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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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2
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Tan E, Lee SSM, Poh KK, Xu C, Sia CH. Electrocardiographic manifestations of cardiac disorders in rheumatological conditions. Singapore Med J 2024; 65:410-414. [PMID: 38973190 PMCID: PMC11321537 DOI: 10.4103/singaporemedj.smj-2024-084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Accepted: 06/05/2024] [Indexed: 07/09/2024]
Affiliation(s)
- Elinor Tan
- Department of Cardiology, National University Heart Centre Singapore, Singapore
| | - Samuel Shang Ming Lee
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chuanhui Xu
- Department of Rheumatology, Allergy and Immunology, Tan Tock Seng Hospital, Singapore
| | - Ching-Hui Sia
- Department of Cardiology, National University Heart Centre Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
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3
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Buch MH, Bhatt DL, Charles-Schoeman C, Giles JT, Mikuls T, Koch GG, Ytterberg S, Nagy E, Jo H, Kwok K, Connell CA, Masri KR, Yndestad A. Risk of extended major adverse cardiovascular event endpoints with tofacitinib versus TNF inhibitors in patients with rheumatoid arthritis: a post hoc analysis of a phase 3b/4 randomised safety study. RMD Open 2024; 10:e003912. [PMID: 38609322 PMCID: PMC11029242 DOI: 10.1136/rmdopen-2023-003912] [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: 11/15/2023] [Accepted: 03/24/2024] [Indexed: 04/14/2024] Open
Abstract
OBJECTIVES Compare the risk of extended major adverse cardiovascular (CV) event (MACE) composite outcomes and component events in patients with rheumatoid arthritis (RA) treated with tofacitinib versus tumour necrosis factor inhibitors (TNFi) in Oral Rheumatoid Arthritis Trial (ORAL) Surveillance. METHODS Patients with RA aged ≥50 years and with ≥1 additional CV risk factor received tofacitinib 5 mg or 10 mg two times per day or TNFi. MACE (non-fatal myocardial infarction (MI), non-fatal stroke or CV death (MACE-3)) was extended by sequential addition of CV events (hospitalisation for unstable angina (MACE-4), coronary revascularisation (MACE-5), transient ischaemic attack (MACE-6), peripheral vascular disease (MACE-7)), heart failure (HF) hospitalisation (MACE-8) and venous thromboembolism (VTE; (MACE-8 plus VTE)). HRs (tofacitinib vs TNFi) were evaluated for MACE and individual components. RESULTS HRs for MACE-4 to MACE-8 with combined and individual tofacitinib doses versus TNFi were similar. Risk of MACE-8 plus VTE appeared similar with tofacitinib 5 mg two times per day versus TNFi (HR 1.12 (0.82 to 1.52)), but higher with tofacitinib 10 mg two times per day versus TNFi (HR 1.38 (1.02 to 1.85)). Risk of MI was higher with tofacitinib versus TNFi, but difference in risk of other individual CV events was not suggested. Across extended MACE definitions, risk appeared higher with tofacitinib versus TNFi in those with atherosclerotic CV disease or age ≥65 years. CONCLUSION In ORAL Surveillance, risk of composite CV endpoints combining all ischaemic CV events and HF did not appear different with tofacitinib versus TNFi. The totality of CV risk was higher with tofacitinib 10 mg two times per day versus TNFi, driven by an increase in VTE. TRIAL REGISTRATION NUMBER NCT02092467.
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Affiliation(s)
- Maya H Buch
- Centre for Musculoskeletal Research, Division of Musculoskeletal and Dermatological Sciences, The University of Manchester, Manchester, UK
- NIHR Manchester Biomedical Research Centre, Manchester, UK
| | - Deepak L Bhatt
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Health System, New York, New York, USA
| | - Christina Charles-Schoeman
- Division of Rheumatology, Department of Medicine, University of California, Los Angeles, California, USA
| | - Jon T Giles
- Division of Rheumatology, Columbia University, College of Physicians and Surgeons, New York, New York, USA
| | - Ted Mikuls
- Department of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gary G Koch
- University of North Carolina at Chapel Hill Department of Biostatistics, Chapel Hill, North Carolina, USA
| | - Steven Ytterberg
- Division of Rheumatology, Mayo Clinic, Rochester, Minnesota, USA
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4
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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: 0] [Impact Index Per Article: 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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5
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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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Dye C, Dela Cruz M, Larsen T, Nair G, Marinescu K, Suboc T, Engelstein E, Marsidi J, Patel P, Sharma P, Volgman AS. A review of the impact, pathophysiology, and management of atrial fibrillation in patients with heart failure with preserved ejection fraction. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2023; 33:100309. [PMID: 38510554 PMCID: PMC10946048 DOI: 10.1016/j.ahjo.2023.100309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Accepted: 07/11/2023] [Indexed: 03/22/2024]
Abstract
Patients with heart failure with preserved ejection fraction (HFpEF) and atrial fibrillation (AF) have increased mortality and increased risk of stroke. Due to the heterogeneous nature of both disease processes, it is difficult to ascertain whether the diagnosis and progression of AF is the cause of deterioration or if it is a symptom of worsening heart failure. This presents physicians with a clinical conundrum of whether optimizing their heart failure will decrease the overall AF burden or if restoration of sinus rhythm is necessary to optimize patients with HFpEF. In this paper, we will review the impact of AF in patients with HFpEF, the pathophysiology and heterogeneity of HFpEF and AF, and the management of these patients. As HFpEF and AF become more prevalent, managing these disease processes needs standardization to improve outcomes. Further research is needed to understand the complex interplay between AF and HFpEF to help determine the best management strategy.
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Affiliation(s)
- Cicely Dye
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Mark Dela Cruz
- Advocate Heart Institute, Advocate Christ Medical Center, Chicago, IL 60453, USA
| | - Timothy Larsen
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Gatha Nair
- Division of Cardiology, University of Washington, Seattle, WA 98105, USA
| | - Karolina Marinescu
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Tisha Suboc
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Erica Engelstein
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Jennifer Marsidi
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Priya Patel
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA
| | - Parikshit Sharma
- Division of Cardiology, Rush University Medical Center, Chicago, IL 60612, USA
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Zinellu A, Mangoni AA. A Systematic Review and Meta-Analysis of the Association between Uric Acid and Allantoin and Rheumatoid Arthritis. Antioxidants (Basel) 2023; 12:1569. [PMID: 37627564 PMCID: PMC10451740 DOI: 10.3390/antiox12081569] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2023] [Revised: 07/27/2023] [Accepted: 08/04/2023] [Indexed: 08/27/2023] Open
Abstract
Alterations in the circulating concentrations of uric acid and its degradation product, allantoin, might account for the systemic pro-oxidant state and the increased cardiovascular risk in rheumatoid arthritis (RA). We sought to address this issue by conducting a systematic review and meta-analysis of the association between the plasma/serum concentrations of uric acid and allantoin and RA. We searched PubMed, Scopus, and Web of Science from inception to 20 June 2023 for studies comparing plasma/serum concentrations of uric acid and allantoin between RA patients and healthy controls. We assessed the risk of bias with the JBI Critical Appraisal Checklist for analytical studies and the certainty of evidence with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) Working Group system. In the 19 studies selected for analysis, there were non-significant differences in uric acid concentrations between RA patients and controls (standard mean difference, SMD = 0.11, 95% CI -0.07 to 0.30, p = 0.22; I2 = 87.9%, p < 0.001; low certainty of evidence). By contrast, the concentrations of allantoin were significantly higher in RA patients (SMD = 1.10, 95% CI 0.66 to 1.55, p < 0.001; I2 = 55.6%, p = 0.08; extremely low certainty of evidence). In meta-regression, a significant association was observed between the SMD of uric acid concentrations and body mass index, a risk factor for atherosclerosis and cardiovascular disease (t = 3.35, p = 0.007). Our study has shown a significant increase in the concentrations of the oxidative stress biomarker allantoin in patients with RA. Further research is warranted to investigate the interplay between uric acid, allantoin, redox balance, and cardiovascular disease in this group. (PROSPERO registration number: CRD42023441127).
