Newswise — Researchers provide new evidence to uncover why people with rheumatoid arthritis have an increased risk for heart failure, according to research presented this week at the American College of Rheumatology Annual Scientific Meeting in San Francisco, Calif.
Rheumatoid arthritis is a chronic disease that causes pain, stiffness, swelling, and limitation in the motion and function of multiple joints. Though joints are the principal body parts affected by RA, inflammation can develop in other organs as well. An estimated 1.3 million Americans have RA, and the disease typically affects women twice as often as men.
It's known that people with RA are at increased risk for heart failure and death due to heart disease. What is less clear, however, are the factors that lead to heart failure in these patients, how to find it sooner, and how to possibly prevent it. Diastolic dysfunction is a condition in which the ventricles of the heart become relatively stiff leading to impaired filling. Over time, this can lead to heart failure.
Researchers recently compared the frequency of diastolic dysfunction in 149 people with RA to a group of 1,405 people without the disease. They conducted a community-based prospective study of adult patients with and without RA living in Olmsted County, Minn., who had no history of heart failure. Participants in both groups completed a questionnaire and had echocardiograms (cardiac ultrasounds), which were interpreted by the same study team to ensure comparability between participants.
Researchers found that diastolic dysfunction was more common in the patients with RA, occurring in 38.9 percent; compared to 28.8 percent in the non-RA group. They also found that patients in the RA group had higher average pulmonary arterial pressure, which is high blood pressure in the lungs and the right side of the heart.
"Wider use of echocardiography in patients with RA may reveal heart abnormalities before they are detected clinically," explains Kimberly Liang, MD; assistant professor, University of Pittsburgh, Pittsburgh, Pa., and lead author of the study. "Early detection could improve long-term outcomes in these patients." The ACR is an organization of and for physicians, health professionals, and scientists that advances rheumatology through programs of education, research, advocacy and practice support that foster excellence in the care of people with or at risk for arthritis and rheumatic and musculoskeletal diseases. For more information on the ACR's annual meeting, see www.rheumatology.org/annual.
Editor's Notes: Dr. Liang will present this research during the ACR Annual Scientific Meeting at the Moscone Center from 4:45 " 5:00 PM on Sunday, October 26, in Room 307. Dr. Liang will be available for media questions and briefing at 8:30 AM on Sunday, October 26 in the on-site press conference room, 114. Although Dr. Liang is currently at the University of Pittsburgh, this research was done when Dr. Liang was at the Mayo Clinic.
Presentation Number: 685
Diastolic Dysfunction in Rheumatoid Arthritis Patients
Kimberly P. Liang, Cynthia S. Crowson, Veronique L. Roger, Barry L. Karon, Daniel D. Borgeson, Terry M. Therneau, Richard J. Rodeheffer, Sherine E. Gabriel. Mayo Clinic, Rochester, MN
Purpose: We have previously shown that patients with rheumatoid arthritis (RA) have an increased risk of heart failure and mortality. In previous community population-based studies, isolated diastolic dysfunction was common and was associated with a marked increase in all-cause mortality. The purpose of this study is to compare the prevalence of diastolic dysfunction in subjects with RA, without a history of heart failure, to subjects without RA or a history of heart failure.
Methods: We conducted a community-based prospective study of RA (1987 ACR criteria) subjects (aged ≥18 years) without heart failure (defined using diagnostic indices) compared to a community-based cohort of subjects without either RA or HF. Study participation included a questionnaire and an echocardiogram. Echocardiograms for both cohorts were read by the same study team to ensure comparability. Diastolic dysfunction was defined as impaired relaxation (with or without increased filling pressures) or advanced reduction in compliance or reversible or fixed restrictive filling. Linear and logistic regression models stratified by sex and decade of age were used to compare the echo measures in the RA and non-RA patients.
Results: The study population included 149 subjects with RA and 1405 subjects without RA. The mean age of the RA subjects was 63.0 years (73% female) and was 64.7 years (51% female) for the non-RA subjects. The vast majority (>98%) of both groups had preserved ejection fraction (EF >50%), and the proportions with preserved EF in the two groups were similar (p=0.76). Left ventricular (LV) mass in the two groups was also similar (p=0.27). However, diastolic dysfunction was more common in the RA subjects (38.9%) compared to 28.8% (age and sex adjusted) in the non-RA subjects (Odds ratio: 1.75; 95% confidence interval: 1.14, 2.69). RA subjects had a higher mean pulmonary arterial (PA) pressure (29.4 mm Hg) compared to non-RA subjects (22.5 mm Hg; p<0.001), as well as a higher mean left atrial volume index (26.8 cc/m2) compared to non-RA subjects (23.3 cc/m2, age and sex adjusted; p<0.001).
Conclusion: When comparing subjects without a history of heart failure, persons with RA have a higher prevalence of diastolic dysfunction and higher PA pressure compared to those without RA. These results suggest that diastolic dysfunction with preserved EF could account for some of the excess risk of heart failure and mortality in patients with RA.
Disclosure Block: K.P. Liang, None; C.S. Crowson, None; V.L. Roger, None; B.L. Karon, None; D.D. Borgeson, None; T.M. Therneau, None; R.J. Rodeheffer, None; S.E. Gabriel, None.
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