“The study suggests cardiac abnormalities already exist in newly diagnosed patients with RA,” senior author Dr. Maya Buch of the University of Leeds in the UK told Reuters Health by email.
“Specifically, a reduction in the thickness of the left ventricle was seen. Over time, this can be associated with reduced heart function. An increase in arterial stiffness was also recorded, which has been associated with increased cardiovascular events. These are fascinating data, as we did not necessarily expect to see changes so early on,” she said.
Dr. Buch presented the findings on June 12 at the European League Against Rheumatism (EULAR) Annual Congress in Rome.
Patients with RA have abnormalities in left ventricular remodeling, but to date cardiac studies have not been conducted in patients with early, treatment-naive disease.
To investigate, Dr. Buch and colleagues performed cardiac magnetic resonance imaging in 66 patients with early RA and no history of cardiovascular disease and 30 healthy controls matched by age, sex, and blood pressure.
The RA patients had significantly reduced aortic distensibility and increased arterial stiffness compared to the control group. Their left ventricular and right ventricular end-systolic and end-diastolic volumes were also significantly lower. There was a trend toward lower left ventricular mass index in the RA patients. Four of the RA patients with focal non-ischemic patterns of late gadolinium enhancement showed signs of overt inflammation and fibrosis.
The study is part of a randomized controlled trial comparing standard disease-modifying anti-rheumatic drugs (DMARDs) to anti-tumor necrosis factor (anti-TNF) therapy, Dr. Buch told Reuters Health.
“Longitudinal evaluation with repeat cardiac MRI will allow us to answer whether the abnormalities we have reported improve, whether this depends on reduction in disease activity, and whether it matters how this is achieved, i.e., DMARD versus anti-TNF. We also wish to evaluate other parameters of cardiovascular health, including exercise capacity. This work is part of a wider program of research being conducted in the Leeds ‘CARDIO-AID’ group,” she said.
Epidemiological studies have shown that DMARD treatment reduces the risk of cardiovascular events in RA patients, while anti-TNF treatment is associated with a greater reduction in cardiovascular event risk, Dr. Buch said. Patients with established RA who have reduced disease activity also have lower risk of cardiovascular events, she added.
“In early RA patients such as those investigated in our study, the presence of abnormalities and impact of DMARD has not been evaluated,” she said.