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Affiliation(s)
- Angelo Zinellu
- Department of Biomedical Sciences, University of Sassari, 07100 Sassari, Italy;
| | - Arduino A. Mangoni
- Discipline of Clinical Pharmacology, College of Medicine and Public Health, Flinders University, Bedford Park, SA 5042, Australia
- Department of Clinical Pharmacology, Flinders Medical Centre, Southern Adelaide Local Health Network, Bedford Park, SA 5042, Australia
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8
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Qian Y, Fei Z, Nian F. The Association Between Rheumatoid Arthritis and Atrial Fibrillation: Epidemiology, Pathophysiology and Management. Int J Gen Med 2023; 16:1899-1908. [PMID: 37223618 PMCID: PMC10202215 DOI: 10.2147/ijgm.s406926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 05/10/2023] [Indexed: 05/25/2023] Open
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia with a significant increase in morbidity and mortality worldwide. Rheumatoid arthritis (RA), as a systemic inflammatory disease, affecting 0.5-1.0% of the adult population, is associated with increased incidence of cardiac arrhythmias such as AF. Several epidemiologic studies find that the risk of AF is increased in RA when compared with the general population. Other studies are inconsistent. Considering that inflammation plays an important role in AF, RA may be involved in the occurrence and development of AF. This review summarizes the epidemiology, pathophysiology, and management of AF in patients with RA.
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Affiliation(s)
- Yezhou Qian
- Department of Cardiology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
| | - Zhangli Fei
- Department of Rheumatology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
| | - Feige Nian
- Department of Rheumatology, The First Hospital of Jiaxing, The Affiliated Hospital of Jiaxing University, Jiaxing, People’s Republic of China
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9
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Suh SH, Jung JH, Oh TR, Yang EM, Choi HS, Kim CS, Bae EH, Ma SK, Han KD, Kim SW. Rheumatoid arthritis and the risk of end-stage renal disease: A nationwide, population-based study. Front Med (Lausanne) 2023; 10:1116489. [PMID: 36817794 PMCID: PMC9932810 DOI: 10.3389/fmed.2023.1116489] [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: 12/05/2022] [Accepted: 01/18/2023] [Indexed: 02/05/2023] Open
Abstract
Introduction Despite the risk of incident chronic kidney disease among the patients with rheumatoid arthritis (RA), the association of RA and the risk of end-stage renal disease (ESRD) has not been clearly elucidated. We aimed to investigate the association of RA and the risk of ESRD. Materials and methods A total of 929,982 subjects with (n = 154,997) or without (n = 774,985) RA from the National Health Insurance Service (NHIS) database in Koreas (corresponding to the period between 2009 and 2017) were retrospectively analyzed. RA was defined by the International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM), codes plus any dispensing of disease-modifying anti-rheumatic drugs. The primary outcome was incident ESRD, identified by a combination of the ICD-10-CM codes and a special code assigned to patients receiving maintenance dialysis for ≥ 3 months or those with a transplant kidney. Results Compared to the subjects without RA, the subjects with RA resulted in an increased incidence of ESRD (incidence rates of 0.374 versus 0.810 cases per 1,000 person-years). Accordingly, compared to the subjects without RA, the risk of ESRD was significantly increased among the subjects with RA (adjusted hazard ratio 2.095, 95% confidence interval 1.902-2.308). Subgroup analyses revealed that the risk of ESRD imposed by RA is relatively higher in relatively young and healthy individuals. Conclusion Rheumatoid arthritis (RA) increase the risk of ESRD. As the risk of ESRD imposed by RA is relatively higher in relatively young and healthy individuals, kidney-protective treatment, such as biologic agents, should be preferentially considered among these patients with RA.
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Affiliation(s)
- Sang Heon Suh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Jin Hyung Jung
- Department of Biostatistics, College of Medicine, Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Ryom Oh
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Eun Mi Yang
- Department of Pediatrics, Chonnam National University Medical School, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Hong Sang Choi
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Chang Seong Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Eun Hui Bae
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Seong Kwon Ma
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea,*Correspondence: Kyung-Do Han,
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Medical School and Chonnam National University Hospital, Gwangju, Republic of Korea,Soo Wan Kim,
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10
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Tilly MJ, Geurts S, Zhu F, Bos MM, Ikram MA, de Maat MPM, de Groot NMS, Kavousi M. Autoimmune diseases and new-onset atrial fibrillation: a UK Biobank study. Europace 2022; 25:804-811. [PMID: 36546587 PMCID: PMC10062304 DOI: 10.1093/europace/euac244] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/21/2022] [Indexed: 12/24/2022] Open
Abstract
AIMS The underlying mechanisms of atrial fibrillation (AF) are largely unknown. Inflammation may underlie atrial remodelling. Autoimmune diseases, related to increased systemic inflammation, may therefore be associated with new-onset AF. METHODS AND RESULTS Participants from the population-based UK Biobank were screened for rheumatic fever, gastrointestinal autoimmune diseases, autoimmune diseases targeting the musculoskeletal system and connective tissues, and neurological autoimmune diseases. Between 2006 and 2022, participants were followed for incident AF. Cox proportional hazards regression analyses were performed to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) to quantify associations. 494 072 participants free from AF were included (median age 58.0 years, 54.8% women). After a median of 12.8 years, 27 194 (5.5%) participants were diagnosed with new-onset AF. Rheumatic fever without heart involvement (HR, 95% CI: 1.47, 1.26-1.72), Crohn's disease (1.23, 1.05-1.45), ulcerative colitis (1.17, 1.06-1.31), rheumatoid arthritis (1.39, 1.28-1.51), polyarteritis nodosa (1.82, 1.04-3.09), systemic lupus erythematosus (1.82, 1.41-2.35), and systemic sclerosis (2.32, 1.57-3.44) were associated with a larger AF risk. In sex-stratified analyses, rheumatic fever without heart involvement, multiple sclerosis, Crohn's disease, seropositive rheumatoid arthritis, psoriatic and enteropathic arthropathies, systemic sclerosis and ankylosing spondylitis were associated with larger AF risk in women, whereas only men showed a larger AF risk associated with ulcerative colitis. CONCLUSIONS Various autoimmune diseases are associated with new-onset AF, more distinct in women. Our findings elaborate on the pathophysiological differences in autoimmunity and AF risk between men and women.
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Affiliation(s)
- Martijn J Tilly
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Sven Geurts
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Fang Zhu
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Maxime M Bos
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Moniek P M de Maat
- Department of Hematology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Natasja M S de Groot
- Department of Cardiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Office Na-2714, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Semb AG, Rollefstad S, Sexton J, Ikdahl E, Crowson CS, van Riel P, Kitas G, Graham I, Kerola AM. Oral anticoagulant treatment in rheumatoid arthritis patients with atrial fibrillation results of an international audit. IJC HEART & VASCULATURE 2022; 42:101117. [PMID: 36118256 PMCID: PMC9479366 DOI: 10.1016/j.ijcha.2022.101117] [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: 08/23/2022] [Accepted: 08/31/2022] [Indexed: 11/22/2022]
Abstract
Objective To describe the prevalence of atrial fibrillation (AF) in patients with rheumatoid arthritis (RA), and to evaluate the proportion of patients with AF receiving guideline-recommended anticoagulation for prevention of stroke, based on data from a large international audit. Methods The cohort was derived from the international audit SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) which collected data from 17 countries during 2014-2019. We evaluated the prevalence of AF across world regions and explored factors associated with the presence of AF with multivariable logistic regression models. The proportion of AF patients at high risk of stroke (CHA2DS2-VASc ≥ 2 in males and ≥ 3 in females) receiving anticoagulation was examined. Results Of the total SURF-RA cohort (n = 14,503), we included RA cases with data on whether the diagnosis of AF was present or not (n = 7,665, 75.1% women, mean (SD) age 58.7 (14.1) years). A total of 288 (3.8%) patients had a history of AF (4.4% in North America, 3.4% in Western Europe, 2.8% in Central and Eastern Europe and 1.5% in Asia). Factors associated with the presence of AF were older age, male sex, atherosclerotic cardiovascular disease, heart failure and hypertension. Two-hundred and fifty-five (88.5%) RA patients had a CHA2DS2-VASc score indicating recommendation for oral anticoagulant treatment, and of them, 164 (64.3%) were anticoagulated. Conclusion Guideline-recommended anticoagulant therapy for prevention of stroke due to AF may not be optimally implemented among RA patients, and requires special attention.
