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Active rheumatoid arthritis increases cardiovascular risk

Among rheumatoid arthritis (RA) patients, higher disease activity is independently associated with greater left ventricular (LV) relative wall thickness, reflecting subclinical heart disease, according to a study published recently in Rheumatology.1

The authors examined clinical and echocardiographic data from 129 RA patients without established cardiovascular disease, and 102 controls. RA disease activity was assessed by different composite scores and active RA defined by the Simplified Disease Activity Index (SDAI) level exceeding the cut-off for remission (SDAI >3.3).

The RA patients were on average 61.3 years old, 77% were women and 67% had active RA (SDAI >3.3). Patients with active RA had greater LV relative wall thickness and included more patients with treated hypertension (all P <0.05), but had LV mass index and blood pressure comparable to patients in remission.

Having active RA by the SDAI score (β = 0.20, P = 0.008) was also independently associated with greater LV relative wall thickness after adjusting for systolic blood pressure, wall stress, age and sex in a multivariate model. This association was robust also in secondary models including other disease activity composite scores such as the Clinical Disease Activity Index and 28-joint DAS.

Screen shot 2015-04-29 at 10.46.29These findings point to the importance of disease activity control in RA patients to prevent progression to clinical heart disease, say the authors.

Speaking to BJC Arrhythmia Watch, co-author Dr Helga Midtbø (Haukeland University Hospital) said: “This study shows that high disease activity in RA, in contrast to remission, adversely affect left ventricular structure that is associated with an increased risk of cardiovascular disease.”

“Echocardiographic screening of RA patients is not recommended at present, but the result of this study strengthens any future recommendation…The diagnosis of RA alone is not a sole indication for primary preventive treatment with cardio-protective agents like statins. However, since patients with RA have an increased risk of cardiovascular disease, special attention should be undertaken to evaluate the cardiovascular disease risk in patients with RA,” Dr Midtbø concluded.


1. Midtbø H, Gerdts E, Kvien TK, Olsen IC, Hirth A, Davidsen ES, Semb AG. Disease activity and left ventricular structure in patients with rheumatoid arthritis. Rheumatology 2015;54:511–9.

Published on: April 29, 2015

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