scholarly journals OP0121 MANAGEMENT OF DYSLIPIDAEMIA AND HYPERTENSION IN PATIENTS WITH RHEUMATOID ARTHRITIS – DATA FROM 19 COUNTRIES

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 80.2-80
Author(s):  
S. Rollefstad ◽  
E. Ikdahl ◽  
J. Sexton ◽  
G. Kitas ◽  
P. Van Riel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
North America ◽  
Goal Attainment ◽  
Preventive Treatment ◽  
Lipid Lowering ◽  
Cvd Risk ◽  
Risk Factor Control ◽  
East Europe ◽  
Very High

Background:The realisation that subjects with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) has led to a growing interest in risk factor control in such people, but whether this has influenced the management of dyslipidaemia and hypertension (HT) is uncertain. In subjects with coronary heart disease (CHD), audits of CVD risk factor control are regularly performed, which makes it possible to evaluate guideline implementation over time.1Updated surveys on CVD risk management in patients with RA are needed.Objectives:To describe differences in lipid and blood pressure (BP) levels among patients with RA from five world regions. Furthermore, to evaluate attainment of guideline recommended targets for lipid lowering and antihypertensive treatment.Methods:The SUrvey of CVD Risk Factors in patients with RA (SURF-RA) was conducted at 53 centres in 19 countries from 2014 to 2019. Data including demographics, RA disease characteristics, CVD comorbidity, risk factors and use of preventive treatment was collected. HT was defined as self-reported HT, and/or measured BP ≥140/90 mmHg, and/or use of anti HT medication (a-HT). The treatment goal of a-HT was BP <140/90 mmHg. The 10-year risk of a fatal CVD event was calculated by the European CVD risk calculator, the Systematic COronary Risk Evaluation (SCORE), and was thereafter multiplied with 1.5 as recommended by the European League Against Rheumatism. Patients were classified in a high or very high CVD risk group according to the 2012 European Society of Cardiology guidelines, with low density lipoprotein cholesterol (LDL-c) goal at <2.6 and <1.8 mmol/L, respectively.2Results:In total, 14503 RA patients were included. The mean age was 59.8±13.6 years, and it was a strong female preponderance (74%). Nearly 2/3 of the patients were hypertensive. Use of a-HT in the total population differed substantially between the cohorts with limited use in West Europe and Latin America (17.4% and 24.8%), in contrast to North America and East Europe (46.8% and 57.0%). On average, half of those with HT were at the recommended BP goal. The lowest BP goal attainment was seen in Asia, West and East Europe (40.8-43.1%), and the highest in North America (63.5%). Overall 51.5% had an indication for lipid lowering therapy (LLT), and of these 43.5% were taking LLT. Only 34.0% of patients with an indication for LLT were at recommended LDL-c goals. The proportion of RA patients on target for LDL-c varied greatly between regions, from 23.1% in East Europe to 51.0% in North America. The LDL-c goal attainment was higher in RA patients at high risk (45.1%) compared to those at very high risk of CVD (18.0%).Conclusion:This large international survey on RA patients revealed considerable geographical differences in CVD preventive treatment. Lower goal attainment for LLT than reported for subjects with CHD was observed. We conclude that there is a substantial need for improvement in CVD preventive measures in RA patients.References:[1]De Backer G, Jankowski P, Kotseva K,et al.Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries.Atherosclerosis. 2019;285:135-146.[2]Perk J, De Backer G, Gohlke H,et al.European Guide-lines on cardiovascular disease prevention in clinical practice.Eur Heart J.2012:1635-701.Disclosure of Interests:Silvia Rollefstad: None declared, Eirik Ikdahl: None declared, Joe Sexton: None declared, Georeg Kitas: None declared, Piet van Riel: None declared, Cynthia S. Crowson Grant/research support from: Pfizer research grant, Ian Graham: None declared, Anne Grete Semb: None declared

scholarly journals Management of dyslipidaemia and hypertension in patients with rheumatoid arthritis in 19 countries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
S Rollefstad ◽  
E Ikdahl ◽  
J Sexton ◽  
G.D Kitas ◽  
P Van Riel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
North America ◽  
Goal Attainment ◽  
Preventive Treatment ◽  
Lipid Lowering ◽  
Funding Source ◽  
Cvd Risk ◽  
East Europe ◽  
Very High