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Affiliation(s)
- Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Joseph Sexton
- Division of Rheumatology and Research, REMEDY, Diakonhjemmet Hospital, Oslo, Norway
| | - Eirik Ikdahl
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Cynthia S Crowson
- Quantitative Health Sciences, Mayo Clinic Rochester, Rochester, MN, USA
| | - Piet van Riel
- IQ Healthcare, Radboud University Nijmegen, Nijmegen, the Netherlands
| | - George Kitas
- Department of Rheumatology, The Dudley Group NHS Foundation Trust, Dudley, UK
| | - Ian Graham
- Cardiology, The University of Dublin Trinity College, Dublin, Ireland
| | - Anne M Kerola
- Preventive Cardio-Rheuma Clinic, Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.,Inflammation Center, Helsinki University Hospital, Helsinki, Finland
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12
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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: 7] [Impact Index Per Article: 3.5] [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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13
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Ihara K, Sasano T. Role of Inflammation in the Pathogenesis of Atrial Fibrillation. Front Physiol 2022; 13:862164. [PMID: 35492601 PMCID: PMC9047861 DOI: 10.3389/fphys.2022.862164] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Accepted: 03/21/2022] [Indexed: 12/15/2022] Open
Abstract
Atrial fibrillation (AF) is one of the most common arrhythmias encountered in clinical practice. AF is a major risk factor for stroke, which is associated with high mortality and great disability and causes a significant burden on society. With the development of catheter ablation, AF has become a treatable disease, but its therapeutic outcome has been limited so far. In persistent and long-standing AF, the expanded AF substrate is difficult to treat only by ablation, and a better understanding of the mechanism of AF substrate formation will lead to the development of a new therapeutic strategy for AF. Inflammation is known to play an important role in the substrate formation of AF. Inflammation causes and accelerates the electrical and structural remodeling of the atria via pro-inflammatory cytokines and other inflammatory molecules, and enhances the AF substrate, leading to the maintenance of AF and further inflammation, which forms a vicious spiral, so-called “AF begets AF”. Breaking this vicious cycle is expected to be a key therapeutic intervention in AF. In this review, we will discuss the relationship between AF and inflammation, the inflammatory molecules included in the AF-related inflammatory process, and finally the potential of those molecules as a therapeutic target.
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Affiliation(s)
- Kensuke Ihara
- Department of Bio-informational Pharmacology, Medical Research Institute, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tetsuo Sasano
- Department of Cardiovascular Medicine, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
- *Correspondence: Tetsuo Sasano,
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14
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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: 10] [Impact Index Per Article: 3.3] [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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15
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Hussain S, Singh A, Antony B, Claure-Del Granado R, Klugarová J, Líčeník R, Klugar M. Association of Acute Kidney Injury with the Risk of Dementia: A Meta-Analysis. J Clin Med 2021; 10:4390. [PMID: 34640408 PMCID: PMC8509598 DOI: 10.3390/jcm10194390] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Revised: 09/16/2021] [Accepted: 09/20/2021] [Indexed: 11/16/2022] Open
Abstract
Acute kidney injury (AKI) is associated with several adverse outcomes, including new or progressive chronic kidney disease, end-stage kidney disease, and mortality. Epidemiological studies have reported an association between AKI and dementia as a long-term adverse outcome. This meta-analysis was aimed to understand the association between AKI and dementia risk. A literature search was performed in MEDLINE and Embase databases, from inception to July 2021, to identify epidemiological studies reporting the association between AKI and dementia risk. Title and abstract followed by the full-text of retrieved articles were screened, data were extracted, and quality was assessed, using the Newcastle-Ottawa scale by two investigators independently. The primary outcome was to compute the pooled risk of dementia in AKI patients. Subgroup analysis was also performed based on age and co-morbidities. Certainty of evidence was assessed using the GRADE approach. Statistical analysis was performed using Review Manager 5.4 software. Four studies (cohort (n = 3) and case-control (n = 1)) with a total of 429,211 patients, of which 211,749 had AKI, were identified. The mean age of the patients and the follow-up period were 64.15 ± 16.09 years and 8.9 years, respectively. Included studies were of moderate to high quality. The pooled estimate revealed a significantly higher risk of dementia in AKI patients with an overall relative risk/risk ratio (RR) of 1.92 (95% CI: 1.52-2.43), p ≤ 0.00001. Dementia risk increases by 10% with one year increase in age with an RR of 1.10 (95% CI: 1.09-1.11), p < 0.00001. Subgroup analysis based on stroke as a co-morbid condition also revealed significantly higher dementia risk in AKI patients (RR 2.30 (95% CI: 1.62-3.28), p = 0.009). All-cause mortality risk was also significantly higher in AKI patients with dementia with a pooled RR of 2.11 (95% CI: 1.20-3.70), p = 0.009. The strength of the evidence was of very low certainty as per the GRADE assessment. Patients with AKI have a higher risk of dementia. Further large epidemiological studies are needed to confirm the mechanistic association.
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Affiliation(s)
- Salman Hussain
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre Cochrane, Czech Republic), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (R.L.); (M.K.)
| | - Ambrish Singh
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia; (A.S.); (B.A.)
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, 17 Liverpool Street, Hobart, TAS 7000, Australia; (A.S.); (B.A.)
| | - Rolando Claure-Del Granado
- Division of Nephrology, Hospital Obrero No 2–CNS, Cochabamba, Bolivia;
- Universidad Mayor de San Simon School of Medicine, Cochabamba, Bolivia
| | - Jitka Klugarová
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre Cochrane, Czech Republic), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (R.L.); (M.K.)
| | - Radim Líčeník
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre Cochrane, Czech Republic), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (R.L.); (M.K.)
| | - Miloslav Klugar
- Czech National Centre for Evidence-Based Healthcare and Knowledge Translation (Czech EBHC: JBI Centre of Excellence, Masaryk University GRADE Centre Cochrane, Czech Republic), Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 5, 625 00 Brno, Czech Republic; (J.K.); (R.L.); (M.K.)
