title: Disease activity and left ventricular structure in patients with rheumatoid arthritis.
abstract: OBJECTIVE
  Increased left ventricular (LV) wall thickness/internal diameter ratio (relative wall thickness) was recently reported in RA patients. The aim of this study was to assess the association between LV relative wall thickness and RA disease activity.
  
  
  METHODS
  Clinical and echocardiographic data from 129 RA patients without established cardiovascular disease and 102 controls were used. RA disease activity was assessed by different composite scores and active RA defined by the Simplified Disease Activity Index (SDAI) level exceeding the cut-off for remission (SDAI >3.3).
  
  
  RESULTS
  The RA patients were on average 61.3 years old, 77% were women and 67% had active RA (SDAI >3.3). Patients with active RA had greater LV relative wall thickness and included more patients with treated hypertension (all P < 0.05), but had LV mass index and blood pressure comparable to patients in remission. Having active RA by the SDAI score (β = 0.20, P = 0.008) was also independently associated with greater LV relative wall thickness after adjusting for systolic blood pressure, wall stress, age and sex in a multivariate model. This association was robust also in secondary models including other disease activity composite scores such as the Clinical Disease Activity Index and 28-joint DAS.
  
  
  CONCLUSIONS
  Among RA patients, higher disease activity was independently associated with greater LV relative wall thickness, reflecting subclinical heart disease. The findings point to the importance of disease activity control in RA patients to prevent progression to clinical heart disease.
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway. Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway. helgamit@online.no.
authors.forename: Helga
authors.initials: H
authors.lastname: Midtbø
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway.
authors.forename: Eva
authors.initials: E
authors.lastname: Gerdts
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway.
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway.
authors.forename: Inge C
authors.initials: IC
authors.lastname: Olsen
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway.
authors.forename: Asle
authors.initials: A
authors.lastname: Hirth
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway.
authors.forename: Einar Skulstad
authors.initials: ES
authors.lastname: Davidsen
authors.affiliation: Department of Heart Disease, Haukeland University Hospital, Department of Clinical Science, University of Bergen, Bergen, Department of Rheumatology, Diakonhjemmet Hospital, Oslo and Childrens Department, Haukeland University Hospital, Bergen, Norway.
authors.forename: Anne Grete
authors.initials: AG
authors.lastname: Semb
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000175:diagnosis / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D016022:Case-Control Studies; D004452:Echocardiography; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: cardiovascular disease; disease activity; hypertension; rheumatoid arthritis