scholarly journals Cardiovascular Risk in Rheumatoid Arthritis: Literature Review

2021 ◽  
Vol 36 (3) ◽  
pp. e262-e262
Author(s):  
Suad MA Hannawi ◽  
Haifa Hannawi ◽  
Issa Al Salmi
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Heart Failure ◽  
Literature Review ◽  
Inflammatory Arthritis ◽  
Healthy Population ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Mortality And Morbidity ◽  
Underlying Inflammation

Rheumatoid arthritis (RA) is the most common inflammatory arthritis disease with a worldwide prevalence of 1–3%. RA patients are at higher risk of atherosclerosis than their matched age-sex controls. Cardiovascular diseases (CVDs) account for a 50% risk of increased mortality and morbidity in RA. The pattern of CVD in RA patients differs from that in the general population; RA patients are more likely to have silent ischemic heart disease, sudden death, heart failure, and die early. RA patients tend to have a 5–10 years reduction in their life span than their matched healthy population. Traditional (classical) CV risk factors work separately or synergistically with the underlying inflammation to increase CVD risk in RA. Moreover, inflammation is defined as an independent CVD risk factor. This literature review aims to discuss the traditional CVD risk factors and their association with inflammation in RA.

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.

The Extent of Subclinical Atherosclerosis Is Partially Predicted by the Inflammatory Load: A Prospective Study over 5 Years in Patients with Rheumatoid Arthritis and Matched Controls

2015 ◽  
Vol 42 (6) ◽  
pp. 935-942 ◽  
Author(s):  
Anna Södergren ◽  
Kjell Karp ◽  
Christine Bengtsson ◽  
Bozena Möller ◽  
Solbritt Rantapää-Dahlqvist ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Linear Regression ◽  
Prospective Study ◽  
Risk Score ◽  
Subclinical Atherosclerosis ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
A Prospective Study ◽  
Reynolds Risk Score

Objective.This prospective followup study investigated subclinical atherosclerosis in relation to traditional cardiovascular disease (CVD) risk factors and inflammation in patients with rheumatoid arthritis (RA) recruited at diagnosis compared with controls.Methods.Patients diagnosed with early RA were consecutively recruited into a prospective study. From these, a subgroup aged ≤ 60 years (n = 71) was consecutively included for ultrasound measurement of intima-media thickness (IMT) and flow-mediated dilation (FMD) at inclusion (T0) and after 5 years (T5). Age- and sex-matched controls (n = 40) were also included.Results.In the Wilcoxon signed-rank test, both IMT and FMD were significantly aggravated at T5 compared to baseline in patients with RA, whereas only IMT was significantly increased in controls. In univariate linear regression analyses among patients with RA, the IMT at T5 was significantly associated with age, systolic blood pressure (BP), cholesterol, triglycerides, Systematic Coronary Risk Evaluation (SCORE), and Reynolds Risk Score at baseline (p < 0.05). Similarly, FMD at T5 was significantly inversely associated with age, smoking, systolic BP, SCORE, and Reynolds Risk Score (p < 0.05). A model with standardized predictive value from multiple linear regression models including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of IMT after 5 years. When also including the area under the curve for the 28-joint Disease Activity Score over 5 years, the observed value of IMT was predicted to a large extent.Conclusion.This prospective study identified an increased subclinical atherosclerosis in patients with RA. In the patients with RA, several traditional CVD risk factors at baseline significantly predicted the extent of subclinical atherosclerosis 5 years later. The inflammatory load over time augmented this prediction.

scholarly journals Cardiovascular system status of long-livers in Moscow: the prevalence of cardiovascular diseases and their risk factors

2021 ◽  
Vol 26 ◽  
pp. 4028
Author(s):  
K. A. Eruslanova ◽  
A. V. Luzina ◽  
Yu. S. Onuchina ◽  
V. S. Ostapenko ◽  
N. V. Sharashkina ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Cardiovascular Diseases ◽  
Cardiovascular System ◽  
Interventricular Septum ◽  
Systolic Heart Failure ◽  
Left Ventricular ◽  
Past Century ◽  
Cvd Risk Factors ◽  
Cvd Risk

