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The objective was to compare the prevalence of subclinical atherosclerosis and cardiovascular risk (CVR) reclassification using six CVR algorithms and a carotid ultrasound in psoriatic arthritis (PsA) patients and controls. The method was cross-sectional study. A total of 81 patients aged 40-75 years, who fulfilled the 2006 CASPAR criteria and 81 controls matched by age, gender, and comorbidities were recruited. CVR was evaluated according to six CVR algorithms, including Framingham Risk Score (FRS)-lipids, FRS-body mass index (BMI), Atherosclerotic Cardiovascular Disease (ASCVD) Algorithm, Systematic Coronary Risk Evaluation (SCORE), QRISK3, and Reynolds Risk Score (RRS). A carotid ultrasound was performed to identify the presence of carotid plaque (CP) defined as a carotid intima media thickness ≥ 1.2 mm or a focal narrowing of the surrounding lumen ≥ 0.5mm. Patients with presence of CP, classified in the low-moderate risk by the CVR algorithms, were reclassified to a higher risk category. CP was more prevalent in PsA patients (44.4% vs 24.7%, p = 0.008), as was subclinical atherosclerosis (51.9% vs 33.3%, p = 0.017). When comparing the CVR reclassification to a higher risk category, a difference was found in the six CVR algorithms. The reclassification was more prevalent in PsA patients: 30.8% vs 12.3%, p = 0.004 with FRS-lipids; 28.4% vs 9.9%, p = 0.003 with FRS-BMI; 40.7% vs 19.8%, p = 0.003 with SCORE; 30.9% vs 16.0%, p = 0.026 with ASCVD algorithm; 37.0% vs 19.8%, p = 0.015 with RRS; and 33.3% vs 16.0%, p = 0.011 with QRISK3. The CVR algorithms underestimate the actual CVR of PsA patients. A carotid ultrasound should be considered as part of the CVR evaluation of PsA patients. KEY POINTS: • Subclinical atherosclerosis was more prevalent in psoriatic arthritis patients than controls. • Cardiovascular risk reclassification, through a carotid ultrasound, according to traditional cardiovascular risk algorithms was more common in psoriatic arthritis patients. • The cardiovascular risk algorithm that showed the lowest reclassification rate in psoriatic arthritis patients was the FRS-BMI. • All cardiovascular risk algorithms underestimate the actual risk of psoriatic arthritis patients, preventing the initiation of an adequate cardiovascular treatment.

Psoriatic arthritis (PsA) is a chronic, inflammatory and immune-mediated disease that affects up to 30% of psoriasis (PsO) patients.1 Nail involvement affects 80% of PsA patients and 30%–50% of PsO patients. Nail PsO has been associated with worse quality of life, higher score on the PsO Area Severity Index, early disease onset, arthritis, depression and anxiety.2 Patients with PsO and PsA have a higher risk of cardiovascular atherosclerotic morbidity and mortality than the general population. Nail PsO and cardiovascular disease have been seldom studied. Nail involvement in PsO patients has been associated to a higher prevalence of metabolic syndrome, higher risk of heart failure and higher cardiovascular risk overall.3 4 If PsA patients with nail PsO also have a higher cardiovascular risk is unknown. We aimed to determine if nail involvement in PsA patients is associated with a higher prevalence of subclinical atherosclerosis by carotid ultrasound. We performed a cross-sectional, observational and comparative study that included a total of 64 PsA patients consecutively recruited from …

Background:Patients with Rheumatoid Arthritis (RA) have a higher prevalence of cardiovascular diseases (1) and a strong association with abnormalities in the left ventricle (LV) geometry. Both concentric and eccentric remodeling have been determined as an independent factor for sudden cardiac arrest in the general population with normal or slightly decreased ventricular function (2) but there is still controversy about the factors involved and the pathophysiology in patients with RA.Objectives:The aim of the study is to determine the characteristics of LV geometry and the impact of RA.Methods:A cross-sectional, observational, and comparative study of fifty-two RA patients that fulfilled ACR / EULAR 2010 classification criteria, aged 40-75 years. Controls were included and matched by age, gender, and comorbidities. Subjects were evaluated using a transthoracic echocardiogram performed and reviewed by two certified echocardiographers. Ventricular geometry was evaluated with indexed left ventricular mass and relative wall thickness. Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student’s t test and Mann-Whitney U test were used for comparations between groups. A logistic binary regression was performed with the traditional cardiovascular risk factors (CVRFs), age and RA diagnosis. A p value Results:No significant differences were found in the traditional CVRFs (type 2 diabetes mellitus, dyslipidemia, active smoking, and hypertension) (Table 1). Most of the subjects reported normal geometry in both groups (55.8% for RA group vs 64.0% for controls). A higher prevalence of eccentric hypertrophy was found in the RA group, 13 (25%) subjects versus 3 (6%) in the control group, p = 0.009. The binary regression showed that the diagnosis of RA was the only independent risk factor for the presence of eccentric hypertrophy, OR 7.22 95% CI (1.68-31.02, p = 0.008).Table 1.Demographic characteristics and echocardiographic findings.RA(n=52)Control(n=50)pAge, years ± DE51.4 ±6.251.1 ± 5.5NSWomen, n (%)51 (98.1)49 (98.0)NSActive smoking, n (%)8 (15.4)8 (16.0)NSDyslipidemia, n (%)11 (21.2)13 (26.0)NSType 2 Diabetes Mellitus, n (%)5 (9.6)5 (10.0)NSHTN, n (%)8 (15.4)10 (20.0)NSBMI kg/m2, median (p25-p75)27.8 (24.5-31.4)28.3 (25.4-30.3)NSBSA, median (p25-p75)1.7 (1.6-1.8)1.8 (1.6-1.9)0.003Systolic blood pressure, mmHg (p25-p75)119.5 (110.0-127.5)120.0 (110.7-130.0)NSEchocardiography findingsLVPWTd, median (p25-p75)0.9 (0.8-1.0)0.9 (0.8-1.0)NSLVIDd, median (p25-p75)4.8 (4.3-5.2)4.6 (4.5-4.9)NSLV mass, median (p25-p75)131.2 (119.5-155.7)131.2 (113.2-154.3)NSLV mass index, median (p25-p75)78.6 (69.7-95.6)76.0 (66.7-84.6)NSRWT, mean ± SD0.4 ± 0.090.4 ± 0.07NSNS, no significant; BMI, body mass index; BSA, body surface area; LVPWTd, left ventricular posterior wall thickness at end-diastole; LVIDd, left ventricular internal dimension at end-diastole; RWT, relative wall thickness.Conclusion:There is a higher prevalence of eccentric remodeling in patients with RA independently of traditional CVRF. The diagnosis of RA is an independent risk factor for the presence of eccentric hypertrophy that is associated with higher mortality. Treatment of cardiovascular comorbidities should be intensified in those patients with abnormalities in LV geometry in order to prevent cardiovascular diseases such as heart failure.References:[1]You S, Cho CS, Lee I, et al. A systems approach to rheumatoid arthritis. PLoS One 2012;7(12):e51508. doi: 10.1371/journal.pone.0051508[2]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:Systemic lupus erythematosus (SLE) is a chronic and autoimmune disease characterized by systemic involvement. Patients with SLE have accelerated atherosclerosis, resulting in an up to nine-fold increased risk of cardiovascular disease, compared to the general population (1), being the leading cause of death for these patients. Speckle tracking echocardiography (STE) is an accurate technique to estimate myocardial function and deformation.Objectives:This study aims to determine the association between echocardiographic findings and the presence of antibodies in SLE patients.Methods:This was a cross-sectional and observational study. A total of forty-three patients ≥18 years with a diagnosis of SLE according to EULAR/ACR 2019 criteria were included for this study. Those with a history of cardiovascular disease (myocardial infarction, cerebrovascular accident, or peripheral arterial disease) and pregnancy were excluded. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists, in all study subjects. Blood samples obtained from all patients were analyzed for the following: anti-nuclear antibodies (ANA), anti, SSA/Ro, SSB/La antibodies, anti-cardiolipin antibodies (IgA, IgM, IgG), and complement levels. Distribution was evaluated with the Kolmogorov-Smirnov test. Correlations between numerical variables were done using Spearman’s rho, considering two-tailed p-values Results:The 39 female patients (90.7%) and 4 male patients (9.3%) had a mean age of 35.5 ± 12.0 years and a median disease duration of 72 months (14-132). At the time of inclusion, 90.7% of the patients were being treated with glucocorticoids and antimalarials. Concerning traditional cardiovascular risk factors; 20.9% of the patients had hypertension, 7.0% had dyslipidemia, 2.3% had diabetes mellitus and 18.6% were active smokers. Correlations between echocardiographic findings and antibodies are shown in Table 1. We found a moderate positive correlation between global circumferential strain and IgA anticardiolipin antibody (r=0.507, p=0.002), a low positive correlation in left ventricular ejection fraction with anti-Ro (r=0.397, p=0.012) and anti-La (r=0.397, p=0.012) and a low positive correlation between TAPSE and C3 levels (r=0.396, p=0.013).Conclusion:There is an association between anticardiolipin antibody titers, anti-Ro, and anti-La with echocardiographic alterations. All SLE patients especially those who had positive antibodies should be screened for the presence of structural cardiac abnormalities. STE can be helpful as a noninvasive diagnostic tool, that could result in earlier treatment and prognosis.References:[1]Hesselvig JH, Ahlehoff O, Dreyer L, et al. Cutaneous lupus erythematosus and systemic lupus erythematosus are associated with