Rheumatoid Arthritis Linked to Elevated Risk of Degenerative Valvular Heart Disease

Individuals with rheumatoid arthritis (RA) face a significantly higher risk of developing certain types of degenerative valvular heart disease (VHD), according to a large prospective cohort study published in the Journal of the American Heart Association.¹

To come to this finding, researchers analyzed data from 492,745 participants in the UK Biobank, of whom 6673 had RA at baseline and none had pre-existing VHD. Over a median follow-up of nearly 14 years, investigators identified 359 new cases of degenerative VHD among those with RA compared with 13,518 cases among those without RA.

RA Linked to 3 Forms of Heart Disease

After adjusting for demographic factors, lifestyle, and comorbidities, RA was significantly associated with an increased risk of 3 forms of degenerative VHD:

• Aortic stenosis (HR, 1.64; 95% CI, 1.40-1.92)
• Aortic regurgitation (HR, 1.69; 95% CI, 1.34-2.13)
• Mitral regurgitation (HR, 1.54; 95% CI, 1.32-1.81)

No statistically significant associations were found between RA and mitral stenosis, tricuspid regurgitation, pulmonary regurgitation, or other subtypes once adjustments were made.

Younger Women at Highest Risk

Epidemiological evidence has shown RA disproportionately affects women, with incidence rates quadrupled for younger women and doubled among older women compared with their male peers.^2,3 Subgroup analyses in the current study revealed notable differences by sex and age.¹ Women with RA had an 85% higher risk of aortic stenosis and a 70% higher risk of mitral regurgitation compared with men (P for interaction = .038).

Looking at age, RA was associated with a 41% increased risk of mitral regurgitation in younger patients (< 65 years) and an 82% increased risk in older patients (P for interaction = .215). Younger patients were more likely to develop aortic stenosis and aortic regurgitation than their older counterparts, and have more significant correlations.

“To our knowledge, this is the first study to comprehensively explore and unravel the role of RA in the risk of incident diverse types of degenerative VHD,” the authors said. “Our findings aligned with previous studies and provided further evidence on the relationship between specific subtypes of valvular diseases and RA, while also comprehensively assessing the impact of various factors, particularly sex differences, on this association.”

Potential Multi-Valvular Involvement

Degenerative VHD is a growing burden in aging populations and shares overlapping risk factors with atherosclerotic disease, including smoking, dyslipidemia, hypertension, and diabetes. In RA, chronic inflammation and immune dysregulation may accelerate valvular pathology.

The study highlights RA as an independent risk factor for VHD, even after accounting for shared cardiovascular risks.

“Our study refines the current understanding of the risk factor spectrum for degenerative valvular heart disease and underscores the importance of regular cardiovascular screening in patients with rheumatoid arthritis, particularly for early detection of aortic stenosis, aortic regurgitation, and mitral regurgitation,” the authors said.

Patients with RA who first developed degenerative aortic disease—either stenosis or regurgitation—were more likely to subsequently develop mitral regurgitation, suggesting a progression to multi-valvular involvement in some cases.

Limitations and Future Research

As with other UK Biobank studies, the authors noted the predominantly White population may limit generalizability to more diverse groups. Additionally, reliance on ICD-10 codes meant that only advanced cases of VHD were captured, possibly underestimating the true prevalence. Researchers also could not stratify risks by RA disease severity or treatment exposures.

Despite these limitations, the authors said these findings expand the cardiovascular risk profile associated with RA, stressing the need for targeted monitoring strategies—particularly in women and younger patients—and calling for additional research into inflammatory pathways linking RA and valvular disease.

“Our study extends the current knowledge for the risk factor profile of degenerative VHD, and further studies are needed to integrate these results into primary prevention in high‐risk populations,” they said.

References

1. Wang Z, Lv J, Qian X, et al. Association between rheumatoid arthritis and the risk of incident degenerative valvular heart disease: evidence from a prospective cohort study. J Am Heart Assoc. 2025;14(16):e042025. doi:10.1161/JAHA.125.042025
2. AJMC Contributor. Increased incidence but lower mortality from RA seen over last 3 decades. AJMC^®. May 24, 2025. Accessed August 28, 2025. https://www.ajmc.com/view/increased-incidence-but-lower-mortality-from-ra-seen-over-last-3-decades
3. Alpízar-Rodríguez D, Pluchino N, Canny G, Gabay C, Finckh A. The role of female hormonal factors in the development of rheumatoid arthritis. Rheumatology (Oxford). 2017;56(8):1254-1263. doi:10.1093/rheumatology/kew318