The Impact of Different Classification Criteria Sets on the Estimated Prevalence and Associated Risk Factors of Diastolic Dysfunction in Rheumatoid Arthritis

This study compared the estimated prevalence and potential determinants of left ventricular (LV) diastolic dysfunction upon applying different classification criteria in rheumatoid arthritis (RA). LV diastolic function was assessed echocardiographically by pulsed Doppler (E/A), tissue Doppler (E/e′, lateral and septal e′), and left atrial volume index in 176 RA patients. Relationships of traditional cardiovascular risk factors and RA characteristics with LV diastolic function and dysfunction according to previous and current criteria were determined in multivariate regression models. Waist-hip ratio was associated with E/A (standardised β (SE) = -0.28±0.09, p=0.0002) and lateral e′ (standardised β (SE) = 0.26±0.09, p=0.01); low diastolic blood pressure was related to E/e′ (standardised β (SE) = -0.16±0.08, p=0.04). Diastolic dysfunction prevalence differed upon applying previous (59%) compared to current (22%) criteria (p<0.0001). One SD increase in waist-hip ratio was associated with diastolic dysfunction when applying current criteria (OR = 2.61 (95% CI = 1.51–4.52), p=0.0006), whereas one SD increase in diastolic blood pressure was inversely related to diastolic dysfunction upon using previous criteria (OR = 0.57 (95% CI = 0.40–0.81), p=0.002). In conclusion, application of current and previous diastolic dysfunction criteria markedly alters the prevalence and risk factors associated with diastolic dysfunction in RA

Kidney function, endothelial activation and atherosclerosis in black and white Africans with rheumatoid arthritis

OBJECTIVE: To determine whether kidney function independently relates to endothelial activation and ultrasound determined carotid atherosclerosis in black and white Africans with rheumatoid arthritis (RA). METHODS: We calculated the Jelliffe, 5 Cockcroft-Gault equations, Salazar-Corcoran, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (EGFR) equations in 233 (112 black) RA patients. RESULTS: The CKD-EPI eGFR was 0.1 for comparisons of AUC (SE)) for the other 8 equations. Based on optimal eGFR cutoff values with sensitivities and specificities ranging from 42 to 60% and 70 to 91% respectively, as determined in ROC curve analysis, a low eGFR increased the odds ratio for plaque 2.2 to 4.0 fold. CONCLUSION: Reduced kidney function is independently associated with atherosclerosis and endothelial activation in black and white Africans with RA, respectively. CKD is highly prevalent in black Africans with RA. Apart from the MDRD, eGFR equations are useful in predicting carotid plaque presence, a coronary heart disease equivalent, amongst black African RA patients

Comparison of energy supplements during prolonged exercise for maintenance of cardiac function: carbohydrate-only verse carbohydrate plus whey or casein hydrolysate

Cardiac function is often suppressed following prolonged strenuous exercise and may partly occur due to an energy deficit. This study compared left ventricular (LV) function by 2-dimensional echocardiography and tissue Doppler imaging (TDI) before and after ~2.5 h of cycling (2-h steady-state 60%Wmax plus 16-km time trial) in 8 male cyclists when they ingested either: placebo, carbohydrate-only (CHO-only), carbohydrate-casein hydrolysate (CHO-casein) or carbohydrate-whey hydrolysate (CHO-whey). No treatment-by-time interactions occurred, but pre-to-post exercise time effects occurred selectively. While diastolic function measured by pulsed-wave Doppler early-to-late (E:A) transmitral blood flow velocity was suppressed in all trials from pre to post exercise (E:A, mean change post-pre exercise(95%CI): -0.53(-0.15;-0.91), TDI early-to-late (e’:a’) tissue velocity was only significantly suppressed pre to post exercise with placebo, CHO-only and CHO-whey (septal and lateral wall e’:a’ average change(95%CI): -0.62(-1.12;-0.12); -0.69(-1.19;-0.20); -0.79(-1.28;-0.29), respectively) but not with CHO-casein (-0.40(-0.90;0.09)). Left ventricular contractility was or tended to be significantly reduced pre to post exercise with placebo, CHO-only and CHO-whey (systolic blood pressure/end systolic volume, change(95%CI) mmHg∙mL-1: -0.8(-1.2;-0.4) p=0.0003; -0.5(-0.9;-0.02) p=0.035; -0.4(-0.8;0.04) p=0.086, respectively), but not with CHO-casein (-0.3(-0.8;0.1) p=0.22). However, ejection fraction (EF) and ventricular-arterial coupling were only significantly reduced pre to post exercise with placebo (placebo change(±95%CI): EF, -4.6(-8.4;-0.7)%; stroke volume/end systolic volume, -0.3(-0.6;-0.04)). Despite no treatment-by-time interactions, pre-to-post exercise time-effects with only specific beverages may be meaningful for athletes. Tentatively, the order of beverages with least-to-most variables displaying a time-effect indicating suppression of LV function following exercise was: CHO-caseinThe accepted manuscript in pdf format is listed with the files at the bottom of this page. The presentation of the authors' names and (or) special characters in the title of the manuscript may differ slightly between what is listed on this page and what is listed in the pdf file of the accepted manuscript; that in the pdf file of the accepted manuscript is what was submitted by the author