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16
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Yun JP, Choi EK, Han KD, Park SH, Jung JH, Park SH, Ahn HJ, Lim JH, Lee SR, Oh S. Risk of Atrial Fibrillation According to Cancer Type: A Nationwide Population-Based Study. JACC: CARDIOONCOLOGY 2021; 3:221-232. [PMID: 34396327 PMCID: PMC8352078 DOI: 10.1016/j.jaccao.2021.03.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Revised: 03/10/2021] [Accepted: 03/12/2021] [Indexed: 02/07/2023]
Abstract
Background Patients with cancer have an increased risk of atrial fibrillation (AF). However, there is a paucity of information regarding the association between cancer type and risk of AF. Objectives This study sought to evaluate the risk of AF according to the type of cancer. Methods We enrolled 816,811 patients who were diagnosed with cancer from the Korean National Health Insurance Service database between 2009 and 2016. Age- and sex-matched noncancer control subjects (1:2; n = 1,633,663) were also selected. Newly diagnosed AF was identified based on the type of cancer. Results During a median follow-up of 4.5 years, AF was newly diagnosed in 25,356 patients with cancer (6.6 per 1,000 person-years). In multivariable Fine and Gray’s regression analysis, cancer was an independent risk factor for incident AF (adjusted subdistribution hazard ratio [aHR]: 1.63; 95% confidence interval [CI]: 1.61 to 1.66). Multiple myeloma showed a higher association with incident AF (aHR: 3.34; 95% CI: 2.98 to 3.75). Esophageal cancer showed the highest risk among solid cancers (aHR: 2.69; 95% CI: 2.45 to 2.95), and stomach cancer showed the lowest association with AF risk (aHR: 1.27; 95% CI 1.23 to 1.32). Conclusions Although patients with cancer were found to have a higher risk of AF, the impact on AF development varied by cancer type.
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Key Words
- AF, atrial fibrillation
- CI, confidence interval
- CKD, chronic kidney disease
- CNS, central nervous system
- CVD, cardiovascular disease
- DM, diabetes mellitus
- HR, hazard ratio
- ICD-10, International Classification of Diseases–10th Revision
- IQR, interquartile range
- NHIS, National Health Insurance Service
- atrial fibrillation
- cancer
- epidemiology
- type of cancer
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Affiliation(s)
- Jun Pil Yun
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea
| | - Sang Hyun Park
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sang Hyeon Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo-Jeong Ahn
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jae-Hyun Lim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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17
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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: 1.0] [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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18
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Naaraayan A, Meredith A, Nimkar A, Arora G, Bharati R, Acharya P. Arrhythmia prevalence among patients with polymyositis-dermatomyositis in the United States: An observational study. Heart Rhythm 2021; 18:1516-1523. [PMID: 34048962 DOI: 10.1016/j.hrthm.2021.05.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/03/2021] [Accepted: 05/19/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Systemic inflammation has been associated with atherosclerotic cardiovascular diseases (ASCVD) and arrhythmia occurrence in rheumatologic conditions such as rheumatoid arthritis. Polymyositis and dermatomyositis (PD) are rare rheumatologic conditions characterized by symmetrical proximal muscle weakness and, in the case of dermatomyositis, cutaneous eruption. Although there is literature associating PD with ASCVD, no population-level studies have analyzed arrhythmia risk in PD. OBJECTIVE The purpose of this study was to assess the prevalence of arrhythmia and its subtypes by age and sex in patients with PD and to determine associations between arrhythmia and PD. METHODS This retrospective cohort study included adults for whom hospitalizations had been recorded in the National Inpatient Sample database in the United States between 2016 and 2018. Patients with PD were matched (1:10) by age to patients without PD. Prevalence of arrhythmia was calculated in the 2 groups and compared by sex and age groups. Associations between PD and arrhythmia were determined after adjustment for common arrhythmia risk factors. RESULTS From 107,001,355 hospitalizations, 32,085 adults with PD were matched to 320,850 controls. Patients with PD aged <70 years had a higher prevalence of arrhythmia and higher adjusted odds of arrhythmia compared with controls. This increased risk was only seen for supraventricular arrhythmias. Adults with PD had increased odds of in-hospital mortality if they had an arrhythmia diagnosis (odds ratio 3.3; 95% confidence interval 2.5-4.5; P <.001). CONCLUSION We found a higher prevalence and odds of arrhythmias, particularly supraventricular arrhythmias, in young and middle-aged patients with PD compared with matched controls. Arrhythmias were associated with significant mortality among patients with PD.
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Affiliation(s)
- Ashutossh Naaraayan
- Department of Medicine, Montefiore New Rochelle Hospital, New Rochelle, New York.
| | - Amanda Meredith
- Department of Medicine, Rutgers University Medical Center, Newark, New Jersey
| | - Abhishek Nimkar
- Department of Medicine, Montefiore New Rochelle Hospital, New Rochelle, New York
| | - Geetika Arora
- Department of Medicine, Mt Sinai Beth Israel, New York, New York
| | - Rajani Bharati
- Department of Community Health and Health Policy, CUNY Graduate School of Public Health and Health Policy, New York, New York
| | - Prakash Acharya
- Department of Cardiology, University of Kansas Medical Center, Kansas City, Kansas
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19
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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: 1.7] [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: 03/18/2021] [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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20
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Chen L, Jiang C. Does Chronic Intestinal Inflammation Promote Atrial Fibrillation: A Mendelian Randomization Study With Populations of European Ancestry. Front Cardiovasc Med 2021; 8:641291. [PMID: 34041279 PMCID: PMC8141578 DOI: 10.3389/fcvm.2021.641291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/23/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Inflammatory bowel disease (IBD), comprising ulcerative colitis (UC), and Crohn's disease (CD), has been reported to be associated with an increased risk of atrial fibrillation (AF). However, the causal role of the chronic intestinal inflammation (CII) in the development of AF remains controversial. We use Mendelian randomization (MR) analysis to explore the causal inference of CII on AF. Methods: A two-sample MR analysis was performed to estimate the potential causal effect of CII on AF. Statistical summaries for the associations between single nucleotide polymorphisms (SNPs) and phenotypes of CII were obtained from genome-wide association studies (GWAS) with cohorts of CD (n = 51,874), UC (n = 47,745), and IBD (n = 65,642) of European descent. The GWAS of 1,030,836 people of European ancestry, including 60,620 AF cases and 970,216 controls was collected to identify genetic variants underlying AF. The causal inference was estimated using the multiplicative random effects inverse-variance weighted method (IVW). The methods of MR-Egger, simple median, and weighted median were also employed to avoid the bias of pleiotropy effects. Results: Using three sets of SNPs (75 SNPs of CD, 60 SNPs of UC, and 95 SNPs of IBD), multiplicative random-effect IVW model estimated a universal null effect of CII on AF (CD: OR = 1.0059, 95% CI: 0.9900, 1.0220, p = 0.47; UC: OR = 1.0087, 95% CI: 0.9896, 1.0281, p = 0.38; IBD: OR = 1.0080, 95% CI: 0.9908, 1.0255, p = 0.37). Similar results were observed using the MR-Egger, simple median, weighted median methods. Conclusion: As opposing to the traditional observational studies, our two-sample MR analysis did not find enough evidence to support a causal role of either CD or UC in the development of AF.
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Affiliation(s)
- LaiTe Chen
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - ChenYang Jiang
- Department of Cardiology of Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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21
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Cardiovascular Risk Factors from Another Point of View. JOURNAL OF INTERDISCIPLINARY MEDICINE 2021. [DOI: 10.2478/jim-2021-0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Cardiovascular diseases remain the main cause of death in western societies. This contributes to the appearance of new diagnostic and treatment methods addressed to reduce the burden of cardiovascular diseases. In the last decades new imaging methods have emerged; furthermore, routine biomarkers were found to be useful in cardiovascular risk stratification. Data reviewed in this article emphasize the multifactorial etiology of cardiovascular disease. The authors describe the role of inflammation in the precipitation and progression of atherosclerosis and atrial fibrillation. Affordable and well-known inflammatory markers can be used alone or in combination with new imaging methods for a better cardiovascular risk stratification. Coronary computed tomographic angiography findings and inflammatory markers are capable to identify patients with high risk of major adverse cardiovascular events or atrial fibrillation. Furthermore, they also have an important role in the choice of treatment strategy and follow-up.
