POS0486 FACTORS ASSOCIATED WITH CHRONOTROPIC RESPONSE IN PEOPLE WITH RHEUMATOID ARTHRITIS

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

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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211735 ◽

2017 ◽

Vol 77 (1) ◽

pp. 48-54 ◽

Cited By ~ 75

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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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

The Journal of Rheumatology ◽

10.3899/jrheum.140694 ◽

2015 ◽

Vol 42 (6) ◽

pp. 935-942 ◽

Cited By ~ 12

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.

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A study of the conventional cardiovascular disease (CVD) risk factors in rheumatoid arthritis (RA) among Indians

Indian Journal of Rheumatology ◽

10.1016/j.injr.2012.12.006 ◽

2013 ◽

Vol 8 (1) ◽

pp. 19-23 ◽

Cited By ~ 2

Author(s):

Divya Agarwal ◽

Anand N. Malaviya

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Cardiovascular Disease ◽

Cvd Risk Factors ◽

Cvd Risk

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Restrictive pattern on spirometry: association with cardiovascular risk and level of physical activity in asymptomatic adults

Jornal Brasileiro de Pneumologia ◽

10.1590/s1806-37562016000000030 ◽

2016 ◽

Vol 42 (1) ◽

pp. 22-28 ◽

Cited By ~ 11

Author(s):

Evandro Fornias Sperandio ◽

Rodolfo Leite Arantes ◽

Agatha Caveda Matheus ◽

Rodrigo Pereira da Silva ◽

Vinícius Tonon Lauria ◽

...

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Arterial Hypertension ◽

Cardiorespiratory Fitness ◽

Physical Inactivity ◽

Center Of Pressure ◽

Cvd Risk Factors ◽

Cvd Risk ◽

Systemic Arterial Hypertension ◽

Restrictive Pattern

Objective : To determine whether a restrictive pattern on spirometry is associated with the level of physical activity in daily life (PADL), as well as with cardiovascular disease (CVD) risk factors, in asymptomatic adults. Methods : A total of 374 participants (mean age, 41 ± 14 years) underwent spirometry, which included the determination of FVC and FEV1. A restrictive pattern on spirometry was defined as an FEV1/FVC ratio > 0.7 and an FVC < 80% of the predicted value. After conducting demographic, anthropometric, and CVD risk assessments, we evaluated body composition, muscle function, and postural balance, as well as performing cardiopulmonary exercise testing and administering the six-minute walk test. The PADL was quantified with a triaxial accelerometer. Results : A restrictive pattern on spirometry was found in 10% of the subjects. After multivariate logistic regression, adjusted for confounders (PADL and cardiorespiratory fitness), the following variables retained significance (OR; 95% CI) as predictors of a restrictive pattern: systemic arterial hypertension (17.5; 1.65-184.8), smoking (11.6; 1.56-87.5), physical inactivity (8.1; 1.43-46.4), larger center-of-pressure area while standing on a force platform (1.34; 1.05-1.71); and dyslipidemia (1.89; 1.12-1.98). Conclusions : A restrictive pattern on spirometry appears to be common in asymptomatic adults. We found that CVD risk factors, especially systemic arterial hypertension, smoking, and physical inactivity, were directly associated with a restrictive pattern, even when the analysis was adjusted for PADL and cardiorespiratory fitness. Longitudinal studies are needed in order to improve understanding of the etiology of a restrictive pattern as well as to aid in the design of preventive strategies.

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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2018-214075 ◽

2019 ◽

pp. annrheumdis-2018-214075 ◽

Cited By ~ 2

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.

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

Annals of the Rheumatic Diseases ◽

10.1136/ard.2008.095596 ◽

2008 ◽

Vol 68 (2) ◽

pp. 242-245 ◽

Cited By ~ 51

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.

