Factors associated with left ventricular mass during disease modifying antirheumatic drug therapy in patients with rheumatoid arthritis: the Joint Heart study

Background

We explored factors associated with left ventricular (LV) mass index during biological (b) or targeted synthetic (ts) disease modifying antirheumatic drug (DMARD) therapy in patients with rheumatoid arthritis (RA).

Methods

Eighty-three outpatients with RA (age 55 ± 12 years, 71% women) with an indication for b/ts DMARD therapy were examined with echocardiography at baseline and after a mean follow-up of 22 months. LV mass was calculated according to guidelines and indexed for height^2.7.

Results

At baseline, 37% had hypertension, 6% diabetes, 21% obesity, and 100% were using b/ts DMARDs. During follow-up, 17% discontinued b/tsDMARD treatment. The LV mass index remained unchanged during follow-up (33.1 ± 8.1 g/m^2.7 vs. 33.5 ± 7.3 g/m^2.7, p = 0.57, mean change 0.3 ± 4.9 g/m^2.7). Lower LV mass index at follow-up was observed in patients using bDMARDs at follow-up (31.7 ± 6.2 g/m^2.7 vs. 36.6 ± 8.9 g/m^2.7, p = 0.001). In multivariable linear regression analyses, use of bDMARDs (β −0.22, p = 0.03) at follow-up were associated with lower LV mass index at follow-up, independent of C-reactive protein (CRP), age, sex, and obesity at baseline. Obesity at baseline (β 0.39, p < 0.001) was associated with a higher LV mass index both at baseline and follow-up. Higher CRP at baseline was associated with higher LV mass index at baseline (β 0.31, p = 0.001), but not at follow-up.

Conclusion

In patients with RA on DMARD treatment, the mean LV mass index remained stable during 22 months of follow-up. Obesity was the strongest factor associated with higher LV mass index, while use of bDMARD throughout the study period was associated with lower LV mass index.