Background Rheumatoid arthritis (RA) is characterized by a high risk of cardiovascular events (CVE). The duration and severity of RA are significant factors in the process of accelerated development of CVE. Indicators of cardiac autonomic neuropathy (CAN) such as low heart rate variability (HRV) indexes and QT-interval prolongation are suggested markers of CVE. Arterial stiffening is also recognized as an important and independent risk factor for CVE.
Objectives to evaluate evidence of CAN and arterial stiffening in women with early (<12m, mean DD-6,5±0,5m) and longstanding RA (>12m, mean DD-133,52±6,0m).
Methods Signs of CAN assessed by time-domain HRV parameters, normalized by MeanNN and age, and duration of corrected QT (QTc) interval from 24h ambulatory ECG recording were investigated in 58 women with early RA and 312 - with RA>12m (mean age - 48,2±0,59 years, DAS28-5,5±0,1, moderate to severe disease activity – 82%, RF+ - 79%, anti-CCP+ - 79%). The control group consisted of 131 age-matched women without rheumatic disease. Arterial stiffness (stiffness index) was measured by digital volume pulse contour analysis (Micro Medical, UK) in 24 pt with early RA, 158 pt with RA>12m and 25 controls.
Results There were not differences between age (47 vs 48 years), frequency of CHD (16% vs 19%), carotid intima media thickness (0,76 vs 0,76 mm), arterial hypertension (61% vs 59%), atherogenic ratio (4,67 vs 4,51), smoking (16% vs 16%), body mass index (26 vs 25 kg/m2), menopause (48% vs 54%), DAS28 (5,6 vs 5,6) and RF+ (74% vs 81%) in women with early RA and RA>12m.However the women with RA>12m had more extraarticular manifestations (36% vs 15%, p=0,002) higher HAQ score (1,58±0,04 vs 1,16±0,16, p=0,007), frequency of III, IV radiographic stage (64% vs 0,06%, p<0,001) and anti-CCP+ (82% vs 67% p=0,009).
Lower values of SDNNc, SDANNc, SDNNic were detected in early RA (1,36±0,01, 1,30±0,01, 0,98±0,01) and RA>12m (1,36±0,01, 1,30±0,01, 0,97±0,01) when compared with the controls (1,41±0,01, 1,36±0,01, 1,04±0,01, p<0,001 respectively). Significant lower values of RMSSDc and PNN50c, reflecting reduction of parasympathetic tone, were detected only in RA>12m when compared with the controls (0,80±0,01, 0,26±0,03 vs 0,89±0,01, 0,56±0,03, p<0,001). In early RA RMSSDc (0,88±0,03) and PNN50c (0,46±0,08) were higher when in RA>12m (p<0,001) and comparable with these parameters in the controls (p=0,7). Duration of QTc and frequency of high QTc>440ms were also higher in RA>12m (407,4±1,2ms, 8,2%) when in early RA (395,1±3,6ms, 0%) and controls (396,3±1,7ms, 0,8%, p<0,01). Stiffness index and frequency of pt with “stiff arteries” were higher in RA>12m (12,7±0,5 m/s, 37%) when in early RA (9,3±0,9m/s, 9%) and controls (6,7±0,2m/s, 0%, p<0,018).
Conclusions Women with longstanding RA had more arterial stiffness and signs of CAN reflecting higher sympathetic activity and regional inhomogeneity of ventricular repolarization. These results confirm the significance of RA duration and severity in development of the changes and that in turn may lead to an increased CVE. Early and effective anti-inflammatory therapy with disease-modifying antirheumatic drugs aimed at achieving remission, to prevent joint damage and disability, becomes a critical component of CVE prevention in women with RA.
Disclosure of Interest None Declared