Over the past century, an increase in life expectancy has been observed in Russia and in the world. According to the United Nations, by 2100, the number of centenarians worldwide will reach 25 million. Despite the annual increase in the number of super-centenarians, this age group remains poorly understood.Aim. To estimate the prevalence of cardiovascular diseases (CVD) and the main risk factors among super-centenarians in Moscow.Material and methods. According to the register of long-livers in Moscow, 82 people aged 95 to 105 were included. Participants were examined at home.The history of life and the presence of chronic diseases was collected by participant words. To assess the state of cardiovascular system, an ultrasound of the heart and main arteries was performed.Results. Conventional CVD risk factors were the exception rather than the rule among study participants (smoking — 8 patients (9,8%), alcohol abuse — 4 (4,9%), obesity — 6 (7,3%)). Dyslipidemia was relatively widespread (n=37; 45,1%), however, there were no pronounced abnormalities in the lipid profile: the maximum increase in low-density lipoproteins was 5,6 mmol/L. The most common CVDs among the participants were hypertension (n=64; 78%), coronary artery disease (n=42; 51,2%), and heart failure (n=26; 31,7%); other diseases were much less common. The most common echocardiographic changes were left atrial dilatation (n=38; 74,5%), increased left ventricular mass, thickening of left ventricular posterior wall (n=24; 48%) and interventricular septum (n=51; 100%). Diastolic and systolic heart failure were not widespread among long-livers: 16 (32%) and 2 (3,9%), respectively. Despite a rather large number of atherosclerotic plaques in the common carotid and femoral arteries, the number of hemodynamically significant plaques was low (n=3; 4,6%). An intima-media thickening up to 1,0-1,1 mm was found.Conclusion. Long-livers in Moscow are characterized by a low prevalence of traditional CVD risk factors (with the exception of hypertension) and a fairly high prevalence of atherosclerotic CVDs, which are characterized by a subclinical course.

Effect of a treat-to-target intervention of cardiovascular risk factors on subclinical and clinical atherosclerosis in rheumatoid arthritis: a randomised clinical trial

2019 ◽  
pp. annrheumdis-2018-214075 ◽  
Author(s):  
Benjamin Burggraaf ◽  
Deborah F van Breukelen-van der Stoep ◽  
Marijke A de Vries ◽  
Boudewijn Klop ◽  
Anho H Liem ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Usual Care ◽  
Cardiovascular Events ◽  
Target Group ◽  
Secondary Outcome ◽  
Treat To Target ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Increased Risk

BackgroundPatients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease (CVD). No long-term intervention trials on CVD risk factors have been published, and a debate on the efficacy of controlling traditional risk factors in RA is ongoing. We aimed to evaluate a treat-to-target approach versus usual care regarding traditional CVD risk factors in patients with RA.MethodsIn this open-label, randomised controlled trial, patients with RA aged <70 years without prior CVD or diabetes mellitus were randomised 1:1 to either a treat-to-target approach or usual care of traditional CVD risk factors. The primary outcome was defined as change in carotid intima media thickness (cIMT) over 5 years, and the secondary outcome was a composite of first occurrence of fatal and non-fatal cardiovascular events.ResultsA total of 320 patients (mean age 52.4 years; 69.7% female) with RA underwent randomisation and 219 patients (68.4%) completed 5 years of follow-up. The mean cIMT progression was significantly reduced in the treat-to-target group compared with usual care (0.023 [95% CI 0.011 to 0.036] mm vs 0.045 [95% CI 0.030 to 0.059] mm; p=0.028). Cardiovascular events occurred in 2 (1.3%) of the patients in the treat-to-target group vs 7 (4.7%) in those receiving usual care (p=0.048 by log-rank test).ConclusionThis study provides evidence on the benefit of a treat-to-target approach of traditional CVD risk factors for primary prevention in patients with well-treated RA.Trial registration numberNTR3873.

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 MECHANISMS IN ENDOCRINOLOGY: Cardiovascular risk in women with type 2 diabetes mellitus and prediabetes: is it indeed higher than men?