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22
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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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23
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The risk of leukemia in patients with rheumatoid arthritis: a systematic review and meta-analysis. Clin Rheumatol 2020; 40:1283-1289. [PMID: 32939570 DOI: 10.1007/s10067-020-05396-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 08/18/2020] [Accepted: 09/12/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES The relationship between rheumatoid arthritis (RA) and the risk of leukemia was still controversial. This study aimed to assess the risk of leukemia in patients with rheumatoid arthritis by systematic review and meta-analysis. METHODS Relevant studies were identified by searching PubMed, Embase, Cochrane Library, and SinoMed up to December 2019. Random effects model analysis was used to pool standardized incidence ratios (SIRs) and 95% confidence interval. RESULTS A total of 15 relevant studies that met the criteria were included. Compared with the general population, patients with RA showed an increased risk of leukemia (SIR = 1.51, 95% CI: 1.34-1.70). The statistical heterogeneity was moderate with an I2 of 55.5%. In subgroup analysis, the source of heterogeneity may be due to differences in sample size. Publication bias was not found in the Begg funnel plot and the Egger test. CONCLUSION Our findings suggested that the risk of leukemia in RA was increased compared with the general population. Key points • This is the first systematic review and meta-analysis to assess the risk of leukemia in RA. • Our study suggested that the risk of leukemia in RA was increased compared with the general population. • This study indicated that the risk of leukemia in RA was higher in non-Asian populations.
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24
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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: 7] [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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25
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Kawai VK, Shi M, Feng Q, Chung CP, Liu G, Cox NJ, Jarvik GP, Lee MTM, Hebbring SJ, Harley JB, Kaufman KM, Namjou B, Larson E, Gordon AS, Roden DM, Stein CM, Mosley JD. Pleiotropy in the Genetic Predisposition to Rheumatoid Arthritis: A Phenome-Wide Association Study and Inverse Variance-Weighted Meta-Analysis. Arthritis Rheumatol 2020; 72:1483-1492. [PMID: 32307929 DOI: 10.1002/art.41291] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/14/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE This study was undertaken to investigate the hypothesis that a genetic predisposition toward rheumatoid arthritis (RA) increases the risk of 10 cardiometabolic and autoimmune disorders previously associated with RA in epidemiologic studies, and to define new genetic pleiotropy present in RA. METHODS Two approaches were used to test our hypothesis. First, we constructed a weighted genetic risk score (wGRS) and then examined its association with 10 prespecified disorders. Additionally, a phenome-wide association study (PheWAS) was carried out to identify potential new associations. Second, inverse variance-weighted regression (IVWR) meta-analysis was used to characterize the association between genetic susceptibility to RA and the prespecified disorders, with the results expressed as odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS The wGRS for RA was significantly associated with type 1 diabetes mellitus (DM) (OR 1.10 [95% CI 1.04-1.16]; P = 9.82 × 10-4 ) and multiple sclerosis (OR 0.82 [95% CI 0.77-0.88]; P = 1.73 × 10-8 ), but not with other cardiometabolic phenotypes. In the PheWAS, wGRS was also associated with an increased risk of several autoimmune phenotypes including RA, thyroiditis, and systemic sclerosis, and with a decreased risk of demyelinating disorders. In the IVWR meta-analyses, RA was significantly associated with an increased risk of type 1 DM (P = 1.15 × 10-14 ), with evidence of horizontal pleiotropy (Mendelian Randomization-Egger intercept estimate P = 0.001) likely driven by rs2476601, a PTPN22 variant. The association between type 1 DM and RA remained significant (P = 9.53 × 10-9 ) after excluding rs2476601, with no evidence of horizontal pleiotropy (intercept estimate P = 0.939). RA was also significantly associated with type 2 DM and C-reactive protein levels. These associations were driven by variation in the major histocompatibility complex region. CONCLUSION This study presents evidence of pleiotropy between the genetic predisposition to RA and associated phenotypes found in other autoimmune and cardiometabolic disorders, including type 1 DM.
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Affiliation(s)
- Vivian K Kawai
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mingjian Shi
- Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Qiping Feng
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Cecilia P Chung
- Vanderbilt University Medical Center, Tennessee Valley Healthcare System Nashville Campus, and Vanderbilt University School of Medicine, Nashville, Tennessee
| | - Ge Liu
- Vanderbilt University Medical Center, Nashville, Tennessee
| | - Nancy J Cox
- Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | | | | | - John B Harley
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, and Cincinnati VA Medical Center, Cincinnati, Ohio
| | - Kenneth M Kaufman
- Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, and Cincinnati VA Medical Center, Cincinnati, Ohio
| | - Bahram Namjou
- Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Eric Larson
- Kaiser Permanente Washington Health Research Institute, Seattle
| | - Adam S Gordon
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Dan M Roden
- Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee
| | | | - Jonathan D Mosley
- Vanderbilt University Medical Center and Vanderbilt University School of Medicine, Nashville, Tennessee
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26
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Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol 2020; 16:361-379. [PMID: 32494054 DOI: 10.1038/s41584-020-0428-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 12/18/2022]
Abstract
Patients with rheumatoid arthritis (RA) are at high risk of developing cardiovascular disease (CVD). Inflammation has a pivotal role in the pathogenesis of CVD. RA is an inflammatory joint disease and, compared with the general population, patients with RA have approximately double the risk of atherosclerotic CVD, stroke, heart failure and atrial fibrillation. Although this high risk of CVD has been known for decades, patients with RA receive poorer primary and secondary CVD preventive care than other high-risk patients, and an unmet need exists for improved CVD preventive measures for patients with RA. This Review summarizes the evidence for atherosclerotic CVD in patients with RA and provides a contemporary analysis of what is known and what needs to be further clarified about recommendations for CVD prevention in patients with RA compared with the general population. The management of traditional CVD risk factors, including blood pressure, lipids, diabetes mellitus and lifestyle-related risk factors, as well as the effects of inflammation and the use of antirheumatic medication on CVD risk and risk management in patients with RA are discussed. The main aim is to provide a roadmap of atherosclerotic CVD risk management and prevention for patients with RA.
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27
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Packer M. Link Between Synovial and Myocardial Inflammation: Conceptual Framework to Explain the Pathogenesis of Heart Failure with Preserved Ejection Fraction in Patients with Systemic Rheumatic Diseases. Card Fail Rev 2020. [DOI: 10.15420/cfr.2019.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients with a broad range of systemic rheumatic diseases are at increased risk of heart failure (HF), an event that is not related to traditional cardiovascular risk factors or underlying ischaemic heart disease. The magnitude of risk is linked to the severity of arthritic activity, and HF is typically accompanied by a preserved ejection fraction. Subclinical evidence for myocardial fibrosis, microcirculatory dysfunction and elevated cardiac filling pressures is present in a large proportion of patients with rheumatic diseases, particularly those with meaningful systemic inflammation. Drugs that act to attenuate pro-inflammatory pathways (methotrexate and antagonists of tumour necrosis factor and interleukin-1) may ameliorate myocardial inflammation and cardiac structural abnormalities and reduce the risk of HF events.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, US and Imperial College, London, UK
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28
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Zhou X, Dudley SC. Evidence for Inflammation as a Driver of Atrial Fibrillation. Front Cardiovasc Med 2020; 7:62. [PMID: 32411723 PMCID: PMC7201086 DOI: 10.3389/fcvm.2020.00062] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 03/26/2020] [Indexed: 12/31/2022] Open
Abstract
Atrial fibrillation (AF) is one of the most common types of arrhythmias and increases cardiovascular morbidity and mortality. Current therapeutic approaches to AF that focus on rhythm control have high recurrence rates and no life prolongation value. While possible explanations include toxicity of current therapies, another likely explanation may be that current therapies do not address fundamental mechanisms of AF initiation and maintenance. Inflammation has been shown to affect signaling pathways that lead to the development of AF. This paper reviews the roles of inflammation in the occurrence, development, and mechanisms of AF and reviews the therapeutic implications of the correlation of inflammation and AF.
