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In Rheumatoid Arthritis Patients, Hydroxychloroquine Does Not Raise Heart Failure Risk

According to a study, hydroxychloroquine (HCQ) does not contribute to the development of heart failure (HF) in rheumatoid arthritis (RA) patients.

"To our knowledge, this is the first population-based investigation to quantify the link between HCQ use and HF in RA patients," the researchers wrote.

In Rheumatoid Arthritis Patients, Hydroxychloroquine Does Not Raise Heart Failure Risk
Photo: Doctor with Elderly Rheumatoid Arthritis Patient | InStyleHealth

Residents of Olmsted County, Minnesota, who acquired HF following RA incidence were identified in this nested case-control study from 1980 to 2013 who had incident RA based on the 1987 American College of Rheumatology criteria. Each case was matched with a RA control who did not develop HF based on birth year, gender, and year of RA onset.

The researchers then evaluated the information about HCQ use, such as start and stop dates, as well as dose adjustments. They used this information to determine the duration and cumulative dose of HCQ. Finally, age-adjusted logistic regression models were used to investigate the link between HCQ and HF.

The study comprised 143 people with RA who had been diagnosed with HF (mean age 65.8 years, 62% female) and 143 people with RA who had not been diagnosed with HF (mean age 64.5 years, 62% female).

The cumulative dose of HCQ had no effect on the risk of heart failure (odds ratio [OR] 0.96 per 100 g increase in cumulative dose, 95 percent confidence interval [CI], 0.90–1.03). Patients with a total dose of less than 300 g had no connection (OR, 0.92, 95 percent CI, 0.41–2.08). Furthermore, the duration of HCQ use in the years leading up to the index had no significant association with HF (OR, 0.98, 95 percent CI, 0.91–1.05).

"The elevated risk of cardiovascular (CV) illness, especially HF, has been linked to the inflammatory burden characteristic of RA," the researchers wrote. "The development of HF in people with RA is complex, with CV risk factors and RA disease-related variables both contributing."

A meta-analysis examining the association of HCQ and chloroquine usage with CV risk in rheumatic patients found that HCQ users had a lower probability of developing CV illness.

Conduction problems, restrictive cardiomyopathy, left ventricular hypertrophy, ventricular dysfunction, and valve abnormalities have all been linked to HCQ use in several studies. Instead of population-based longitudinal data, this evidence was derived mostly from case reports/series and drug monitoring reports. However, such signals were backed by two rationales.

"First, the histological appearance of HCQ cardiotoxicity on endomyocardial biopsy has been identified. Second, clinical and histological improvements have been recorded following the discontinuation of HCQ, according to the researchers.

"Larger prospective studies are needed to define the safety of higher cumulative doses of HCQ in terms of HF development, as well as to identify the incidence of HCQ-related cardiotoxicity in patients with RA, in order to define high-risk subgroups and the need for cardiovascular screening," they wrote.


Source: J Rheumatol 2021;48:1508-1511

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