Study Links Active RA to Heart Failure Risk: Questions for Your Doctor

Written by Ted Samson

Posted on July 23, 2026

Feel better informed on RA and get real support from your community.

Key Takeaways

A large German study found that people with rheumatoid arthritis are more likely to develop heart failure when they are older, have coronary heart disease or high blood pressure, or have more active RA.

A large German study found that people with rheumatoid arthritis (RA) were more likely to develop heart failure when they were older, had coronary heart disease or hypertension (high blood pressure), or had more active RA.

Researchers also compared heart failure patterns in men and women with RA. Overall, men had higher odds of heart failure, especially among those who also had coronary heart disease.

However, high blood pressure, diabetes, and length of time with RA appeared to have a stronger association with heart failure in women.

🗳️ Have you been diagnosed with heart failure while living with rheumatoid arthritis (RA)?

Yes, I’ve been diagnosed with heart failure.

I’ve been diagnosed with a heart condition other than heart failure.

I haven’t been diagnosed with any heart conditions but suspect I may have one.

I haven’t been diagnosed with a heart condition and don’t suspect I have one.

The findings suggest that heart health in RA is shaped by both traditional cardiovascular risks and RA-related inflammation. Regardless of a person’s sex or gender, keeping the condition well controlled and regularly reviewing heart health with a healthcare provider may be an important part of long-term care.

Because the study was observational, it found associations and cannot show that any one factor directly caused heart failure.

Heart Health and RA: What’s the Connection?

Heart failure doesn’t mean that the heart has stopped. It means the heart is not pumping blood or filling with blood as well as the body needs.

Heart failure is when the heart is not pumping blood or filling with blood as well as the body needs.

Past research has found that people with RA have nearly twice the risk of heart failure compared with the general population. The reasons are likely complex.

Traditional cardiovascular risk factors may contribute to the connection between RA and heart failure, including:

High blood pressure
Diabetes
Coronary heart disease

Chronic inflammation from RA may also affect blood vessels and heart muscle over time.

Previous studies have linked systemic inflammation in RA to heart failure with preserved ejection fraction. In this form of heart failure, the heart’s pumping strength may be normal, but the heart muscle can be too stiff to fill properly between beats.

Heart failure can also be difficult to recognize in people with RA. Symptoms such as fatigue, reduced stamina, and difficulty with daily activities may be mistaken for RA symptoms or other health conditions.

What This Study Adds

The researchers studied 15,807 adults with RA — 4,022 men and 11,785 women — who didn’t have heart failure when they entered the study. Participants were followed for up to 10 years.

During follow-up, heart failure was reported in 156 men, or 3.9 percent, and 302 women, or 2.6 percent. After the researchers adjusted for other factors, men had 48 percent higher odds of heart failure than women.

The difference was greatest among participants with coronary heart disease. In that group, men had more than twice the odds of heart failure than women.

For both men and women, the main factors associated with heart failure were:

Older age
Coronary heart disease
High RA disease activity

High blood pressure, longer RA duration, and glucocorticoid doses of at least 10 milligrams per day were also associated with heart failure in both groups.

Other Differences by Gender

Some patterns differed by gender. As noted, researchers found that the overall odds of heart failure were higher in men.

However, they also found:

Diabetes was significantly associated with heart failure among women but not among men.
The estimated association between high blood pressure and heart failure was stronger in women.
Heart failure may have been underdiagnosed in some older women.

Study Limitations

Although it was large, the study had several important limitations:

The study was observational, so it cannot show cause and effect.
Heart failure was reported through routine rheumatology care, and the exact diagnosis date wasn’t available for many participants.
Researchers lacked detailed information about heart failure types and symptoms, as well as the severity and treatment of several cardiovascular conditions.
All participants came from a German registry, and many had RA that required advanced treatment, so the results may not apply equally to everyone living with RA.

Why These Findings Matter for People With RA

The study adds to evidence that heart health in RA involves more than the usual cardiovascular risk factors. Age, coronary heart disease, high blood pressure, and diabetes remain important, but RA disease activity and disease duration may also help identify people who could benefit from closer heart-health monitoring.

The findings don’t mean that everyone with active or long-standing RA will develop heart failure. They do suggest that managing RA inflammation and checking heart disease risks should go hand in hand as part of routine care.

5 Questions To Ask Your Doctor About Heart Health With RA

Consider asking your rheumatologist or primary care doctor:

1. How often should my blood pressure, blood sugar, and cholesterol be checked?

2. How does my RA disease activity affect my cardiovascular risk?

3. Do any of my RA medications require heart-health monitoring?

4. Would I benefit from a formal cardiovascular risk assessment?

5. Could new fatigue, shortness of breath, swelling, or reduced stamina be signs that I need a heart evaluation?

Tell a healthcare provider about new or worsening shortness of breath, swelling, a persistent cough, unusual fatigue, or difficulty breathing while lying down. These symptoms can have many causes, but they are worth having evaluated.