Abstract Background/Introduction The realisation that subjects with rheumatoid arthritis (RA) are at increased risk of cardiovascular disease (CVD) has led to a growing interest in risk factor control in such people, but whether this has influenced the management of dyslipidaemia and hypertension (HT) is uncertain. Purpose To describe differences in lipid and blood pressure (BP) levels among patients with RA from five world regions. Furthermore, to evaluate attainment of guideline recommended targets for lipid lowering and antihypertensive treatment. Methods The SUrvey of CVD Risk Factors in patients with RA (SURF-RA) was conducted at 53 centres in 19 countries from 2014 to 2019. Data including demographics, RA disease characteristics, CVD comorbidity, risk factors and use of preventive treatment was collected. HT was defined as self-reported HT, and/or measured BP &gt;140/90 mmHg, and/or use of anti HT medication (a-HT). The treatment goal of a-HT was BP &lt;140/90 mmHg. The 10-year risk of a fatal CVD event was calculated by the European CVD risk calculator, the Systematic COronary Risk Evaluation (SCORE), and was thereafter multiplied with 1.5 as recommended by the European League Against Rheumatism. Patients were classified in a high or very high CVD risk group according to the 2012 European Society of Cardiology guidelines, with low density lipoprotein cholesterol (LDL-c) goal at &lt;2.6 and &lt;1.8 mmol/L, respectively. Results In total, 14503 RA patients were included. The mean age was 59.8±13.6 years, most of whom (74%) were female. Nearly 2/3 of the patients were hypertensive. Use of a-HT in the total population differed substantially between the cohorts with limited use in West Europe and Latin America (17.4% and 24.8%), in contrast to North America and East Europe (46.8% and 57.0%). On average, half of those with HT were at the recommended BP goal. The lowest BP goal attainment was seen in Asia, West and East Europe (40.8–43.1%), and the highest in North America (63.5%). Overall 51.5% had an indication for lipid lowering therapy (LLT), and of these only 43.5% were taking LLT. Only 34.0% of patients with an indication for LLT were at recommended LDL-c goals. The proportion of RA patients on target for LDL-c varied greatly between regions, from 23.1% in East Europe to 51.0% in North America. The LDL-c goal attainment was higher in RA patients at high risk (45.1%) compared to those at very high risk of CVD (18.0%). Conclusion(s) This large international survey on RA patients revealed considerable geographical differences in CVD preventive treatment. Only one half of subjects were at blood pressure goals, and achievement of lipid goals was even poorer at one third of those eligible for treatment, which is lower than what is reported for subjects with coronary heart disease. We conclude that there is a substantial need for improvement in CVD preventive measures in RA patients. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): Unrestricted research collaboration with Lilly

Survey of cardiovascular disease and risk factor management in patients with rheumatoid arthritis across 5 world regions: results from the SURF-RA

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.N.N.E Semb ◽  
E Ikdahl ◽  
J Sexton ◽  
G Kitas ◽  
P Van Riel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Lipid Lowering ◽  
Funding Source ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
East Europe ◽  
World Regions ◽  
The Mean

Abstract Background Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD). Purpose The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA disease characteristics, RA and CVD preventive medication in patient with RA. Methods The audit is termed SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) and was performed in 53 centres/19 countries/5 world regions in 2014–2019. SURF-RA have been performed in patients with coronary heart disease, in primary care, and now in patients with stroke, SLE and antiphophlipid syndrome. The survey was approved by the Data Protection Officer (2017/7243) and a GDPR evaluation has been performed (10/10–2018). Results Among 14 503 patients with RA in West (n=8 493) and East (n=923) Europe, Latin (n=407) and North (n=4 030) America and Asia (n=650) the mean (SD) age was 59.9 (13.6) years, and 2/3 or more were female (table). RA disease duration was comparable across the world regions, ranging from 9.9 to 12.6 years. The prevalence of atherosclerotic CVD (ASCVD) was lowest in Latin America (2.5%) and highest in East Europe (21.4%), and this pattern was similar regarding familial premature CVD. The mean prevalence (% of each entity) of blood pressure above 140/90 mmHg was 5.3%, of low density lipoprotein cholesterol &gt;2.5 mmol/L: 63.3%. Overall, 29% used antihypertensive medication, lowest in West Europe (17.4%) and highest in East Europe (57.0%), and 26.4% used lipid lowering agent(s), lowest in Asia (7.2%) and highest in North America (31.1%). Body mass index &gt;30 kg/m2 was present in 26.6%, with the smallest waist circumference in Asia [mean (SD): 84.1 (13.6) cm] and highest in East Europe [92.5 (15.5) cm]. The proportion of current smokers was on average: 16.2%, lowest in Asia (7.8%) and highest in East Europe (28.5%). Conclusion The high prevalence of CVD risk factors and ASCVD in patients with RA across five world regions shows that there is still an unmet need for vigilance and improved implementation of preventive measures in this high CVD risk patient population. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Lilly