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Physical Activity for Campus Employees: A University Worksite Wellness Program

Journal of Physical Activity and Health ◽

10.1123/jpah.2013-0185 ◽

2015 ◽

Vol 12 (4) ◽

pp. 470-476 ◽

Cited By ~ 14

Author(s):

Carling E. Butler ◽

B. Ruth Clark ◽

Tamara L. Burlis ◽

Jacqueline C. Castillo ◽

Susan B. Racette

Keyword(s):

Physical Activity ◽

Risk Factors ◽

Cardiorespiratory Fitness ◽

Self Efficacy ◽

Worksite Wellness ◽

Wellness Program ◽

Cvd Risk Factors ◽

Cvd Risk ◽

University Employees ◽

Daily Step Count

Background:Workplaces provide ideal environments for wellness programming. The purpose of this study was to explore exercise self-efficacy among university employees and the effects of a worksite wellness program on physical activity, cardiorespiratory fitness, and cardiovascular disease (CVD) risk factors.Methods:Participants included 121 university employees (85% female). The worksite wellness program included cardiovascular health assessments, personal health reports, 8 weeks of pedometer-based walking and tracking activities, and weekly wellness sessions. Daily step count was assessed at baseline, Week 4, and Week 8. Exercise self-efficacy and CVD risk factors were evaluated at baseline and follow-up.Results:Daily step count increased from 6566 ± 258 (LSM ± SE) at baseline to 8605 ± 356 at Week 4 and 9107 ± 388 at Week 8 (P < .0001). Steps increased among normal weight, overweight, and obese subgroups. Exercise self-efficacy correlated with baseline steps (P < .05). Small improvements were observed in cardiorespiratory fitness, body mass index, blood pressure, blood glucose, total cholesterol, and triglycerides (all P < .01).Conclusions:A worksite wellness program was effective for improving physical activity, cardiorespiratory fitness, and CVD risk factors among university employees. Exercise barriers and outcome expectations were identified and have implications for future worksite wellness programming.

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Cardiovascular Risk in Rheumatoid Arthritis: Literature Review

Oman Medical Journal ◽

10.5001/omj.2021.25 ◽

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.

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Dietary α-linolenic acid and health-related outcomes: a metabolic perspective

Nutrition Research Reviews ◽

10.1079/nrr2005113 ◽

2006 ◽

Vol 19 (1) ◽

pp. 26-52 ◽

Cited By ~ 181

Author(s):

Graham C Burdge ◽

Philip C Calder

Keyword(s):

Risk Factors ◽

Fatty Acids ◽

Linolenic Acid ◽

Inflammatory Markers ◽

De Novo ◽

Cvd Risk Factors ◽

Dietary Interventions ◽

Cvd Risk ◽

Beneficial Effects ◽

Epa And Dha

α-Linolenic acid (αLNA; 18: 3n-3) is essential in the human diet, probably because it is the substrate for the synthesis of longer-chain, more unsaturatedn-3 fatty acids, principally EPA (20: 5n-3) and DHA (22: 6n-3), which confer important biophysical properties on cell membranes and so are required for tissue function. The extent to which this molecular transformation occurs in man is controversial. The present paper reviews the recent literature on the metabolism of αLNA in man, including the use of dietary αLNA in β-oxidation, recycling of carbon by fatty acid synthesisde novoand conversion to longer-chain PUFA. Sex differences in αLNA metabolism and the possible biological consequences are discussed. Increased consumption of EPA and DHA in fish oil has a number of well-characterised beneficial effects on health. The present paper also reviews the efficacy of increased αLNA consumption in increasing the concentrations of EPA and DHA in blood and cell lipid pools, and the extent to which such dietary interventions might be protective against CVD and inflammation. Although the effects on CVD risk factors and inflammatory markers are variable, where beneficial effects have been reported these are weaker than have been achieved from increasing consumption of EPA+DHA or linoleic acid. Overall, the limited capacity for conversion to longer-chainn-3 fatty acids, and the lack of efficacy in ameliorating CVD risk factors and inflammatory markers in man suggests that increased consumption of αLNA may be of little benefit in altering EPA+DHA status or in improving health outcomes compared with other dietary interventions.

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