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Rheumatoid arthritis (RA) is a chronic, inflammatory disease closely linked with atherosclerosis. Recommended cardiovascular disease (CVD) integral evaluation includes screening for asymptomatic atherosclerosis plaques with carotid ultrasound (US). The aim of this study is to evaluate the carotid US characteristics, including carotid intima media thickness (cIMT) and carotid plaque (CP), and compare RA-patients and controls in a Mexican-mestizo population. Method Prospective cross-sectional, observational study comparing RA-patients and matched controls without RA. Medical history and physical exam was performed in all subjects by a rheumatologist and two clinical blinded radiologists did the carotid US. Increased cIMT was defined as ≥0.9 mm. CP was defined as a focal narrowing ≥0.5 mm of the surrounding lumen or a cIMT ≥1.2 mm. Multivariable analysis was done comparing RA-patients and control subjects characteristics with carotid US. Result In the final analysis 209 patients were included, 103 patients with RA and 106 controls. Bilateral CP was found more than twice in RA than controls (15.5% vs 6.6%). Unilateral CP was more common in either side evaluated, being heterogeneous plaques the most common in RA-patients. The prevalence of increased cIMT was found higher in RA-patients either in both sides (right 37.9% vs 15.1%, P = 0.00; left 43.7% vs 19.8%, P = 0.00) were statistically significant. Conclusion It was confirmed that RA-patients have greater subclinical atherosclerosis represented in the carotid US measuring cIMT and CP as surrogates. RA-patients with subclinical atherosclerotic disease have more heterogeneous plaques characteristics.

Background:A relationship between rheumatoid arthritis (RA) and the presence of abnormalities in left ventricular (LV) geometry such as eccentric remodeling has recently been determined, even in the absence of cardiovascular risk factors and before clinical manifestations (1). The 2016 European League Against Rheumatism (EULAR) recommendations that cardiovascular (CV) risk prediction models should be adapted by a 1.5 multiplication factor in RA patients. Risk prediction algorithms based on the CV risk factors (CVRF) have been an important tool for adopting preventive measures and intensifying therapies based on the estimated risk but their application in predicting cardiac structural abnormalities has never been studied.Objectives:The aim of the study is to determine the CV risk calculator that best predicts alterations in ventricular geometry in RA.Methods:A cross-sectional, observational study of 108 RA patients between 40-75 years (ACR / EULAR 2010 classification criteria). The QRISK3, OMNIBUS, Framingham Risk Score Lipids (FRSL), Framingham Risk Score BMI (FRS-BMI) and Reynolds Risk Score (RRS) calculators were compared. The diagnostic performance was determined by ROC curves, and the discriminative capacity by the Area Under the Curve (AUC) 95% CI. The echocardiogram was the diagnostic gold standard. A p value Results:The prevalence of abnormalities in ventricular geometry was 38.9%. QRISK3 reported AUC of 0.656, 95% CI (0.550-0.762, p=0.006), cut-off point ≥4.6, sensitivity of 73.8% and specificity of 54.5%, and likelihood ratio of +1.62. FRS-BMI showed AUC of 0.653, 95% CI (0.543-0.762, p=0.008), cut-off point ≥11.02, sensitivity and specificity of 61.9% and 57.6% respectively, and likelihood ratio of +1.46. OMNIBUS showed AUC of 0.635, CI 95% (0.525-0.746, p=0.018), cut-off point ≥3.8, sensitivity and specificity of 57.1% and 68.2%. While RRS had AUC 0.644, 95% CI (0.534-0.755, p=0.012), cut-off point of 2.25, sensitivity of 47.6% and specificity 78.8%, and likelihood ratio of +2.24 (Figure 1 and Table 1).Table 1.Discriminatory capacity of the different cardiovascular risk calculators.Calculators (cut-off point).AUCCI 95%pSensitivitySpecificityInferiorSuperiorQRISK (≥4.60)0.6460.5370.7540.01273.8%54.5%SCORE0.5910.4750.706NS--OMNIBUS (≥3.80)0.6210.5090.7340.03857.1%68.2%FRSL0.5940.4800.707NS--FRS-BMI (≥11.02)0.6420.5300.7540.01561.9%57.6%RRS (≥2.25)0.6270.5140.7410.02947.6%78.8%Conclusion:The QRISK3 calculator showed the highest discriminative ability and sensitivity to predict abnormalities in LV geometry. However, all calculators demonstrated the need for a lower cut-off point to predict alterations in ventricular geometry. Our findings require adequate reproducibility in other population groups to determine the applicability of CV risk algorithms as predictors of structural alteration of LV.References:[1]Pascale V, Finelli R, Giannotti R, et al. Cardiac eccentric remodeling in patients with rheumatoid arthritis. Sci Rep 2018;8(1):5867. doi: 10.1038/s41598-018-24323-0Disclosure of Interests:None declared

