Disease Remission Reduces Risk of Heart Failure in Rheumatoid Arthritis Patients Independent of Treatment Strategy

Thomas Schau¹, Michael Gottwald², Christian Butter¹ and Michael Zaenker³, ¹Cardiology Dept., Immanuel Klinikum Bernau Heart Center Brandenburg, Bernau, Germany, ²Internal Med. Dept., Immanuel Klinikum Bernau, Rheumatology Center Northern Brandenburg, Bernau, Germany, ³Immanuel Klinikum Bernau, Rheumatology Center Northern Brandenburg, Bernau, Germany

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease, heart disease and rheumatoid arthritis (RA)

Session Information

Title: Rheumatoid Arthritis - Clinical Aspects II: Remission and De-escalation of Therapy

Session Type: Abstract Submissions (ACR)

Background/Purpose

Risk of heart failure (HF) is increased in patients with RA, however there is great variance in reported prevalence rates due to different diagnostic standards and underestimation of diastolic HF. Besides traditional risk factors, systemic inflammation and persistent RA-activity are thought to be independent contributors to increased HF risk. This study was to determine influence of RA-activity on prevalence of HF in a community-based RA-cohort compared to age- and gender-matched controls by using the European Society of Cardiology (ESC) diagnostic guidelines.

Methods

A prospective, cross-sectional study including 157 consecutively recruited RA-patients from our outpatient clinic during a 3 months period. Inclusion criteria were written consent and diagnosis of RA fulfilling ACR/EULAR-criteria. Blinded to any health information, an age- and gender-matched control group (n=77) was recruited from a district office and veterans of our hospital staff. Data were obtained using standardized questionnaire, clinical investigation, lab tests including NT-proBNP (Roche), and echocardiography containing tissue doppler and strain imaging.

Results

The RA and control cohorts were comparable in age (mean (SD) 61 years (±13) vs. 59(±12) and gender distribution (67% vs. 69% females). In RA, median HAQ was 1.1 (Interquartile range (IQR) 0.8-2.0), median DAS28 was 2.8 (IQR 2.0-3.4), with remission (DAS28<2.6) in 45%, low disease activity (DAS28 2.6-3.2) in 25% and higher disease activity (DAS28>3.2) in 30% of the patients. Prevalence of HF was significantly higher in RA vs. controls (38(24%) vs. 5(6%), p<0.001). Of all diagnosed HF, only 2 RA patients showed reduced ejection fraction. Comparing RA and control group, traditional risk factors were not significantly different except mean BMI (29±5 vs. 27±4, p<0.001) and prevalence of hypertension (59% vs. 40%, p=0.019). No significant differences were found for diabetes, chronic kidney disease, hyperlipidaemia. Subgroup analysis revealed 37% prevalence of HF in patients with DAS28>3.2 (RR 5.7, p<0.001 compared to controls), 30% in patients with DAS28 2.6-3.2 (RR 4.6, p=0.0015) and 13% in patients with DAS28-remission (RR 1.95, p=0.264). In multivariate analysis adjusted for age and gender, remaining risk factors for HF in RA were DAS28≥2.6 (OR 3.4, 95%CI 1.3-9.8), RA-duration>10years (OR 2.6, 95%CI 1.2-5.8), CRP median>10mg/l (OR 4.8, 95%CI 1.1-21), and ESR>16mm/h (OR 5.4, 95%CI 2.1-16). We found no influence of treatment type.

Conclusion

Compared to age and gender matched controls, prevalence of mostly diastolic HF was found 4-6fold increased in active RA but only 2fold increased in states of disease remission. We conclude that optimal control of RA and awareness for diastolic HF more than type of treatment are crucial for adequately addressing cardiovascular risk in RA patients.

Disclosure:

T. Schau,
None;

M. Gottwald,
None;

C. Butter,
None;

M. Zaenker,
None.

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