2014 ◽  
Vol 171 (6) ◽  
pp. R245-R255 ◽  
Author(s):  
Panagiotis Anagnostis ◽  
Azeem Majeed ◽  
Desmond G Johnston ◽  
Ian F Godsland
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factors ◽  
Absolute Risk ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Mortality And Morbidity ◽  
Blood Pressure Targets ◽  
Definite Difference ◽  
Cvd Mortality

The relative risk for cardiovascular disease (CVD) events and mortality in diabetic women (in comparison with non-diabetic women) is believed to be greater than that in diabetic men. However, the absolute risk for CVD mortality and morbidity does not appear to be higher in women. In general, there is heterogeneity between studies, and whether there is any definite difference in the CVD risk between sexes at any level of glycaemia is not known. The same arguments also apply when comparing the CVD risk factors, such as lipid profiles and systemic inflammation indices, which seem to be worse in women than in men with diabetes mellitus (DM). The same questions emerge at any given glycaemic state: are women at worse risk and do they have a worse risk factor profile than men? These issues have yet to be resolved. Similar, though less extensive, data have been reported for prediabetes. Furthermore, women with DM are suboptimally treated compared with men regarding lipid and blood pressure targets. Large prospective studies representative of the general population are therefore needed to define the differences between sexes regarding CVD events and mortality at a given glucose level and after adjusting for any other confounders.

Abstract P165: Associations of Coronary Artery Calcium Volume and Density With Incident Heart Failure in the Multi-Ethnic Study of Atherosclerosis

Circulation ◽  
2018 ◽  
Vol 137 (suppl_1) ◽  
Author(s):  
Nketi I Forbang ◽  
Erin Michos ◽  
Sonia Ponce ◽  
Isac Thomas ◽  
Matthew Allison ◽  
...  
Keyword(s):  
Risk Factors ◽  
Heart Failure ◽  
Coronary Artery ◽  
Coronary Artery Calcium ◽  
Low Frequency ◽  
P Value ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Increased Risk ◽  
Incident Heart Failure

Background: Coronary artery calcium (CAC) predicts incident heart failure (HF) independent of cardiovascular disease (CVD) risk factors. In MESA, Components of CAC, volume and density, have opposite associations with incident CVD, such that for a given volume of CAC, higher CAC density is inversely associated with events. The relationship between CAC volume and density with HF is unknown. Methods: We studied 6814 participants in a multi-ethnic, community-based cohort, free from clinical CVD at recruitment. CAC volume and density were measured by non-contrast cardiac CT at the baseline exam (2000-2002). Adjudicated HF events were assessed through 2014, and analysis limited to those with imaging confirmation and estimated ejection fraction (EF). Cox proportional hazard was used to estimate independent associations of baseline CAC volume and density with incident HF: HF with reduced (< 50%), and preserved EF (HFrEF & HFpEF respectively). Results: The mean age was 62 + 10 years, 47% were men, 38% identified as European-, 28% as African-, 22% as Hispanic-, and 12% as Chinese-ethnicity. Average time to 189 HF events (119 HFrEF & 70 HFpEF) was 6.6 years. In unadjusted models, higher CAC volume (HR 1.27 [1.02-1.59], p=0.03), but not CAC density (HR 0.87 [0.67-1.13], p=0.29) was significantly associated with incident HF, non-significant associations were observed with HFrEF, or HFpEF, and no significant associations were observed for all three outcomes after adjustments for demographics and CVD risk factors (Table). Also, in unadjusted analyses, stratified by sex (p-value for interaction = 0.13), higher CAC volume was associated with increased risk for HF (HR 1.37 [1.03-1.81], p=0.03) and HFpEF (HR 1.76 [0.99-3.16], p=0.06), in males only. No significant associations were observed after adjustments. Conclusion: In a multi-ethnic cohort, CAC volume and density were not independently associated with HF, the trend for volume was positive while density was inverse. Low frequency of incident HF in our cohort was an important limitation.

Sign in / Sign up

Export Citation Format

Share Document