Cardiovascular Disease Risk amongst African Black Patients with Rheumatoid Arthritis: The Need for Population Specific Stratification

Rheumatoid arthritis (RA) enhances the risk of cardiovascular disease to a similar extent as diabetes. Whereas atherogenesis remains poorly elucidated in RA, traditional and nontraditional risk factors associate similarly and additively with CVD in RA. Current recommendations on CVD risk stratification reportedly have important limitations. Further, reported data on CVD and its risk factors derive mostly from data obtained in the developed world. An earlier epidemiological health transition is intrinsic to persons living in rural areas and those undergoing urbanization. It is therefore conceivable that optimal CVD risk stratification differs amongst patients with RA from developing populations compared to those from developed populations. Herein, we briefly describe current CVD and its risk factor profiles in the African black population at large. Against this background, we review reported data on CVD risk and its potential stratification amongst African black compared to white patients with RA. Routinely assessed traditional and nontraditional CVD risk factors were consistently and independently related to atherosclerosis in African white but not black patients with RA. Circulating concentrations of novel CVD risk biomarkers including interleukin-6 and interleukin-5 adipokines were mostly similarly associated with both endothelial activation and atherosclerosis amongst African black and white RA patients

Adiponectin and Atherosclerosis in Rheumatoid Arthritis

In the present study, we examined the potential impact of adiponectin on carotid ultrasound determined atherosclerosis in 210 (119 black and 91 white) RA patients in mixed regression models. Total adiponectin concentrations were smaller in patients with compared to those without the metabolic syndrome (MetS) defined waist criterion (median (range) = 6.47 (1.23–34.54) versus 8.38 (0.82–85.30) ng/mL, P=0.02, resp.); both total and high molecular weight (HMW) adiponectin concentrations were larger in patients with compared to those without joint deformities (7.97 (0.82–85.30) and 3.51 (0.01–35.40) versus 5.36 (1.29–19.49) and 2.34 (0.01–19.49) ng/mL, P=0.003 and 0.02, resp.). Total and HMW adiponectin concentrations were associated with carotid artery plaque in patients with MetS waist (odds ratio (95% CI) = 0.87 (0.76–0.99) and 0.92 (0.85–0.99) per 1-standard deviation increment, P=0.02 for both) and those without joint deformities (odds ratio (95% CI) = 0.94 (0.88–0.99) and 0.94 (0.89–0.99), P=0.03 for both). Plaque prevalence was lower in patients without compared to those with joint deformities (23.4% versus 42.6, P=0.004 in multivariable analysis). In RA patients with abdominal obesity or no clinically evident joint damage, adiponectin concentrations are reduced but nevertheless associated with decreased carotid atherosclerosis

Associations of inflammatory markers with impaired left ventricular diastolic and systolic function in collagen-induced arthritis.

