Factors associated with left ventricular mass during disease modifying antirheumatic drug therapy in patients with rheumatoid arthritis: the Joint Heart study

TL;DR

This study found that obesity increases heart mass in rheumatoid arthritis patients, while continuous use of certain drugs reduces it.

Contribution

The study identifies obesity and continuous use of biological DMARDs as key factors influencing left ventricular mass in rheumatoid arthritis patients.

Findings

Mean left ventricular mass index remained stable over 22 months of DMARD therapy.

Obesity at baseline was strongly associated with higher left ventricular mass index.

Continuous use of bDMARDs was linked to lower left ventricular mass index.

Abstract

We explored factors associated with left ventricular (LV) mass index during biological (b) or targeted synthetic (ts) disease modifying antirheumatic drug (DMARD) therapy in patients with rheumatoid arthritis (RA).

Eighty-three outpatients with RA (age 55 ± 12 years, 71% women) with an indication for b/ts DMARD therapy were examined with echocardiography at baseline and after a mean follow-up of 22 months. LV mass was calculated according to guidelines and indexed for height2.7.

At baseline, 37% had hypertension, 6% diabetes, 21% obesity, and 100% were using b/ts DMARDs. During follow-up, 17% discontinued b/tsDMARD treatment. The LV mass index remained unchanged during follow-up (33.1 ± 8.1 g/m2.7 vs. 33.5 ± 7.3 g/m2.7, p = 0.57, mean change 0.3 ± 4.9 g/m2.7). Lower LV mass index at follow-up was observed in patients using bDMARDs at follow-up (31.7 ± 6.2 g/m2.7 vs. 36.6 ± 8.9 g/m2.7, p = 0.001). In multivariable linear regression analyses, use of bDMARDs (β −0.22, p = 0.03) at follow-up were associated with lower LV mass index at follow-up, independent of C-reactive protein (CRP), age, sex, and obesity at baseline. Obesity at baseline (β 0.39, p < 0.001) was associated with a higher LV mass index both at baseline and follow-up. Higher CRP at baseline was associated with higher LV mass index at baseline (β 0.31, p = 0.001), but not at follow-up.

In patients with RA on DMARD treatment, the mean LV mass index remained stable during 22 months of follow-up. Obesity was the strongest factor associated with higher LV mass index, while use of bDMARD throughout the study period was associated with lower LV mass index.

Image 1

•We investigated factors associated with left ventricular (LV) mass in rheumatoid arthritis (RA).•Mean LV mass did not change during two years of follow-up.•Patients with obesity had greater LV mass.•Continuous use of immunosuppressive treatment was associated with lower LV mass.

We investigated factors associated with left ventricular (LV) mass in rheumatoid arthritis (RA).

Mean LV mass did not change during two years of follow-up.

Patients with obesity had greater LV mass.

Continuous use of immunosuppressive treatment was associated with lower LV mass.

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