urban medical system was examined, comparing individuals with CIDs with frequency-matched controls without CIDs, all of whom were receiving regular outpatient care. Rates of incident HF were determined by using the Kaplan-Meier method and subsequently used multivariate-adjusted proportional hazards models to compare HF risks for each CID. Exploratory analyses determined HF risks by proxy measurement of CID severity.
Results Of 37,636 patients (n = 18,278 patients with CIDs; and n = 19,358 controls without CIDs) there were 960 incident HF cases over a median of 3.6 years. Risks for incident HF were significantly or borderline significantly elevated for patients with systemic sclerosis (hazard ratio [HR]: 7.26; 95% confidence interval [CI]: 5.72 to 9.21; p < 0.01), systemic lupus erythematosus (HR: 3.15; 95% CI: 2.41 to 4.11; p < 0.01), rheumatoid arthritis (HR: 1.39; 95% CI: 1.13 to 1.71; p < 0.01), and human immunodeficiency virus (HR: 1.28; 95% CI: 0.99 to 1.66; p = 0.06). There was no association between psoriasis or inflammatory bowel disease and incident HF, although patients with those CIDs with higher levels of C-reactive protein had higher risks for HF than controls.
Conclusions Systemic sclerosis and systemic lupus erythematosus were associated with the highest risks of HF, followed by rheumatoid arthritis and HIV. Measurements of inflammation were associated with HF risk across different CIDs.
Supported by American Heart Association Fellow-to-Faculty award 16FTF31200010 (to Dr. Feinstein) and by U.S. National Institutes of Health (NIH) grants P30AI117943 and UL1TR001422. Dr. Khan has received support from American Heart Association grant 19TPA34890060 and NIH grant KL2TR001424. Dr. Palella is a consultant and a member of the Speakers Bureau for Gilead Sciences, Janssen, ViiV, and Merck. Dr. Lee has received research support from Pfizer; and holds stock equity in Cigna Corp. Dr. Shah has received research grants from the National Institutes of Health (R01 HL107577, R01 HL127028, R01 HL140731, and R01 HL149423), Actelion, AstraZeneca, Corvia, and Novartis; and has served as a consultant or an Advisory Board member for Abbott, Actelion, AstraZeneca, Amgen, Bayer, Boehringer Ingelheim, Cardiora, Coridea, CVRx, Eisai, Ionis, Ironwood, Merck, MyoKardia, Novartis, Pfizer, Sanofi, Shifamed, Tenax, and United Therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Heart Failure author instructions page.
- Received October 23, 2019.
- Revision received November 26, 2019.
- Accepted November 29, 2019.
- 2020 American College of Cardiology Foundation
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