BACKGROUND:High-grade inflammation may play a pivotal role in the pathogenesis of left ventricular (LV) dysfunction. Evidence to support a role of systemic inflammation in mediating impaired LV function in experimental models of rheumatoid arthritis (RA) remains limited. The aim of the present study was to determine the effects of high-grade systemic inflammation on LV diastolic and systolic function in collagen-induced arthritis (CIA). METHODS:To induce CIA, bovine type-II collagen emulsified in incomplete Freund's adjuvant was injected at the base of the tail into 21 three-month old Sprague Dawley rats. Nine-weeks after the first immunisation, LV function was assessed by pulsed Doppler, tissue Doppler imaging and Speckle tracking echocardiography. Cardiac collagen content was determined by picrosirius red staining; circulating inflammatory markers were measured using ELISA. RESULTS:Compared to controls (n = 12), CIA rats had reduced myocardial relaxation as indexed by lateral e' (early diastolic mitral annular velocity) and e'/a' (early-to-late diastolic mitral annular velocity) and increased filling pressures as indexed by E/e'. No differences in ejection fraction and LV endocardial fractional shortening between the groups were recorded. LV global radial and circumferential strain and strain rate were reduced in CIA rats compared to controls. Higher concentrations of circulating inflammatory markers were associated with reduced lateral e', e'/a', radial and circumferential strain and strain rate. Greater collagen content was associated with increased concentrations of circulating inflammatory markers and E/e'. CONCLUSION:High-grade inflammation is associated with impaired LV diastolic function and greater myocardial deformation independent of haemodynamic load in CIA rats

Optimal cut-off EGFR values in ROC curves with corresponding characteristics and associations with plaque in black patients with RA.

<p>Significant associations are shown in bold.</p><p>EGFR = estimated glomerular filtration rate, ROC = receiver operator characteristic, RA = rheumatoid arthritis, PPV = positive predictive value, NPV = negative predictive value, OR = odds ratio, CI = confidence interval, C-G = Cockcroft-Gault, AWB = actual body weight, IBW = ideal body weight, ADBW = adjusted body weight, LBW = lean body weight, NBW = no body weight, MDRD = Modification of Diet in Renal Disease, CKD-EPI = Chronic Kidney Disease Epidemiology Collaboration.</p><p>*Associations were assessed in modified Framingham score adjusted logistic regression models.</p><p>Optimal cut-off EGFR values in ROC curves with corresponding characteristics and associations with plaque in black patients with RA.</p

Recorded characteristics in all 233 and 112 black and 121 white patients with RA.

<p>Results are expressed as mean (SD), median (interquartile range) or proportion as appropriate.</p><p>Significant relations are shown in bold.</p><p>RA = rheumatoid arthritis, NSAID = non steroidal antiinflammatory agents, VCAM-1 = vascular adhesion molecule-1, ICAM-1 = intercellular adhesion molecule-1, MCP-1 = monocyte chemoattractant protein-1, IDMS = isotope dilution mass spectrometry, eGFR = estimated glomerular filtration rate, C-G = Cockcroft-Gault, AWB = actual body weight, IBW = ideal body weight, ADBW = adjusted body weight, LBW = lean body weight, NBW = no body weight, MDRD = Modification of Diet in Renal Disease, CKD-EPI = Chronic Kidney Disease Epidemiology Collaboration.</p><p>Recorded characteristics in all 233 and 112 black and 121 white patients with RA.</p

Receiver operator characteristic curves showing the accuracy of the eGFR equations (AUCs shown as dotted lines) in predicting plaque presence independent of the mFramingham score (AUCs shown as dashed lines).

<p>The <i>P</i> values given are for the AUC-plaque associations. The mFramingham score was consistently unrelated to plaque presence (AUC = 0.596 (<i>P</i> = 0.1) in each analysis). EGFR = estimated glomerular filtration rate; AUC = area under the curve; C-G = Cockcroft-Gault; MDRD = Modification of Diet in Renal Disease; CKD-EPI = Chronic Kidney Disease Epidemiology Collaboration.</p