scholarly journals Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

Medicina ◽  
2020 ◽  
Vol 56 (3) ◽  
pp. 134
Author(s):  
Gediminas Urbonas ◽  
Lina Vencevičienė ◽  
Leonas Valius ◽  
Ieva Krivickienė ◽  
Linas Petrauskas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Risk ◽  
Primary Prevention ◽  
High Risk ◽  
Lipid Lowering ◽  
Blood Pressure Target ◽  
Cvd Risk ◽  
Cross Sectional ◽  
Risk Patients ◽  
Very High

Background and Objectives: Cardiovascular disease (CVD) prevention guidelines define targets for lifestyle and risk factors for patients at high risk of developing CVD. We assessed the control of these factors, as well as CVD risk perception in patients enrolled into the primary care arm of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey in Lithuania. Materials and Methods: Data were collected as the part of the EUROASPIRE V survey, a multicenter, prospective, cross-sectional observational study. Adults without a documented CVD who had been prescribed antihypertensive medicines and/or lipid-lowering medicines and/or treatment for diabetes (diet and/oral antidiabetic medicines and/or insulin) were eligible for the survey. Data were collected through the review of medical records, patients’ interview, physical examination and laboratory tests. Results: A total of 201 patients were enrolled. Very few patients reached targets for low-density lipoprotein cholesterol (LDL-C) (4.5%), waist circumference (17.4%) and body mass index (15.4%). Only 31% of very high CVD risk patients and 52% of high-risk patients used statins. Blood pressure target was achieved by 115 (57.2%) patients. Only 21.7% of patients at very high actual CVD risk and 27% patients at high risk correctly estimated their risk. Of patients at moderate actual CVD risk, 37.5% patients accurately self-assessed the risk. About 60%–80% of patients reported efforts to reduce the intake of sugar, salt or alcohol; more than 70% of patients were current nonsmokers. Only a third of patients reported weight reduction efforts (33.3%) or regular physical activity (27.4%). Conclusions: The control of cardiovascular risk factors in a selected group of primary prevention patients was unsatisfactory, especially in terms of LDL-C level and body weight parameters. Many patients did not accurately perceive their own risk of developing CVD.

scholarly journals Associations of obesity with modifiable risk factors for the development of cardiovascular disease in patients with rheumatoid arthritis

2008 ◽  
Vol 68 (2) ◽  
pp. 242-245 ◽  
Author(s):  
A Stavropoulos-Kalinoglou ◽  
G S Metsios ◽  
V F Panoulas ◽  
K M J Douglas ◽  
A M Nevill ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Insulin Resistance ◽  
Cardiovascular Disease ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Metabolic Syndrome ◽  
And Gender

Objectives:To assess the association of body mass index (BMI) with modifiable cardiovascular disease (CVD) risk factors in patients with rheumatoid arthritis (RA).Methods:BMI, disease activity, selected CVD risk factors and CVD medication were assessed in 378 (276 women) patients with RA. Patients exceeding accepted thresholds in ⩾3 CVD risk factors were classified as having the metabolic syndrome (MetS).Results:BMI independently associated with hypertension (OR = 1.28 (95% CI = 1.22 to 1.34); p = 0.001), high-density lipoprotein (OR = 1.10 (95% CI = 1.06 to 1.15); p = 0.025), insulin resistance (OR = 1.13 (95% CI = 1.08 to 1.18); p = 0.000) and MetS (OR = 1.15 (95% CI = 1.08 to 1.21); p = 0.000). In multivariable analyses, BMI had the strongest associations with CVD risk factors (F1–354 = 8.663, p = 0.000), and this was followed by lipid-lowering treatment (F1–354 = 7.651, p = 0.000), age (F1–354 = 7.541, p = 0.000), antihypertensive treatment (F1–354 = 4.997, p = 0.000) and gender (F1–354 = 4.707, p = 0.000). Prevalence of hypertension (p = 0.004), insulin resistance (p = 0.005) and MetS (p = 0.000) was significantly different between patients with RA who were normal, overweight and obese, and BMI differed significantly according to the number of risk factors present (p = 0.000).Conclusions:Increasing BMI associates with increased CVD risk independently of many confounders. RA-specific BMI cut-off points better identify patients with RA at increased CVD risk. Weight-loss regimens should be developed and applied in order to reduce CVD in patients with RA.

