Session Information
Date: Tuesday, November 15, 2016
Title: Muscle Biology, Myositis and Myopathies - Poster II: Clinical
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose: Research has indicated that cardiovascular disease is the leading cause of death in the Idiopathic Inflammatory Myopathies (IIM). Only a small number of studies have investigated the burden of cardiovascular morbidity in patients with myositis in comparison to a healthy population. Arterial stiffness, a strong predictor of cardiovascular risk, can be non-invasively quantified via the Reactive Hyperaemia Index (RHI) and the Augmentation Index (AI), unadjusted and adjusted to 75 beats per minute. A reduced RHI and a raised AI is indicative of endothelial dysfunction and increased arterial stiffness. The aim of this study was to characterise the presence of cardiovascular risk factors in an IIM population in comparison to a healthy population.
Methods: Adults with a verified IIM diagnosis were recruited. A healthy matched control cohort was also recruited. The following investigations were carried out on each patient on the same day: tobacco use assessment, brain natriuretic peptide (BNP) measurement, body composition analysis, blood pressure measurement, measurement of fasting cholesterol, triglyceride, C-reactive protein (CRP), insulin and glucose concentrations, carotid artery intima-medial thickness (CIMT) and plaque identification via ultrasound, ejection fraction measurement and valve dysfunction identification via echocardiography. Radial artery stiffness (RHI and AI) was quantified non-invasively using the endoPAT system. Ten year cardiovascular disease (CVD) risk was calculated for each patient via QRISK2. Continuous variables were compared between the two groups with the Mann-Whitney U test and categorical variables were compared with the Chi-squared test.
Results: Nineteen IIM patients with confirmed disease according to the Bohan and Peter criteria and 20 healthy controls were recruited (Table 1). A higher proportion of the IIM cases were female and were slightly younger. AI (unadjusted and adjusted to 75 bpm) was higher for the IIM cases and RHI did not differ. Previous tobacco use was similar between the two groups. Median lean fat mass and total body water was lower in the IIM cases and body mass index (BMI) was raised. Cholesterol, insulin, CRP, glucose and triglyceride measurements did not vary between the two groups. Median haemodynamic measurements (BNP, SBP, DBP, ejection fraction), CIMT and the number of identified carotid plaques and heart valve abnormalities were similar in each group. Ten year CVD risk was similar between each group.
Conclusion: This study indicates that arterial stiffness (measured as AI), a strong indicator of cardiovascular risk, is increased in IIM patients. Further, IIM is associated with increased BMI and variations in body composition. Cardiac function, atherosclerosis burden, 10 year CVD risk, cholesterol profile and insulin resistance is similar in IIM cases and controls. A further study of the cardiovascular manifestations in a larger IIM cohort is warranted.
| Table 1 – Comparison of demographic and cardiovascular variables between IIM cases and controls | |||
|
|
Cases n = 19 |
Controls n = 20 |
p-value |
|
No. female (%) |
15 (79) |
9 (45) |
0.09 |
|
Median age/years (IQR) |
39 (34, 49) |
42 (33, 47) |
0.92 |
|
Median alcohol intake/units per week (IQR) |
0 (0, 2) |
3 (1, 16) |
<0.01 |
|
No. current smokers (%) |
5 (26) |
6 (30) |
1.00 |
|
Median smoking pack years (IQR) |
1 (0, 7) |
1 (0, 7) |
0.94 |
|
Median BNP/pg/ml (IQR) |
67 (50, 90) |
53 (23, 91) |
0.19 |
|
Median EF percentage (IQR) |
58 (55, 64) |
61 (59, 66) |
0.17 |
|
No. with a valvular abnormality (%) |
9 (47) |
7 (35) |
0.63 |
|
Median systolic blood pressure/mmHg (IQR) |
135 (113, 144) |
120 (112, 133) |
0.16 |
|
Median diastolic blood pressure/mmHg (IQR) |
77 (69, 83) |
74 (69, 78) |
0.50 |
|
Median CIMT/mm (IQR) |
0.06 (0.05, 0.06) |
0.06 (0.05, 0.06) |
0.93 |
|
No. with plaque present (%) |
1 (5) |
2 (10) |
1.00 |
|
Median RHI (IQR) |
2.1 (1.7, 2.6) |
2.1 (1.9, 2.6) |
0.63 |
|
Median AI (IQR) |
16.0 (-4.8, 24.0) |
6 (-5.5, 14.0) |
0.22 |
|
Median AI @ 75bpm (IQR) |
6.5 (-10.8, 20.5) |
-1.0 (-8.5, 9.5) |
0.14 |
|
Median body fat % (IQR) |
36.2 (27.6, 44.6) |
32.4 (26.0, 36.6) |
0.29 |
|
Median lean fat mass/Kg (IQR) |
44.8 (42.4, 51.9) |
55.4 (46.2, 61.6) |
0.06 |
|
Median total body water/Kg (IQR) |
33.8 (31.8, 38.6) |
40.6 (33.8, 45.1) |
0.13 |
|
Median body water % (IQR) |
46.7 (40.5, 53.1) |
49.4 (46.0, 54.1) |
0.18 |
|
Median BMR/Kcal (IQR) |
1432 (1330, 1690) |
1707 (1440, 1871) |
0.11 |
|
Median whole body impedance/Ω (IQR) |
637 (584, 746) |
611 (551, 678) |
0.37 |
|
Median BMI/Kg/m2 (IQR) |
29.6 (23.3, 33.1) |
25.8 (25.1, 31.4) |
0.64 |
|
Median fasting insulin/mU/L (IQR) |
6.4 (4.2, 11.3) |
7.5 (5.2, 11) |
0.88 |
|
Median fasting glucose/mmol/L (IQR) |
4.7 (4.2, 5) |
4.8 (4.5, 5) |
0.62 |
|
Median total cholesterol/mmol/L (IQR) |
5.1 (4.3, 5.4) |
4.9 (4.3, 5.5) |
0.78 |
|
Median triglyceride/mmol/L |
1.2 (0.9, 1.8) |
1 (0.7, 1.8) |
0.37 |
|
Median HDL/mmol/L (IQR) |
1.5 (1.1, 1.8) |
1.4 (1.2, 1.6) |
0.88 |
|
Median LDL/mmol/L |
2.9 (2.4, 3.3) |
2.8 (2.5, 3.3) |
0.94 |
|
Median cholesterol:HDL ratio (IQR) |
3.4 (3.0, 4.8) |
3.3 (2.7, 4.1) |
0.65 |
|
No. raised cholesterol:HDL ratio (%) |
7 (37) |
7 (35) |
0.73 |
|
Median CRP/mg/L (IQR) |
1.4 (0.5, 4.5) |
1.2 (0.8, 2.2) |
0.12 |
|
Mean 10 Year CVD risk percentage (SD) |
4.7 (5.4) |
4.2 (4.5) |
0.76 |
To cite this abstract in AMA style:
Oldroyd AGS, Cooper R, Parker B, Bruce IN, New P, Chinoy H. Profile of Cardiovascular Burden in Myositis: A Case-Control Study [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/profile-of-cardiovascular-burden-in-myositis-a-case-control-study/. Accessed .« Back to 2016 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/profile-of-cardiovascular-burden-in-myositis-a-case-control-study/