Rheumatoid arthritis is independently related to increased left ventricular (LV) mass and hypertrophy, according to a study in the January issue of Arthritis & Rheumatism.
Because age at diagnosis and disease duration were also independently related to LV mass, co-author Dr. Mary Roman of Weill Medical College of Cornell University and colleagues suggest that rheumatoid arthritis might have a direct effect on LV structure, linking the chronic inflammation caused by the disease to the development of LV hypertrophy.
The study also found that systolic function was preserved in rheumatoid arthritis patients; ejection fraction was higher among these patients than among the healthy matched control subjects (p < 0.001). This suggests, the authors wrote, "that systolic dysfunction is not an intrinsic feature of rheumatoid arthritis or the cause of heart failure in rheumatoid arthritis independent of other cardiovascular disease."
Premature death in rheumatoid arthritis patients is often caused by cardiovascular disease, especially ischemic heart disease and congestive heart failure. In a prior study, published in the journal Circulation in 2007, the researchers had shown that the presence of systemic lupus erythematosus predicts increased LV mass. They also noted that only a few previous studies had examined LV structure and function in patients with rheumatoid arthritis, and that the results had been inconclusive.
In this case control study, Dr. Roman's group recruited 89 patients with rheumatoid arthritis and without clinical cardiovascular disease. Eight-eight patients were female, the mean age was 46.7 years, and mean duration of rheumatoid arthritis was 12 years. These patients were matched with 89 healthy controls for age (within 5 years), gender, ethnicity and hypertension status. All participants underwent echocardiography, carotid ultrasonography and radial tonometry to measure arterial stiffness.
Rheumatoid arthritis patients with LV hypertrophy, compared with those without rheumatoid arthritis were older, had higher systolic blood pressure, higher body mass index and a higher arterial stiffness index. In addition, they were more likely to be hypertensive, to have carotid atherosclerosis and to be current smokers.
Based on the study's results, physicians should be aggressive about treating comorbidities in patients with rheumatoid arthritis, such as hypertension, obesity and diabetes, Dr. Roman told Reuters Health. She added that aggressive treatment of the rheumatoid arthritis itself might be cardioprotective.
Arthritis Rheum 2009;60:22-29.