Background Rheumatoid arthritis (RA) is a chronic, systemic inflammatory disease, which mainly affects synovial joints.1 Heart structural abnormalities are more prevalent in RA-patients than in general population, such as pericarditis, increased left ventricle mass and valvular disease.2 Left atrial (LA) dilation predicts atrial fibrillation and congestive heart failure. It also increases the risk of developing thromboembolic events.3 Objectives The aim of this study was to determine the prevalence of LA dilation in RA-patients and compare it with matched controls. Methods An observational, cross-section, case-control study was designed. Patients who fulfilled 1987 ACR and/or 2010 ACR/EULAR classification criteria for RA, 40–75 years old, with no overlap syndromes or atherosclerotic cardiovascular disease were included. The control group was matched by age, gender and comorbidities. A standard transthoracic echocardiogram was performed by a board-certified cardiologist. LA structure alterations were evaluated according to the American Society of Echocardiography guidelines. Results A total of 63 RA-patients and 41 control subjects were included. Demographic characteristics are shown in table 1. LA dilation, defined as a LA indexed volume (LAIV) >34 mL/m2, was found in 9 (14.3%) patients of the RA-group, whereas no control subjects presented that condition (p=0.011). Mitral regurgitation was detected in 39 (62%) RA-patients and 7 (17%) control subjects (p Conclusions LA dilation is more prevalent in RA-patients when compared to matched controls. Prospective studies are needed to evaluate the influence of this condition in cardiovascular outcomes. References [1] You S, Cho CS, Lee I, Hood L, Hwang D, Kim WU. A systems approach to rheumatoid arthritis. PloS one2012;7(12):e51508. [2] Corrao S, et al. Heart involvement in rheumatoid arthritis: systematic review and meta-analysis. International Journal of Cardiology2013Sep 1;167(5):2031–8. [3] Foglieni C, et al. Early LA tissue features in patients with chronic mitral regurgitation and sinus rhythm: Alterations of not remodeled left atria. International Journal of Cardiology2016;219:433–438. Disclosure of Interest None declared

Background Rheumatoid arthritis (RA) is a chronic, systemic and autoimmune disease with articular and extra-articular manifestations. RA is associated with increased prevalence of comorbidities and higher cardiovascular risk when compared to general population. Atherosclerotic cardiovascular (CV) events are the leading cause of death in RA. In a recent meta-analysis, hypertension, type 2 diabetes mellitus (T2DM) and hypercholesterolemia were shown to increase the risk of CV disease in this population. 1 A study reported a prevalence of hypertension 29.8%; dyslipidemia 27.1% and T2DM 12.4% in Mexican-mestizo RA patients. 2 The cardio-rheuma clinics were designed to provide healthcare for CV diseases in patients with rheumatic conditions. Specific guidelines recommendations have been published to enhance detection and management of specific comorbidities associated to RA. 3 Objectives To identify the prevalence of unknown cardiometabolic risk factors in a Mexican-mestizo cohort with RA. Methods Cross-sectional, observational study. Patients who fulfilled the 1987 ACR and/or the 2010 ACR/EULAR classification criteria were consecutively recruited. Patients were divided in two groups, with and without history of cardiovascular comorbidities. Clinical history and physical exam were performed by a general physician in a cardio-rheuma clinic. Fasting blood glucose and lipid profile were performed on all subjects. Categorical variables are expressed as percentages and numerical variables as means±standard deviations. Results A total of 296 patients were included. Demographical characteristics are shown in Figure 1. Hypertension was the most frequent comorbidity (27.7%), followed by dyslipidemia (26.7%) and T2DM (13.5%). Many of the patients without history of cardiometabolic risk factor had important findings on baseline visit: 18.7% had altered blood pressure without history of hypertension, 76.5% had an abnormal lipid profile without history of dyslipidemia, and 21.5% had an altered fasting glucose without history of T2DM. *Altered lipid profile was defined as TC ≥200 mg/dL, HDL-C Conclusions In our cohort of Mexican-mestizo RA patients there is a high prevalence of cardiometabolic risk factors. An important amount of these were discovered in patients without previous diagnosis at their first visit to a cardio-rheuma clinic. References [1] Dougados, et al. (2014). Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Annals of the rheumatic diseases, 73(1), 62–68. [2] Galarza-Delgado, et al. (2017). Prevalence of comorbidities in Mexican mestizo patients with rheumatoid arthritis. Rheumatology international, 37(9), 1507–1511. [3] Perk, J., et al. (2012). European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Atherosclerosis, 223(1), 1–68. Acknowledgements None Disclosure of Interest None declared

