Background Chronic rheumatic and cardiovascular (CV) diseases share common pathophysiological factors; immobility, obesity, inflammation and smoking. Previous studies consistently found increased CV morbidity and mortality in patients with rheumatoid arthritis (RA) and gout. Cardiovascular events are more likely to be fatal in RA patients, possibly due to delayed recognition of CV symptoms. Echocardiographic and vascular function studies suggest subclinical CV dysfunction in RA patients. Appropriate non-invasive screening tests are needed to identify patients at increased risk of cardiovascular events due to subclinical CV dysfunction.
Objectives to evaluate the prevalence of -subclinical CV dysfunction by ECG and NT-proBNP in patients with RA and gout compared to patients with noninflammatory rheumatic diseases.
Methods Comparison of prevalences of ECG abnormalities, elevated NT-proBNP and previously documented CV disease (myocardial infarction, coronary artery disease, cardiac arrhythmia, heart failure, cerebrovascular event) between patients with RA (673) and gout (202) versus noninflammatory rheumatic disease (NRD; osteoarthritis and chronic pain syndromes, 458) in a cohort of consecutive patients the Arthritis Center Twente (ACT), a large rheumatology department in The Netherlands. Data were collected in 2009. Subclinical cardiovascular dysfunction was defined as the finding of ECG abnormalities and/or elevated NT-proBNP in patients without previously documented CV disease. Logistic regression analysis of potential predictors of subclinical CV dysfunction, i.e. traditional CV risk factors, ESR, disease specific medication (DMARDs or urate lowering therapy in RA and gout respectively), and DAS-28 disease activity scores (RA only), within patient groups. Analyses were controlled for age and sex.
Results 9.8% of patients had previously documented CV disease (RA 7.6%, gout 17.3% vs. NRD 5.7%, p<0.05). ECG recordings were available for 1164 patients (RA 590, gout 183, NRD 391), NT-proBNP levels for 1331 (RA 672, gout 201, NRD 458). For 1163 patients both measurements were present (RA 589, gout 183, NRD 391). Subclinical ECG abnormalities were significantly more frequent in RA (18.3%) and gout (24.0%) compared with NRD (12.0%, p<0.05). Elevated NT-proBNP was also significantly more frequent in RA (29.5%) and gout (38.3%) vs. NRD (19.0%, p<0.05). Subclinical CV dysfunction occured significantly more often in RA (30.7%) and gout (31.1%) compared with NRD (20.2%, p<0.05). Age was the only predictor of suspected CV dysfunction in both RA and gout.
Conclusions Subclinical CV disease is highly prevalent in rheumatoid arthritis and gout compared to noninflammatory rheumatic disease.
Disclosure of Interest None Declared
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