Pair of Studies Show Slide of Heart Failure, Dementia in RA After Entry of Biologics

Allison Inserro

The studies used population-level data from a county in Minnesota that has served as a national laboratory for health research since the 1960s.

Dementia and heart failure, 2 conditions that have had some evidence of being more likely in individuals with rheumatoid arthritis (RA), both declined when researchers examined trends over 30 years in large population-based studies, a time period during which biologic treatments arrived.

The findings were presented in 2 posters at EULAR 2021.

Investigators used data from Olmstead County, Minnesota, where residents have been part of long-running research projects since 1966.

In the first poster, researchers assessed the incidence of dementia in individuals with RA compared with the general population.1 Medical record data were collected for 895 people diagnosed with RA between 1980 and 2009; all were followed until death, a move out of the area, or until December 31, 2019 to see if they went on to develop dementia.

The 10-year cumulative incidence of dementia in people diagnosed during the 1980s, 1990s, and 2000s was 12.7%, 7.2%, and 6.2%, respectively.

In addition, there was a markedly lower cumulative incidence of dementia for people diagnosed with RA in the 2000s compared with the 1980s. For 880 people in the general population without RA, the 10-year cumulative incidence of dementia in the 1980s, 1990s, and 2000s was 9.3%, 5.0%, and 7.1%, respectively.

Overall, the risk of dementia in RA patients was significantly higher than in people without RA. However, when examined by decade, the risk of dementia in individuals diagnosed with RA was higher in the 1980s and 1990s, but not the 2000s.

Etanercept, the first biologic for RA, was approved in the United States in 1998.

One theory behind RA and dementia is that the two are linked by inflammation; inflammatory factors are also implicated in cardiovascular diseases, and in the second poster, researchers also looked at Olmstead County data to probe the incidence of heart failure, a common cardiovascular condition for patients with RA.2 Previous studies have suggested that people with RA are twice as likely to develop heart failure.

Researchers looked at heart failure trends in 905 patients with RA who were diagnosed between 1980 and 2009 and followed until death, a move, or the end of 2019.

The 10-year cumulative incidence of heart failure in those with RA in the 1980s, 1990s, and 2000s was 8.5%, 10.8%, and 7.1%, respectively. These was no difference in incidence of heart failure in the 1990s and 2000s compared with the 1980s.

Over the same time period, for 903 individuals without RA, the incidence of heart failure was 7.4%, 7.5%, and 7.3%.

Looking at the 2000s alone—ie, after the introduction of biologics—there was no excess risk of heart failure in people RA compared to those without in the general population.

In the 1980s, patients with RA had a 2-fold excess risk of heart failure, and in the 1990s, a 1.5-fold increased risk.

The findings call for further investigation, the researchers said, particularly into the role the inflammation, autoimmunity, and disease-modifying treatments may have in the risk of dementia and heart failure.

References

1. Kronzer V, et al. Trends in occurrence of dementia in patients with rheumatoid arthritis: a population-based cohort study, 1980-2009. Presented at EULAR 2021; Abstract OP0216.

2. Myasoedova E, et al. Decline in excess risk of heart failure in patients with rheumatoid arthritis in recent years. Presented at EULAR 2021; Abstract OP0102.