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Affiliation(s)
- Xiaoxu Zhou
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota at Twin Cities, Minneapolis, MN, United States
| | - Samuel C Dudley
- Division of Cardiology, Department of Medicine, the Lillehei Heart Institute, University of Minnesota at Twin Cities, Minneapolis, MN, United States
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29
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Environmental factors, serum biomarkers and risk of atrial fibrillation: an exposure-wide umbrella review of meta-analyses. Eur J Epidemiol 2020; 35:223-239. [PMID: 32180061 DOI: 10.1007/s10654-020-00618-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 02/24/2020] [Indexed: 01/05/2023]
Abstract
Atrial fibrillation (AF) is the most common cardiac arrhythmia. We designed an umbrella review to systematically assess the epidemiological credibility of the associations of non-genetic factors with risk of AF. We searched PubMed and EMBASE from inception to December 31, 2018 to identify systematic reviews and meta-analyses of observational studies for the association of non-genetic factors with risk of AF. For each meta-analysis, we used the random-effects model, and we estimated the 95% confidence and prediction intervals. We also assessed between-study heterogeneity, small-study effects and excess significance bias. We identified 34 eligible papers that examined 51 associations of 42 unique non-genetic factors with risk of AF. Eighteen associations remained statistically significant at P value < 1 × 10-6. Thirty-one associations presented large or very large between-study heterogeneity. Eight associations presented evidence for small-study effects and 13 associations had evidence for excess significance bias. Ten associations, i.e. corrected QT interval, alcohol consumption (highest vs. lowest category, per 1 drink/day increase), body mass index (> 30 units vs. < 30 units, per 5 units increase), waist circumference, body weight, type 2 diabetes mellitus, and smoking (ever vs. never, per 10 cigarettes/day increase) were supported by convincing or highly suggestive evidence in meta-analyses of prospective cohort studies. Type 2 diabetes mellitus, markers of adiposity, alcohol consumption, smoking, and corrected QT interval constitute credible risk factors of AF. Our proposed grading may guide the design of future studies, including Mendelian randomization studies, to assess whether these associations are causal.
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30
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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: 0.5] [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: 48] [Impact Index Per Article: 12.0] [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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32
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Packer M. Potential Role of Atrial Myopathy in the Pathogenesis of Stroke in Rheumatoid Arthritis and Psoriasis: A Conceptual Framework and Implications for Prophylaxis. J Am Heart Assoc 2020; 9:e014764. [PMID: 31973602 PMCID: PMC7033881 DOI: 10.1161/jaha.119.014764] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute Baylor University Medical Center Dallas TX.,Imperial College London United Kingdom
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33
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Patients with rheumatoid arthritis have an increased risk of incident chronic kidney disease: a systematic review and meta-analysis of cohort studies. Int Urol Nephrol 2019; 52:147-154. [PMID: 31820358 DOI: 10.1007/s11255-019-02346-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVES Patients with rheumatoid arthritis (RA) may have a higher risk of developing chronic kidney (CKD) compared with general population, but the data on this risk are still not well characterized. This systematic review and meta-analysis aimed to comprehensively investigate this association by reviewing all available studies. METHODS A systematic review was performed using MEDLINE and EMBASE database from inception to July 2019 to identify all cohort studies that compared the risk of developing CKD after index date among patients with RA versus individuals without RA. Pooled risk ratio and 95% confidence interval (CI) were calculated using random-effect, generic inverse-variance method of DerSimonian and Laird. RESULTS A total of four cohort studies (three retrospective cohort studies and four prospective cohort study) comprising of 1,627,833 participants met the inclusion criteria and were included in the meta-analysis. The overall quality of the included studies was good. The risk of incident CKD was significantly increased among patients with RA with the pooled risk ratio of 1.52 (95% CI 1.28-1.80). The statistical heterogeneity was high with an I2 of 82%. CONCLUSIONS A significantly increased risk of incident CKD among patients with RA compared with individuals without RA was demonstrated in this study.
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34
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Drugs That Ameliorate Epicardial Adipose Tissue Inflammation May Have Discordant Effects in Heart Failure With a Preserved Ejection Fraction as Compared With a Reduced Ejection Fraction. J Card Fail 2019; 25:986-1003. [DOI: 10.1016/j.cardfail.2019.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 02/08/2023]
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35
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Neef M, Berndt K, Spies C, Laufs U, Metze M. [Cardiac arrhythmias in patients with chronic autoimmune diseases]. Herzschrittmacherther Elektrophysiol 2019; 30:240-244. [PMID: 31444570 DOI: 10.1007/s00399-019-00636-z] [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: 07/12/2019] [Accepted: 07/19/2019] [Indexed: 06/10/2023]
Abstract
Chronic inflammation due to autoimmune diseases is associated with a higher rate of supraventricular and ventricular arrhythmias leading to an increased risk for cardiovascular morbidity and mortality. Involvement of the cardiac conduction system is common in patients with chronic autoimmune diseases, although the penetrance of clinical signs and symptoms is variable and complete heart block with need for therapy is rare. The combination of the increased prevalence of structural cardiovascular disease and the direct impact of inflammatory mechanisms on cardiac electrophysiology seems to be responsible for the higher rate of tachyarrhythmias. In particular, fibroblast activation, gap junction impairment via changes in connexin composition and abnormalities in intracellular calcium-handling are mentioned. Electrocardiographic markers of an increased arrhythmogenic potential in patients with chronic autoimmune disorders may include prolonged P‑wave duration as well as abnormal QTc interval and reduced heart rate variability. Thus, minimizing the inflammatory burden through tight control of disease activity may help reduce the arrhythmic load.
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Affiliation(s)
- Martin Neef
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland.
| | - Katharina Berndt
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Christian Spies
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
| | - Michael Metze
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Liebigstraße 20, 04103, Leipzig, Deutschland
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Trends of Cardiac Complications in Patients With Rheumatoid Arthritis: Analysis of the United States National Inpatient Sample; 2005-2014. Curr Probl Cardiol 2019; 46:100455. [PMID: 31526517 DOI: 10.1016/j.cpcardiol.2019.100455] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 07/10/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is a chronic inflammatory condition. Chronic inflammation is associated with atherosclerosis, hypertension, diabetes, chronic obstructive pulmonary disease (COPD), chronic kidney disease. But sparse data are available regarding the trends of cardiovascular diseases and complications in RA. We conducted a National Inpatient Sample database analysis to demonstrate the trends of cardiac complications in patients with RA. METHODS We used National Inpatient Sample data from 2005 to 2014 to identify admissions with the diagnosis of RA and identified who had associated cardiovascular complications also. The International Classification of Diseases-9th Revision-Clinical Modification codes were used for the diagnoses of RA; congestive heart failure (CHF), acute myocardial infarction (AMI), and atrial fibrillation (AF). RESULTS A statistically significant increasing trend of AMI, CHF, and AF was found. Independent predictors of mortality in RA patients with AMI were age (OR 1.03, CI 1.02-1.04; P < 0.001), COPD (OR 1.67, CI 1.40-2.00; P < 0.001), cerebrovascular disease (OR 2.207, CI 1.71-2.86; P < 0.001), renal disease (OR 1.42, CI 1.16-1.75; P = 0.001), and alcohol abuse (OR 2.73, CI 1.73-4.32; P < 0.001). Independent predictors of mortality in RA patients with CHF were age (odds ratio [OR] 1.02, confidence interval [CI] 1.017-1.024; P < 0.001]), COPD (OR 1.09, CI 1.01-1.18; P = 0.023), cerebrovascular disease (OR 1.67, CI 1.44-1.95; P < 0.001), renal disease (OR 1.16, CI 1.07-1.27; P = 0.001). Independent predictors of mortality in RA patients with AF were age (OR 1.02, CI 1.02-1.03; P < 0.001), race (OR 1.16, CI 1.02-1.31; P = 0.022), COPD (OR 1.56, CI 1.42-1.71; P < 0.001), peripheral arterial disease (OR 1.34, CI 1.16-1.53; P < 0.001), cerebrovascular disease (OR 2.27, CI 1.0-2.58; P < 0.001), renal disease (OR 1.60, CI 1.44-1.80; P < 0.001). The mortality trend has increased significantly in the CHF (P = 0.025) and AF (P = 0.042) groups during this study period. CONCLUSIONS We have found a significant increase in trend of cardiovascular complications in RA patients. The proportion of patients, with cardiovascular comorbidities, have also been increased significantly.
