In a third study reported on at last week’s American College of Rheumatology’s (ACR) annual meeting in San Francisco, a team led Dr. Kimberly Liang, assistant professor at the University of Pittsburgh, found additional evidence that there is a link between RA and diastolic dysfunction.

“Diastolic dysfunction occurred in 38.9 percent, compared to 28.8 percent in the non-rheumatoid arthritis group. We also found that patients in the rheumatoid arthritis group had higher average pulmonary arterial pressure, which is high blood pressure in the lungs and the right side of the heart. This is consistent with the impaired filling of the heart seen in diastolic dysfunction.” – Dr. Kimberly Liang

According to Dr. Liang, increased usage of electrocardiography in rheumatoid arthritis patients may improve detection of heart problems before there are clinical signs.

The chief science officer for the Arthritis Foundation, Dr. John Hardin, says that these studies highlight the impacts that RA can have on the cardiovascular system.

“These studies are consistent with the idea that systemic inflammation promotes cardiovascular disease,” Hardin said. “Rheumatoid arthritis creates a general state of inflammation within the body.”

Dr. Hardin also pointed out that there are some arthritis drugs that can increase the risk of heart failure in RA patients with already damaged hearts.

“For example, Enbrel (etanercept) can, in fact, in some people, potentiate heart failure, which can be a complication of myocardial infarction. To prevent a heart attack, patients with rheumatoid arthritis need to pay particular attention to cholesterol, blood pressure and maintaining a healthy lifestyle. If you have rheumatoid arthritis, the things you do to protect yourself against cardiovascular disease become doubly important.” – Dr. John Hardin.

Originally posted 2008-11-07 12:00:06. Republished by Blog Post Promoter

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Eswar Krishnan, MD, assistant professor of immunology and rheumatology at Stanford University School of Medicine, has conducted a new study looking into just what that relationship is.

Uric acid naturally occurs in the body as a byproduct of many different foods. High levels are best known as a cause of gout.

“Our study shows that high levels of uric acid significantly increase your risk of developing heart failure later in life,” said Dr. Krishnan. “The novelty is that the test for measuring this is very cheap and easily available.”

In fact, a simple $2-blood test may allow doctors to determine whether a patient is at risk of developing heart failure sometime in their future.

Dr. Krishnan analyzed data obtained from the National Heart, Lung and Blood Institute participants of the Framingham Offspring cohort study. That study began in 1971 and the participants were followed for cardiovascular events for 25 years.

Dr. Krishnan was looking for the relationship between high uric acid levels (levels above 6 mg per one-tenth liter) and subsequent heart failure.

There were 4,989 participants in the Framingham Offspring study, and of those, 4,912 were eligible for Dr. Krishnan’s study. There were 196 cases of heart failure recorded.

After adjusting for a long list of variables including smoking, weight, alcohol use, diabetes, kidney problems and use of anti-hypertensive medications, Dr. Krishnan found the occurrence of heart failure was significantly higher among those with high uric acid levels.

The use of a simple blood test that is currently available to physicians to determine a patient’s chances of developing heart failure could be an effective screening tool, Dr. Krishnan said. It could help doctors target younger patients who should aggressively reduce other treatable risk factors for heart failure, such as hypertension or obesity.

On the other hand, he noted that it’s not known whether medications that reduce uric acid levels could help reduce future heart failure cases. Future studies could explore this, Krishnan said.

The study appears online in August in the journal Circulation: Heart Failure.

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Dr. Sherine Gabriel of the Mayo Clinic, lead author of the previous study, and her colleagues have issued another report on the link between RA and cardiovascular disease. This report, published in the January, 2008 issue of the Annals of Rheumatic Diseases, looked at the frequency of traditional cardiovascular risk factors to determine the impact of these factors on selected cardiovascular events, such as heart attack, heart failure and cardiovascular-related death.

The study group consisted of 603 rheumatoid arthritis patients and 603 patients without RA.

Initially, both groups had similar cardiovascular risks. During the follow up periods, 15 years for the RA group, 17 years for the non-RA group, the RA patients were more likely to lose weight, and less likely to develop abnormally high or low levels of cholesterol.

The team did find that gender, smoking and personal cardiac history resulted in different cardiovascular risk impacts on RA vs. non-RA patients. Specifically, men who smoked and had a personal cardiac history had a lower increase in risk of cardiovascular disease than non-RA males that smoked and had a personal cardiac history.

This indicates that there are different mechanisms in rheumatoid arthritis patients that lead to cardiovascular disease. The weaker effect of some of the traditional risk factors indicates that traditional approaches for controlling cardiovascular risks may not have the same benefit for RA patients.

The report concluded that additional research is needed to detect the underlying factors that determine rheumatoid arthritis-associated cardiovascular disease and mortality so therapeutic approaches can be developed.

Originally posted 2008-01-08 18:06:30. Republished by Blog Post Promoter

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I wrote on Monday about a study presented at the American College of Rheumatology’s (ACR) annual meeting in San Francisco. In that research study, a graduate student from Sweden found that people with rheumatoid arthritis (RA) had nearly twice the risk of heart attack and death from heart attack of those without RA.

Another research study presented at ACR meeting also indicates that people with RA have an increased risk of heart problems as those without RA.

The researchers in this study, led by Dr. Hilal Maradit Kremers, found that a condition known as diastolic dysfunction can lead to heart failure. Diastolic dysfunction is an abnormality in the left ventricle of the heart which causes blood returning from the lungs to spill back into the left atrium and eventually back into the lungs. This condition results in stiffness of the heart and can lead to heart failure.

The team followed 38 RA patients who had suffered a heart attack. They compared these patients to patients with RA who had not had a heart attack.

The team’s analysis showed that the patients with rheumatoid arthritis were 45% more likely to develop heart failure after a heart attack compared with the general population. They also found that RA patients had a 75% greater risk of dying from heart failure.

“Rheumatoid arthritis patients not only have more heart attacks and heart failures, but they also have worse prognosis once they have a cardiovascular event,” said Dr. Kremers.

Dr. Kremers is an epidemiologist at the Mayo Clinic in Rochester, Minnesota.

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