Sex-Specific Association of Left Ventricular Hypertrophy With Rheumatoid Arthritis.

Alessandro Giollo,Angelo Fassio,Ombretta Viapiana,Giovanni Cioffi,Luca Idolazzi,Riccardo Bixio,Andrea Dalbeni,Giovanni Adami,Davide Gatti,Giovanni Orsolini,Federica Ognibeni,Maurizio Rossini

doi:10.3389/fcvm.2021.676076

Abstract

Objectives: Clinical expression of rheumatoid arthritis (RA) varies by gender, but whether cardiovascular disease (CVD) is gender related in RA is unknown. Left ventricular (LV) hypertrophy (LVH) is a hallmark of CVD in RA patients. We investigated whether the association of LVH with RA is gender driven.Methods: Consecutive outpatients with established RA underwent echocardiography with measurement of LVH at baseline and one follow-up. All participants had no prior history of CVD or diabetes mellitus. We assessed CVD risk factors associated with LVH at follow-up, including sex, age, arterial blood pressure, and body mass index (BMI). We also evaluated inflammatory markers, autoimmunity, disease activity, and the use of RA medications as predictors of LVH.Results: We recruited 145 RA patients (121 females, 83%) and reassessed them after a median (interquartile range) of 36 months (24–50). At baseline, women were more dyslipidemic but otherwise had fewer CVD risk factors than men, including less prevalent smoking habit and hypertension, and smaller waist circumference. At follow-up, we detected LVH in 42/145 (44%) RA patients. LV mass significantly increased only in women. In multiple Cox regression analysis, women with RA had the strongest association with LVH, independently from the presence of CVD risk factors (OR, 6.56; 95% CI, 1.34–30.96) or RA-specific characteristics (OR, 5.14; 95% CI, 1.24–21.34). BMI was also significantly and independently associated with LVH.Conclusion: Among established RA patients, women carry the highest predisposition for LVH.

Highlights

Rheumatoid arthritis (RA) is a systemic, immune-mediated disease involving both musculoskeletal and extra-articular domains
This association remained significant after adjustment for Cardiovascular disease (CVD) risk factors and comorbidities [3], suggesting that RA-intrinsic factors could be significantly related to the susceptibility of LV hypertrophy (LVH)
The study population consisted of 145 white RA patients consecutively enrolled in the study with >1 follow up visit

Summary

Introduction

Rheumatoid arthritis (RA) is a systemic, immune-mediated disease involving both musculoskeletal and extra-articular domains. Gender Differences in LVH among RA patients. This association remained significant after adjustment for CVD risk factors and comorbidities [3], suggesting that RA-intrinsic factors could be significantly related to the susceptibility of LVH. The findings that LVH may precede hypertension and that patients with similar degrees of hypertension may have marked differences in LV mass strongly suggest that genetic and gender-related factors can promote and retard the development of LVH [9]. Gender leads to a predisposition to RA The incidence of this condition is twice higher in females than males, and disease severity or treatment response differs according to gender [10]. It is unknown whether susceptibility to LVH in RA patients is gender driven

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