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Lazzerini PE, Laghi‐Pasini F, Acampa M, Srivastava U, Bertolozzi I, Giabbani B, Finizola F, Vanni F, Dokollari A, Natale M, Cevenini G, Selvi E, Migliacci N, Maccherini M, Boutjdir M, Capecchi PL. Systemic Inflammation Rapidly Induces Reversible Atrial Electrical Remodeling: The Role of Interleukin-6-Mediated Changes in Connexin Expression. J Am Heart Assoc 2019; 8:e011006. [PMID: 31423933 PMCID: PMC6759884 DOI: 10.1161/jaha.118.011006] [Citation(s) in RCA: 87] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 06/11/2019] [Indexed: 12/17/2022]
Abstract
Background Systemic inflammation is a strong predictor of atrial fibrillation. A key role for electrical remodeling is increasingly recognized, and experimental data suggest that inflammatory cytokines can directly affect connexins resulting in gap-junction dysfunction. We hypothesized that systemic inflammation, regardless of its origin, promotes atrial electric remodeling in vivo, as a result of cytokine-mediated changes in connexin expression. Methods and Results Fifty-four patients with different inflammatory diseases and elevated C-reactive protein were prospectively enrolled, and electrocardiographic P-wave dispersion indices, cytokine levels (interleukin-6, tumor necrosis factor-α, interleukin-1, interleukin-10), and connexin expression (connexin 40, connexin 43) were measured during active disease and after reducing C-reactive protein by >75%. Moreover, peripheral blood mononuclear cells and atrial tissue specimens from an additional sample of 12 patients undergoing cardiac surgery were evaluated for atrial and circulating mRNA levels of connexins. Finally, in vitro effects of interleukin-6 on connexin expression were studied in HL-1 mouse atrial myocytes. In patients with active inflammatory diseases, P-wave dispersion indices were increased but rapidly decreased within days when C-reactive protein normalizes and interleukin-6 levels decline. In inflammatory disease patients, both P-wave dispersion indices and interleukin-6 changes were inversely associated with circulating connexin levels, and a positive correlation between connexin expression in peripheral blood mononuclear cells and atrial tissue was demonstrated. Moreover, interleukin-6 significantly reduced connexin expression in HL-1 cells. Conclusions Our data suggest that regardless of specific etiology and organ localization, systemic inflammation, via interleukin-6 elevation, rapidly induces atrial electrical remodeling by down-regulating cardiac connexins. Although transient, these changes may significantly increase the risk for atrial fibrillation and related complications during active inflammatory processes.
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Affiliation(s)
| | - Franco Laghi‐Pasini
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | | | - Ujala Srivastava
- Cardiovascular Research ProgramVA New York Harbor Healthcare SystemBrooklyn, New YorkNY
- Department of Medicine, Cell Biology and PharmacologyState University of New York Downstate Medical CenterBrooklyn, New YorkNY
| | - Iacopo Bertolozzi
- Cardiology Intensive Therapy UnitDepartment of Internal MedicineHospital of CarraraItaly
| | - Beatrice Giabbani
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Francesco Finizola
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Francesca Vanni
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Aleksander Dokollari
- Department of Cardiac SurgeryUniversity Hospital of SienaItaly
- Department of Cardiovascular SurgerySaint Michael HospitalUniversity of TorontoOntarioCanada
| | - Mariarita Natale
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | | | - Enrico Selvi
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | - Nicola Migliacci
- Department of Medical Sciences, Surgery and NeurosciencesUniversity of SienaItaly
| | | | - Mohamed Boutjdir
- Cardiovascular Research ProgramVA New York Harbor Healthcare SystemBrooklyn, New YorkNY
- Department of Medicine, Cell Biology and PharmacologyState University of New York Downstate Medical CenterBrooklyn, New YorkNY
- Department of MedicineNYU School of MedicineNew YorkNY
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Cardiac and vascular complications in rheumatoid arthritis. Reumatologia 2019; 57:27-36. [PMID: 30858628 PMCID: PMC6409824 DOI: 10.5114/reum.2019.83236] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/23/2019] [Indexed: 12/25/2022] Open
Abstract
Rheumatoid arthritis (RA) is an independent risk factor for the development of a variety of cardiovascular diseases, with a 1.5-factor increase in risk. This literature review aims to provide a global overview of the pathogenesis, effects of anti-rheumatoid treatment on cardiovascular risk, a description of the cardiovascular complications associated with RA, and current opinion on cardiovascular risk assessment and management in patients with RA. Author conducted a literature search in PubMed, Scopus, Web of Science and Embase regarding RA and associated cardiovascular complications. The mechanism of increased risk of cardiovascular disease in patients with RA is complex. There are specific genetic factors associated with both diseases, and traditional cardiovascular risk factors may be more prevalent in patients with RA. Most anti-rheumatic drugs decrease cardiovascular risk, and general recommendations focus on reduction of disease activity and strict management of cardiovascular risk as per the general population.
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Novikova DS, Kirillova IG, Udachkina HV, Popkova TV. Chronic Heart Failure in Rheumatoid Arthritis Patients (Part I): Prevalence, Etiology and Pathogenesis. RATIONAL PHARMACOTHERAPY IN CARDIOLOGY 2018. [DOI: 10.20996/1819-6446-2018-14-5-703-710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
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Zhang Y, Zhang S, Liu Z, Zhao X, Yuan Y, Sheng L, Li Y. Resveratrol prevents atrial fibrillation by inhibiting atrial structural and metabolic remodeling in collagen-induced arthritis rats. Naunyn Schmiedebergs Arch Pharmacol 2018; 391:1179-1190. [PMID: 30135998 DOI: 10.1007/s00210-018-1554-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2018] [Accepted: 08/09/2018] [Indexed: 12/13/2022]
Abstract
Rheumatoid arthritis (RA) causes atrial remodeling that induces the occurrence and maintenance of atrial fibrillation (AF). In this study, we explored the influence of RA on atrial fibrillation and the potential therapeutic effects of resveratrol in a rat model. The following three groups of female Wistar rats (8 weeks old) were used in this study: control, collagen-induced arthritis (CIA), and resveratrol. Rats in the CIA and resveratrol groups were injected twice with type II collagen in Freund's incomplete adjuvant. Three weeks after the second injection, resveratrol (10 mg kg-1 day-1) was administered for 4 weeks. Subsequently, atrial electrophysiological parameters were measured. Levels of inflammatory factors in the atria and serum were measured. Atrial histopathological changes were assessed using microscopy, and cardiomyocyte apoptosis and fibrosis were assessed using TUNEL and Masson's staining. Apoptosis-related and fibrosis-related proteins were assessed using Western blotting. Atrial adenosine triphosphate (ATP) and free fatty acid (FFA) levels were tested using ELISA. Glycogen accumulation and metabolism-related protein expression were assessed. AF inducibility and duration were markedly increased in CIA rats and were reduced by resveratrol. CIA also increased the atrial and serum IL-6 and TNF-a levels and induced atrial apoptosis and fibrosis, which were attenuated by resveratrol. Moreover, CIA induced the impairment of atrial energy metabolism by inhibiting the AMPK/PGC-1α pathway, which was reversed by resveratrol. Resveratrol protects against RA-induced atrial structural and metabolic remodeling, which may provide a new potential therapeutic treatment for RA-related AF.
