Use of disease-modifying antirheumatic drugs may be associated with an increased risk for heart failure among some patients with rheumatic diseases, according to findings presented during the American College of Cardiology Annual Meeting (ACC 2021), held virtually May 15 to 17, 2021.

Data from adult patients (N=86,491) treated at the Cleveland Clinic in Ohio for rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), or systemic sclerosis (SSc) between 2000 and 2020 were retrospectively reviewed for evidence of drug exposures and diagnoses of heart failure.

Patients were treated for RA (n=60,229), SLE (n=20,704), and SSc (n=5558). Heart failure was diagnosed among 16.0%, 14.1%, and 20.3% of the RA, SLE, and SSc cohorts, respectively.

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Heart failure was significantly associated with age, gender, race, diabetes, hypertension, and history of ischemic heart disease among all patient groups (all P <.001). BMI was associated with heart failure among patients with RA (P <.001) and SLE (P <.001).

Use of mycophenolate was associated with increased risk for heart failure among patients with RA (odds ratio [OR], 1.96; 95% CI, 1.66-2.31; P <.001), SLE (OR, 1.38; 95% CI, 1.20-1.59; P <.001), and SSc (OR, 1.83; 95% CI, 1.52-2.21; P <.001). Among patients with RA, heart failure was increased among patients using anakinra (OR, 2.20; 95% CI, 1.27-3.74; P =.05) and decreased among patients who were exposed to methotrexate (OR, 0.81; 95% CI, 0.77-0.86; P <.001) or tumor necrosis factor inhibitor (OR, 0.77; 95% CI, 0.72-0.85; P <.001).

This study was based on a retrospective review of medical records from a single center. It remains unclear whether these findings may be generalizable.

The study authors concluded there was evidence that some disease-modifying antirheumatic drugs increased risk for heart failure among patients with RA, SLE, and SSc. Additional longer-term studies, including a broader set of patients with rheumatic diseases, are needed to replicate these findings and to determine the biologic mechanism behind these associations.


Zagouras A, Chatterjee S, Tang WH. Association between disease modifying antirheumatic drugs and heart failure in patients with systemic autoimmune diseases. Presented at: American College of Cardiology (ACC) Annual Meeting; May 15-17, 2021. Abstract 880.

This article originally appeared on The Cardiology Advisor