Background: Rheumatoid arthritis (RA) is a chronic, systemic, inflammatory, multifactorial disease that mainly affects synovial joints. Pulmonary artery hypertension (PAH) can appear as a complication of connective tissue diseases. It is possible that pulmonary artery systolic pressure (PASP) in RA may be elevated due to interstitial lung disease, pulmonary vasculitis, pulmonary veno-occlusive disease, or cardiac disease (1). Although right heart catheterization is the gold standard, Doppler echocardiography has proved to be a reliable non-invasive method for detecting PAH (2). Objectives: To determine the prevalence of PAH in RA patients and compare it to matched controls. Methods: A case-control study with RA patients aged 40 to 75 years that fulfilled the 2010 ACR/EULAR criteria and matching controls were included. Exclusion criteria: poor acoustic window, absence of tricuspid regurgitation (TR), prior atherosclerotic cardiovascular (CV) disease and overlap syndromes. Patients were matched using age, sex and comorbidities. Transthoracic echocardiogram was performed by a board-certified cardiologist. PASP was calculated using the Bernoulli equation: TR velocity 2 × 4 + right atrial pressure according to ASE’s guidelines. We used Denton’s definition of PAH on Doppler echocardiography as an estimated PASP≥30 mmHg (3). Results: A total of 76 RA patients and 52 matched controls were included. Demographic and clinical characteristics of both groups are shown on table 1. As shown on table 2, the mean PASP was higher RA patients (27.14±6.34 mmHg) than controls (24.68±5.44 mmHg) ( P= 0.024). PASP≥30 mmHg prevalence was significantly higher in RA patients (34.2% vs 11.5%; P= 0.004). Conclusions: Elevated PASP, suggesting PAH, was more prevalent on RA patients than controls. A higher number of CV events that cannot be explained by traditional risk factors have been reported in RA patients; and it is possible that the elevation in the PASP could contribute to the problem. Prospective studies are needed to evaluate the role of elevated PASP in morbidity and mortality of RA patients. References [1]Panagiotidou E, et al. Rheumatoid arthritis associated pulmonary hypertension. Respir Med Case Reports2017;20:164–7. [2]Udayakumar N, et al. Pulmonary hypertension in rheumatoid arthritis-Relation with the duration of the disease. Int J Cardiol2008;127(3):410–2. [3]Denton CP, et al. Comparison of Doppler Echocardiography and Right Heart Catheterization To Assess Pulmonary Hypertension in Systemic Sclerosis. Br J Rheumatol1997;36:239–43. Disclosure of Interest: None declared

Background Metabolic syndrome (MetS) comprises a group of risk factors for type 2 diabetes and cardiovascular diseases. MetS is responsible for a three-fold increase in the risk of atherosclerotic cardiovascular diseases (ASCVD) and increased mortality compared to general population. 1 The frequency of MetS in RA patients is 14% to 56%. However, although many studies have reported a higher prevalence of MetS among RA patients, a number of studies have reported a higher prevalence of MetS in healthy controls. 2 Despite the importance of detection of MetS and its role in RA patients, information is scarce. Objectives To compare the prevalence of MetS among Mexican-mestizo RA-patients and matched controls. Methods Design: observational, cross-sectional, case-control study. Patients of 40 to 75 years old who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA were consecutively enrolled. Patients with any other rheumatic disease were excluded. Our study used ATP III Criteria (Abdominal obesity: Men>102 cm Women>88 cm; Triglyceride level ≥150 mg/dL; HDL: Results There were no differences in any independent variable of these patients. However there was a higher prevalence of high blood pressure in controls than RA patients (See Table 1). Conclusions There is no difference in the diagnosis of MetS in RA patients than control population. However, the role of the diagnosis of MetS in patients with RA represents an important task in the management of the disease in order to reduce its high cardiovascular risk. References [1] Hallajzadeh, J., Safiri, S., Mansournia, M. A., Khoramdad, M., Izadi, N., Almasi-Hashiani, A., Karamzad, N. (2017). Metabolic syndrome and its components among rheumatoid arthritis patients: A comprehensive updated systematic review and meta-analysis. PloS one, 12(3), e0170361. [2] Zafar Z, H.Mahmud T, Rasheed A, AhmedWagan A. Frequency of metabolic syndrome in Pakistani cohort of patients with rheumatoid arthritis. J Pak Med Assoc. 2016; 66(6):671–6. Acknowledgements None Disclosure of Interest None declared

Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Chronic inflammation and traditional risk factors increase cardiovascular risk (CVR) in these patients. Several CVR calculators are used in general population and in RA patients to predict cardiovascular outcomes and tailor therapy but the precision of these calculators in RA patients has yet to be determined. The aim of this study is to determine which risk calculator correlates best with carotid ultrasound (US) findings, specifically carotid plaque (CP) and carotid intima-media thickness (CIMT) in RA patients without clinical manifestations. This was a cross-sectional observational study relating CVR scores in RA patients with the presence of carotid US findings. A total of 97 patients 40 to 75 years old who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA were selected. Clinical assessment of cardiovascular risk was performed using seven calculators and carotid US measurement of intima-media thickness and plaque. The tests with the highest sensitivity for CIMT were the Framingham BMI, Framingham lipids, ACC/AHA 2013, and QRISK2. In CP, the highest sensitivity was in QRISK2, SCORE, and ACC/AHA 2013. RA patients should be comprehensively evaluated to detect cardiovascular risk. Carotid US may be routinely recommended to detect subclinical atherosclerosis in RA patients. A lower cutoff point in CVR scales may be necessary to identify patients with a low and intermediate CVR to detect subclinical atherosclerosis earlier and personalize therapy.