scholarly journals Diabetes mellitus and cardiovascular risk management in patients with rheumatoid arthritis: an international audit

RMD Open ◽  
2021 ◽  
Vol 7 (2) ◽  
pp. e001724
Author(s):  
Anne Grete Semb ◽  
Silvia Rollefstad ◽  
Eirik Ikdahl ◽  
Grunde Wibetoe ◽  
Joseph Sexton ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Diabetes Mellitus ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Goal Attainment ◽  
Disease Risk ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Preventive Medication ◽  
Study Population

AimThe objective was to examine the prevalence of atherosclerotic cardiovascular disease (ASCVD) and its risk factors among patients with RA with diabetes mellitus (RA-DM) and patients with RA without diabetes mellitus (RAwoDM), and to evaluate lipid and blood pressure (BP) goal attainment in RA-DM and RAwoDM in primary and secondary prevention.MethodsThe cohort was derived from the Survey of Cardiovascular Disease Risk Factors in Patients with Rheumatoid Arthritis from 53 centres/19 countries/3 continents during 2014–2019. We evaluated the prevalence of cardiovascular disease (CVD) among RA-DM and RAwoDM. The study population was divided into those with and without ASCVD, and within these groups we compared risk factors and CVD preventive treatment between RA-DM and RAwoDM.ResultsThe study population comprised of 10 543 patients with RA, of whom 1381 (13%) had DM. ASCVD was present in 26.7% in RA-DM compared with 11.6% RAwoDM (p<0.001). The proportion of patients with a diagnosis of hypertension, hyperlipidaemia and use of lipid-lowering or antihypertensive agents was higher among RA-DM than RAwoDM (p<0.001 for all). The majority of patients with ASCVD did not reach the lipid goal of low-density lipoprotein cholesterol <1.8 mmol/L. The lipid goal attainment was statistically and clinically significantly higher in RA-DM compared with RAwoDM both for patients with and without ASCVD. The systolic BP target of <140 mm Hg was reached by the majority of patients, and there were no statistically nor clinically significant differences in attainment of BP targets between RA-DM and RAwoDM.ConclusionCVD preventive medication use and prevalence of ASCVD were higher in RA-DM than in RAwoDM, and lipid goals were also more frequently obtained in RA-DM. Lessons may be learnt from CVD prevention programmes in DM to clinically benefit patients with RA .

Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment

2020 ◽  
Vol 18 (5) ◽  
pp. 431-446 ◽  
Author(s):  
George E. Fragoulis ◽  
Ismini Panayotidis ◽  
Elena Nikiphorou
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Current Evidence ◽  
Pharmacological Intervention ◽  
Cvd Risk ◽  
The Past ◽  
Increased Risk ◽  
Cv Disease ◽  
Obesity Hypertension ◽  
Inflammatory Burden

Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.

scholarly journals Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045482
Author(s):  
Didier Collard ◽  
Nick S Nurmohamed ◽  
Yannick Kaiser ◽  
Laurens F Reeskamp ◽  
Tom Dormans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Icu Admission ◽  
Lowering Therapy ◽  
Secondary Outcomes ◽  
Age And Sex

ObjectivesRecent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes.DesignWe analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection.SettingPatients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included.ParticipantsAdmitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics.Primary and secondary outcomes measuresThe primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors.ResultsWe included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91).ConclusionsThe accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.

scholarly journals Cardiovascular Disease in Rheumatoid Arthritis: Risk Factors, Autoantibodies, and the Effect of Antirheumatic Therapies

2021 ◽  
Vol 14 ◽  
pp. 117954412110287
Author(s):  
Mir Sohail Fazeli ◽  
Vadim Khaychuk ◽  
Keith Wittstock ◽  
Boris Breznen ◽  
Grace Crocket ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Literature Review ◽  
Rheumatoid Factor ◽  
Qualitative Evidence Synthesis ◽  
Cvd Risk ◽  
Rheumatoid Arthritis Risk ◽  
Published Evidence ◽  
Increased Risk