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Affiliation(s)
- Yun Zhang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Song Zhang
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Zonghong Liu
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Xinbo Zhao
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Yue Yuan
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Li Sheng
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital of Harbin Medical University, Youzheng Street 23#, Nangang District, Harbin, 150001, Heilongjiang Province, China.
- Key Laboratory of Cardiac Diseases and Heart Failure, Harbin Medical University, Harbin, 150001, Heilongjiang Province, China.
- Institute of Metabolic Disease, Heilongjiang Academy of Medical Science, Harbin, 150001, Heilongjiang Province, China.
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Black-Maier E, Daubert JP. Editorial Commentary: Prevention and treatment of atrial fibrillation: Is hyperuricemia the next target? Trends Cardiovasc Med 2018; 29:48-49. [PMID: 30057151 DOI: 10.1016/j.tcm.2018.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Accepted: 07/09/2018] [Indexed: 01/07/2023]
Affiliation(s)
- Eric Black-Maier
- Duke Center for Atrial Fibrillation, Electrophysiology Section, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA
| | - James P Daubert
- Duke Center for Atrial Fibrillation, Electrophysiology Section, Division of Cardiology, Duke Clinical Research Institute, Duke University Medical Center, Durham, NC, USA.
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Lazzerini PE, Capecchi PL, Laghi-Pasini F. Systemic inflammation and arrhythmic risk: lessons from rheumatoid arthritis. Eur Heart J 2018; 38:1717-1727. [PMID: 27252448 DOI: 10.1093/eurheartj/ehw208] [Citation(s) in RCA: 120] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Accepted: 05/04/2016] [Indexed: 12/19/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic immuno-mediated disease primarily affecting the joints, characterized by persistent high-grade systemic inflammation. Cardiovascular morbidity and mortality are significantly increased in RA, with >50% of premature deaths attributable to cardiovascular disease. In particular, RA patients were twice as likely to experience sudden cardiac death compared with non-RA subjects, pointing to an increased propensity to develop malignant ventricular arrhythmias. Indeed, ventricular repolarization (QT interval) abnormalities and cardiovascular autonomic nervous system dysfunction, representing two well-recognized risk factors for life-threatening ventricular arrhythmias in the general population, are commonly observed in RA. Moreover, large population-based studies seem to indicate that also the prevalence of atrial fibrillation is significantly higher in RA subjects than in the general population, thus suggesting that these patients are characterized by an abnormal diffuse myocardial electrical instability. Although the underlying mechanisms accounting for the pro-arrhythmogenic substrate in RA are probably intricate, the leading role seems to be played by chronic systemic inflammatory activation, able to promote arrhythmias both indirectly, by accelerating the development of ischaemic heart disease and congestive heart failure, and directly, by affecting cardiac electrophysiology. In this integrated mechanistic view, lowering the inflammatory burden through an increasingly tight control of disease activity may represent the most effective intervention to reduce arrhythmic risk in these patients. Intriguingly, these considerations could be more generally applicable to all the diseases characterized by chronic systemic inflammation, and could help elucidate the link between low-grade chronic inflammation and arrhythmic risk in the general population.
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Lazzerini PE, Capecchi PL, Galeazzi M, Laghi-Pasini F. Biologic drugs and arrhythmic risk in chronic inflammatory arthritis: the good and the bad. Immunol Res 2018; 65:262-275. [PMID: 27423435 DOI: 10.1007/s12026-016-8833-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Increasing evidence indicates that patients with chronic inflammatory arthritis (CIA), including rheumatoid arthritis and spondyloarthropathies, have an increased risk of arrhythmic events, significantly contributing to the higher cardiovascular disease (CVD) morbidity and mortality observed in these subjects compared to the general population. Although the mechanisms accounting for such an arrhythmogenic substrate are not fully understood, the main role is probably played by chronic systemic inflammation, able to accelerate the development of structural CVD, as well as to directly affect cardiac electrophysiology. In the past decade, biologic therapies have revolutionized the treatment of CIA by highly enhancing the probability to effectively control disease activity and its systemic consequences, including cardiovascular involvement. Accordingly, accumulating data demonstrated that by potently inhibiting systemic inflammation, biologic drugs can reduce CVD progression and ameliorate arrhythmic risk parameters, with a putative beneficial impact on arrhythmia incidence. Nevertheless, a significant number of reports from clinical trials and postmarketing experience suggest that some of these medications, particularly TNF inhibitor monoclonal antibodies and rituximab, may in some circumstances precipitate arrhythmia occurrence, probably by acutely amplifying myocardial electric instability intrinsically associated with these diseases. In this review, we analyze the intricate link between biologic drugs and arrhythmias in CIA in the effort to identify which factors are involved in the fine-tuning of antiarrhythmic/pro-arrhythmic balance, and understand how this knowledge should be translated in the clinical practice to obtain the most favorable benefit-to-risk profile when biologic drugs are used in these patients.
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Affiliation(s)
- Pietro Enea Lazzerini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy.
| | - Pier Leopoldo Capecchi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy
| | - Mauro Galeazzi
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy
| | - Franco Laghi-Pasini
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Policlinico "Le Scotte", Viale Bracci, Siena, Italy
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Association Between Atrial, Ventricular and Vascular Morphofunctional Alterations in Rheumatoid Arthritis. High Blood Press Cardiovasc Prev 2018; 25:97-104. [DOI: 10.1007/s40292-017-0246-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Accepted: 12/27/2017] [Indexed: 01/07/2023] Open
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Dai H, Wang X, Yin S, Zhang Y, Han Y, Yang N, Xu J, Sun L, Yuan Y, Sheng L, Gong Y, Li Y. Atrial Fibrillation Promotion in a Rat Model of Rheumatoid Arthritis. J Am Heart Assoc 2017; 6:JAHA.117.007320. [PMID: 29269354 PMCID: PMC5779041 DOI: 10.1161/jaha.117.007320] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Background The prevalence of atrial fibrillation (AF) is significantly higher in rheumatoid arthritis (RA) patients, but the underlying mechanisms remain poorly understood. The goal of this study was to assess the effects of RA on AF susceptibility and atrial arrhythmogenic remodeling in a rat model of RA. Methods and Results Collagen‐induced arthritis was induced in rats by immunization with type II collagen in Freund's incomplete adjuvant. Among the rats that developed arthritis, AF susceptibility and atrial remodeling were examined 8 weeks after the primary immunization. AF inducibility and duration were substantially increased in collagen‐induced arthritis rats, and AF duration was significantly and positively correlated with the serum IL‐6 and TNF‐α levels. Rats with collagen‐induced arthritis showed prolonged atrial conduction time with no changes in the atrial effective refractory period. Atrial conduction delay was accompanied by significantly increased atrial fibrosis. In addition, atrial structural and autonomic remodeling, including left atrial dilation, apoptosis and autophagy of atrial myocytes, and atrial heterogeneous sympathetic hyperinnervation, was observed. Interestingly, we found that collagen‐induced arthritis had no significant effects on connexins, Nav1.5, and the main ion channels' protein expressions in atria. Conclusions We demonstrated that RA increased AF susceptibility by inducing AF‐promoting atrial remodeling. This study may provide insights into mechanisms underlying RA‐induced AF and validate a model that is suitable for further mechanistic and therapeutic exploration.
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Affiliation(s)
- Hui Dai
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Xiaoyu Wang
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Shuangli Yin
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yun Zhang
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yu Han
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Ning Yang
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Jicheng Xu
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Li Sun
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yue Yuan
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Li Sheng
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yongtai Gong
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
| | - Yue Li
- Department of Cardiology, The First Affiliated Hospital, Harbin Medical University, Harbin, China
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