Sex-specific traditional and disease-related risk factors for incident heart failure in patients with rheumatoid arthritis: a registry-based cohort study

Abstract Objectives To investigate associations with incident heart failure (HF) in patients with rheumatoid arthritis (RA) in relation to sex, traditional risk factors, and RA-specific factors, with analyses stratified by sex. Method Patients without prevalent HF enrolled between January 2007 and June 2022 in the biologics register RABBIT were included and followed up to 10 years until December 2022. Patients were observed from the time of enrollment until the diagnosis of HF (outcome of interest), death, dropout, or end of study, whichever occurred first. The association of sex with HF and the association of traditional and RA-specific variables with HF, stratified by sex, were analyzed using multiple logistic regression. Results The study sample consisted of 4022 men (3.9% HF) and 11,785 women (2.6% HF). For men compared to women, adjusted odds ratio for HF 95% CI was 1.48 1.20–1.83 overall, 2.42 1.60–3.66 in patients with coronary heart disease (CHD), and 1.40 1.10–1.78 for patients without CHD. Age, CHD, and high disease activity (DAS28-ESR) were the main risk factors for both sexes. The effect estimate of hypertension and particularly diabetes was higher in women than in men. Our results suggest a possible underdiagnosis of HF in women, especially of higher age. Conclusions Our exploratory study suggests a higher chance for HF, particularly in men with CHD compared to women, among patients with RA. Age, CHD, and high disease activity may be important risk factors for HF for both sexes, whereas diabetes, hypertension, and longer RA duration seem to be more deleterious in women than men. Key Points • Male RA patients with coronary heart disease (CHD) may have a higher chance for HF compared to females. • Effect estimates for diabetes and hypertension were higher in women than in men. • Age, CHD, and high RA disease activity were associated with HF in both sexes.