Objective: To scope the current published evidence on cardiovascular risk factors in rheumatoid arthritis (RA) focusing on the role of autoantibodies and the effect of antirheumatic agents. Methods: Two reviews were conducted in parallel: A targeted literature review (TLR) describing the risk factors associated with cardiovascular disease (CVD) in RA patients; and a systematic literature review (SLR) identifying and characterizing the association between autoantibody status and CVD risk in RA. A narrative synthesis of the evidence was carried out. Results: A total of 69 publications (49 in the TLR and 20 in the SLR) were included in the qualitative evidence synthesis. The most prevalent topic related to CVD risks in RA was inflammation as a shared mechanism behind both RA morbidity and atherosclerotic processes. Published evidence indicated that most of RA patients already had significant CV pathologies at the time of diagnosis, suggesting subclinical CVD may be developing before patients become symptomatic. Four types of autoantibodies (rheumatoid factor, anti-citrullinated peptide antibodies, anti-phospholipid autoantibodies, anti-lipoprotein autoantibodies) showed increased risk of specific cardiovascular events, such as higher risk of cardiovascular death in rheumatoid factor positive patients and higher risk of thrombosis in anti-phospholipid autoantibody positive patients. Conclusion: Autoantibodies appear to increase CVD risk; however, the magnitude of the increase and the types of CVD outcomes affected are still unclear. Prospective studies with larger populations are required to further understand and quantify the association, including the causal pathway, between specific risk factors and CVD outcomes in RA patients.

scholarly journals POS0486 FACTORS ASSOCIATED WITH CHRONOTROPIC RESPONSE IN PEOPLE WITH RHEUMATOID ARTHRITIS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 475.2-476
Author(s):  
A. Osailan
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiorespiratory Fitness ◽  
Inflammatory Markers ◽  
Exercise Intolerance ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Chronotropic Response ◽  
Factors Associated ◽  
The University

Background:People with rheumatoid arthritis (RA) are at high risk for cardiovascular diseases (CVD) and CVD mortality. Reduced Chronotropic response (CR), which produces exercise intolerance, is known as a contributing factor to CVD and mortality. Studies have shown that people with RA have reduced CR. However, knowledge about the factors associated with CR in people with RA is limited.Objectives:To explore the factors associated with CR including CVD risk factors, inflammatory markers and cardiorespiratory fitness (VO2 peak).Methods:106 people with RA completed a treadmill exercise tolerance test while heart rate (HR) was monitored via 12 leads ECG. CR was defined as the percentage of [(achieved peak HR minus resting HR) divided by (age-predicted maximum HR minus resting HR)]. Serological CVD risk factors and inflammatory markers including lipids profile, markers of insulin resistance and sensitivity (HOMA, QUICKi), high sensitivity C-reactive protein (hsCRP), erythrocyte sedimentation rate (ESR), fibrinogen and white blood cells (WBC) were examined via a fasted blood sample. VO2 peak was assessed via breath-by-breath gas analysis.Results:34% had reduced CR based on the cut-off value (≤ 80%) and the average CR was 86.2 ± 21%. Body mass index (r=-0.33, p=.001), HOMA (r=-0.26, p=.009), hsCRP (r=-0.23, p=.02), ESR (r=-0.21, p=.04), fibrinogen (r=-0.2, p=.05), WBC (r=-0.21, p=.04) were inversely associated with CR, whereas, high density lipoprotein (HDL) (r=0.43, p<.001), QUICKi (r=0.31, p=.002), and VO2 peak (r=0.4, p<.001) were positively associated with CR. When all the variables were entered into a stepwise linear regression, HDL (p<.001) and VO2 peak (p=.009) were independently associated with CR.Conclusion:The current findings suggest that CR in RA was associated with many CVD risk factors, inflammatory markers, and cardiorespiratory fitness. Among all the varibales, HDL and cardiorespiratory fitness were moderately and independently associated with CR. Future studies should investigate the effect of improving these associated variables on CR in people with RA via exercise training programes.Acknowledgements:Thanks to physical activity in Rheumatoid arthritis research team and Research department in Dudley Hospital. Sincere appreciation and gratitude to Dr Jet Veldhuizen van Zanten, Prof. Joan Duda, and Prof. George Kitas from the University of Birmingham and Prof. George Metsios from the University of Wolverhampton.Disclosure of Interests:None declared

scholarly journals Impact of risk factors associated with cardiovascular outcomes in patients with rheumatoid arthritis

2017 ◽  
Vol 77 (1) ◽  
pp. 48-54 ◽  
Author(s):  
Cynthia S Crowson ◽  
Silvia Rollefstad ◽  
Eirik Ikdahl ◽  
George D Kitas ◽  
Piet L C M van Riel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Total Cholesterol ◽  
Smoking Prevalence ◽  
Disease Activity Score ◽  
Population Attributable Risk ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
The Impact

ObjectivesPatients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA.MethodsIn 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions.Results5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics).ConclusionsIn a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.

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