Background and objectives The risk of cardiovascular disease (CVD) is increased in RA. The chronic inflammation appears to potentiate the traditional cardiovascular (CV) risk factors in this context. In 2009, the Swedish Society of Rheumatology (SRF) approved a set of recommendations for screening and primary prevention of CVD in RA (www.svenskreumatologi.se/riktlinjer). Low aerobic capacity is a strong CV risk factor in the general population. In a pilot study, intensive spinning exercise could improve CV risk factors, including aerobic capacity, in RA. The aim of this study was to evaluate the SRF guidelines in a clinical setting and to highlight the relation between physical exercise and CV risk in RA.
Materials and methods 47 patients with recent onset RA during 2012 at the department of Rheumatology, University Hospital of Umeå, were recruited. Three months after initial diagnosis of RA, patients were examined physically and blood samples were collected for traditional CV risk factors according to the SRF guidelines and CV risk (Heart-SCORE) was calculated. Furthermore, aerobic capacity was tested in a submaximal ergometer test (Åstrand). Additionally, patients received counselling regarding diet, tobacco use and exercise from a nurse and a physiotherapist. The counselling session, based upon national guidelines from The National Food Agency and The Public Health Agency respectively, was performed once per patient for approximately 45 min. A follow-up was performed nine months after the first examination. Results were adjusted for disease activity and disability. Aerobic capacity at baseline was related to SCORE.
Results Among the 47 included patients, 45 could be evaluated in the follow-up. Mean diastolic blood pressure decreased significantly from 80 mmHg to 77 mmHg (P < 0.05), Scholesterol decreased from 5.5 mmol/l to 5.2 mmol/l (P < 0.05) and mean ApoA1/ApoB from 0.73 to 0.65 (P < 0.05). In all remaining variables (waist circumference, BMI, systolic blood pressure, LDL, HDL, triglycerides, fP-glucose) numerical improvements were observed (P > 0.05). CV risk, as measured by SCORE, was normal. Aerobic capacity was, however, 28 ml O2/kg/min at baseline, a level regarded as high risk for CVD in the general population. Aerobic capacity remained unchanged during follow up (P > 0.05).
Conclusion Several traditional risk factors of CVD were improved at the nine-month followup. This suggests that this model of screening according to the SRF guidelines and simple counselling according to national guidelines might be useful in primary prevention of CVD in patients with RA. More research is needed regarding aerobic capacity and the value of physical training for CV risk in RA.