Myocardial dysfunction in rheumatoid arthritis: epidemiology and pathogenesis

Table 2 Established risk factors and associative markers for the development of congestive heart failure

Associated with CHF risk in the general population	Shown to be comparatively over-represented in rheumatoid arthritis
Clinical risk factors
Systemic hypertension	+/-
Coronary atherosclerosis/myocardial infarction	+++
Diabetes	-
Valvular heart disease	+
Intrinsic pulmonary disease	+(+)
Sleep apnea/sleep-disordered breathing	+(?)
Smoking	+
Obesity	+
Echocardiographic predictors
Asymptomatic left ventricular enlargement	+
Increased left ventricular mass	+
Asymptomatic left ventricular systolic dysfunction	(+)/-
Left ventricular diastolic dysfunction	+++
Biochemical risk markers
Cardiac natriuretic hormones	+
Hyperhomocysteinemia	+
Inflammatory cytokines	+++
Medications
Non-steroidal anti-inflammatory drugs	++
Rare causes of CHF in the general population
Myocardial nodules	+
Restrictive pericarditis	+(+)
Coronary arteritis	+

CHF, congestive heart failure. + evidence for increased prevalence; -, no evidence for increased prevalence; +/-, evidence equivocal for increased prevalence; +(?), questionable/insufficient evidence for increased prevalence.

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