Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Rheumatoid Arthritis (RA) patients face a burden of cardiovascular disease (CVD) twice that of the general population. RA patients have reduced physical fitness, a risk factor for CVD not routinely measured or addressed. Enhanced risk profiling was performed in 100 RA patients between October 2010 and March 2011 combining traditional risk factors with a novel assessment of physical fitness. Patients were given written feedback on lifestyle modification, smoking cessation, where appropriate offered statin or antihypertensive medications, and invited to an 8-week aerobic training research programme. Here we examine the impact on CVD risk and fitness 2 years on.
Methods:
All 100 RA patients (69 female, 31 male) were invited for reassessment between February and June 2013. Of these, 58 did not participate (3 died, 28 opted-out, 23 unable to attend, 4 not eligible). Forty-two patients returned for assessment of RA activity scores (DAS-28), CVD risk factors, anthropometric measures, 10-year Framingham and QRISK2-2013 risk score, and physical fitness using the Siconolfi Step Test. Assessments using the Health Assessment (HAQ), International Physical Activity (IPAQ) and study specific questionnaires were completed. Statistical analysis was performed in SPSS v21 and GraphPad.
Results:
During the follow-up period (median 2.2 years) there were no cardiovascular events. Results are outlined in table 1. Patients found feedback on CVD risk and fitness useful in 76% cases, citing it prompted an increase in exercise for 48% and to pursue a low fat diet in 63%. Lifestyle modification occurred with smoking cessation in 4 of 7 active smokers and greater engagement with lipid-lowering and antihypertensive agents. A significant rise in physical activity was reported, however observed physical fitness decreased (p = 0.026) and body mass index rose (p = 0.014).
The QRISK2 10-year CVD risk estimate rose slightly, whereas Framingham risk scores did not significantly change. Ageing increases CVD risk, and Framingham 10-year risk at reassessment (15%) was significantly lower than that predicted by age-adjusted initial CVD risk factor data (18%). Diastolic pressures fell, and a similar trend in systolic blood pressure was seen.
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Table 1 Two-Year Follow-up Data: Changes in CVD Risk, Physical Fitness and RA Status |
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|
|
Initial Assessment |
Reassessment |
Probability (2-tailed) |
|
Number |
42 |
42 |
– |
|
Age |
62.3 ± 9.3 |
64.6 ± 9.3 |
– |
|
Sex (F : M) |
29:14 |
29:14 |
– |
|
Rheumatoid Arthritis Factors |
|
|
|
|
Disease duration / years |
13.3 ± 10.2 |
15.4 ± 10.2 |
– |
|
DAS28 CRP |
2.64 ± 1.2 |
2.45 ± 0.77 |
0.355 |
|
Health Assessment Questionnaire (HAQ) |
0.74 ± 0.64 |
0.97 ± 0.80 |
0.009** |
|
Physical Fitness |
|
|
|
|
Step test VO2 (ml/kg/min) |
21.6 ± 5.5 |
20.4 ± 5.1 |
0.026* |
|
Observed vs. Predicted V02 (ml/kg/min) |
21.6 ± 5.3 |
21.2 ± 5.3 |
0.491 |
|
Able to step (%) |
76 |
79 |
1.000 † |
|
IPAQ Activity Category (low/moderate/vigorous) |
21/17/4 |
12/11/19 |
0.0001 ** †† |
|
Anthropometry |
|
|
|
|
Body mass index (kg/m2) |
26 ± 4.9 |
27 ± 5.5 |
0.014** |
|
Body fat (%) |
36 ± 14 |
35 ± 13 |
0.353 |
|
Waist : hip ratio |
0.89 ± 0.7 |
0.88 ± 0.9 |
0.388 |
|
Cardiovascular Risk Factors |
|
|
|
|
Systolic Blood Pressure (mmHg) |
141 ± 20 |
134 ± 21.8 |
0.081 |
|
Diastolic Blood Pressure (mmHg) |
80 ± 11 |
73 ± 16 |
0.012* |
|
Hypertensive or on anti-hypertensive (%) |
60 |
64 |
0.823 † |
|
Hypertensive not on medication (%) |
29 |
19 |
0.443 † |
|
Total Cholesterol (mmol/L) |
5.4 ± 1.1 |
5.2 ± 1.1 |
0.112 |
|
Triglyceride (mmol/L) |
1.4 ± 0.7 |
1.6 ± 1.1 |
0.284 |
|
Low density lipoprotein (mmol/L) |
3.2 ± 1.0 |
3.0 ± 0.9 |
0.132 |
|
High density lipoprotein (mmol/L) |
1.6 ± 0.5 |
1.6 ± 0.5 |
0.778 |
|
Dyslipidaemia not on medication (%) |
40 |
37 |
0.791 † |
|
Current Smoking (%) |
17 |
7 |
0.313 † |
|
Cardiovascular Risk Score |
|
|
|
|
10 year Framingham risk (%) |
16 ± 8.6 |
15 ± 9.2 |
0.454 |
|
Predicted vs. Observed Framingham risk (%) |
18 ± 9.1 |
15 ± 9.2 |
0.026* |
|
10 year QRISK2 (%) |
19 ± 11 |
21 ± 12 |
0.020* |
|
Predicted vs. Observed QRISK2 (%) |
22 ± 12 |
21 ± 12 |
0.272 |
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Paired T-Test unless otherwise stated. †- Fisher’s Exact Test, ††- Chi Squared * – Significant at 5%, **- Significant at 1% |
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Conclusion:
Our study showed providing patients with an assessment of CVD risk factors and physical fitness had a positive impact on smoking, uptake of risk modifying medications, and perceived physical activity and healthy diet. CVD risk increased but less than that expected with ageing. Disappointingly this was not reflected in body composition or physical fitness, and uptake of a training programme was low (19%) – even in this returning cohort. Behavioural modification such as improving physical activity is fundamental to improving cardiac risk and functional status. Further work is needed in how these changes can be introduced and maintained as pharmacological and prescriptive interventions alone are inadequate.
Disclosure:
M. J. Ponsford,
None;
J. K. Cooney,
None;
B. Anthony,
None;
F. A. Huws,
None;
L. Evans,
None;
J. Thom,
None;
Y. Ahmad,
None.
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