ROCHESTER, Minneapolis—Rheumatoid arthritis (RA) patients are at increased risk for cardiovascular problems, and those with persistently elevated erythrocyte sedimentation rate (ESR) values are at especially high risk of heart failure, researchers report in Annals of the Rheumatic Diseases. ¹

"Physicians who care for RA patients should be aware of the higher risk of heart failure in RA patients and should actively monitor them, especially those with persistently elevated ESR values," study author Hilal Maradit Kremers, MD, MSc, a research associate in the Mayo Clinic Department of Health Sciences Research in Rochester, Minneapolis, told CIAOMed.

In the population-based inception cohort study,  575 RA patients who were free of heart failure at the time of  RA diagnosis were  followed longitudinally until death or 2001. During 15 years of follow-up, they had a median of 15 ESR tests. Over this time 172 patients had new-onset heart failure.

The follow-up period was divided into 6-month intervals. Researchers plotted the proportions of patients with at least one ESR value  40 mm/hr  or with anemia within each 6-month interval against time from fulfillment of  heart failure criteria.

RA patients were most likely to develop heart failure within the 6-months after having an ESR  40 mm/hr, the investigators report. The incidence of anemia peaked during the 6-month period immediately after heart failure. 

"Our findings indicate that the proportion of RA patients with significantly elevated ESR values was highest during the 6 month period immediately prior to heart failure diagnosis as compared to any other period over time (including both before and after heart failure), suggesting that ESR may signal heart failure in RA patients," Dr. Maradit-Kremers said. "The mechanism for the increased risk of heart failure in RA is unknown, but several lines of evidence suggest that the persistent inflammatory state in RA patients may play an important pathological role."

Pros and cons of ESR as a biomarker for heart failure in RA patients

While ESR appears to be associated with development of heart failure among RA patients. "establishment of ESR as a biomarker for the risk of heart failure requires validation in other studies and other populations." Dr. Maradit-Kremers said.  "Certainly, in the absence of other more specific biomarkers for the risk of heart failure, and given the fact that ESR is routinely measured in clinical settings, it may have a potential role as a screening tool for heart failure among patients with RA."  Going forward, "a better understanding of the inflammatory etiology of heart failure in RA [will] likely to lead to more specific biomarkers."

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