clinically significant cardiovascular risk: a Danish nationwide cohort study. Lupus 2017;26(1):48-53. doi: 10.1177/0961203316651739Table 1.Spearman rho correlations between antibody titers and echocardiographic findings.VariablesGLS,mean ± SD-19.11 ± 3.33LVEF,mean ± SD57.43 ± 7.17TAPSE,mean ± SD22.23 ± 3.24ANA, median (p25-p75)640 (160-2550)NSNSNSIgA Anti-Cardiolipin, median (p25-p75)2 (2-3)0.507**NSNSIgM Anti-Cardiolipin, median (p25-p75)2 (2-4)NSNSNSIgG Anti-Cardiolipin, median (p25-p75)4 (3-6)NSNSNSAnti-Ro, median (p25-p75)17 (2-80)NS0.326*NSAnti-La, median (p25-p75)3 (2-5.5)NS0.397*NSC3, mean ± SD91.41 ± 37.38NSNS0.396***Correlation is significant at the 0.01 level (2-tailed). *Correlation is significant at the 0.05 level. NS, not significant; GLS, global circumferential strain; LVEF, left ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.Disclosure of Interests:None declared

Background:Pulse pressure (PP) is defined as the difference between systolic and diastolic blood pressure and represents arterial compliance and reflective properties of blood flow (1). It is well known that gender, age, and race / ethnicity are intrinsic factors of the patient that influence PP. Brachial PP has recently been associated with markers of subclinical cardiovascular disease after adjustment with traditional cardiovascular risk factors in the general population (2). However, this relationship has not been studied in patients with rheumatoid arthritis (RA) and its identification would allow earlier adjustments of cardiovascular therapies in this high-risk group.Objectives:The aim of the study is to analyze the difference in PP between patients with RA and healthy controls. Additionally, to analyze the difference between patients with carotid plaque (CP) and without CP.Methods:A cross-sectional, observational, and comparative study of ninety-two patients with RA aged 40-75 years and who fulfilled ACR/EULAR 2010 classification criteria. Also, we included ninety-two controls without RA, matched by gender, age and comorbidities. A carotid ultrasound was performed in patients with RA and it was divided into two subgroups, with the presence of CP and without CP. A blood pressure measurement was taken after 15 minutes of rest on the right arm of all patients. Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student’s t test and Mann-Whitney U test were used for comparations between groups. A p value Results:We found no statistical difference between groups regarding age, gender and, comorbidities (type 2 diabetes mellitus, hypertension, dyslipidemia and, active smoking) (Table 1). There was a significant difference in PP between patients with RA and controls (50 mmHg vs 41 mmHg respectively, p = 0.032). Patients with RA had a significant difference in PP of patients with CP and without CP (50 mmHg vs 44 mmHg respectively, p = 0.008) (Figure 1). When performing a binary logistic regression, it was found that PP was the only independent factor for the presence of CP in patients with RA, OR 1.054 (95% CI 1.008-1.101, p = 0.020).Conclusion:Patients with RA had a higher PP than controls. Binary logistic regression showed PP as the only independent factor for the presence of subclinical atherosclerosis in patients with RA. PP is a parameter that all rheumatologists should consider when evaluating cardiovascular risk in patients with RA.References:[1]Winston GJ, Palmas W, Lima J, et al. Pulse pressure and subclinical cardiovascular disease in the multi-ethnic study of atherosclerosis. Am J Hypertens 2013;26(5):636-42. doi: 10.1093/ajh/hps092[2]Zureik M, Touboul PJ, Bonithon-Kopp C, et al. Cross-sectional and 4-year longitudinal associations between brachial pulse pressure and common carotid intima-media thickness in a general population. The EVA study. Stroke 1999;30(3):550-5. doi: 10.1161/01.str.30.3.550Table 1.Demographic characteristics.RA (n=92)Control (n=92)pWomen, n (%)85 (92.4)85 (92.4)NSAge, years ± SD58.0 (55.0-63.0)56.5 (54.0-61.0)NST2DM, n (%)17 (18.5)15 (16.3)NSHypertension, n (%)33 (35.9)33 (35.9)NSDyslipidemia, n (%)30 (32.6)29 (31.5)NSObesity, n (%)30 (32.6)31 (33.7)NSActive smoking, n (%)11 (12.0)20 (21.7)NSRA patients with CP (n=39)RA patients without CP (n=53)pWomen, n (%)36 (92.3)49 (92.5)NSAge, years ± SD60.13 ± 5.9858.08 ± 7.00NST2DM, n (%)9 (23.1)8 (15.1)NSHypertension, n (%)16 (41.0)17 (32.1) NSDyslipidemia, n (%)13 (33.3)17 (32.1)NSObesity, n (%)15 (38.5)15 (28.3)NSActive smoking, n (%)6 (15.4)5 (9.4)NSDisease duration, years (p25-p75)8.44 (3.00-15.50)12.86 (4.66-19.66)NSNS, no significant; T2DM, type 2 diabetes mellitus; CP, carotid plaque.Disclosure of Interests:None declared

Background:Systemic lupus erythematosus (SLE) is a chronic, inflammatory, and autoimmune disease that damages vital organs such as the heart. Patients with SLE have a higher risk of developing a cardiovascular (CV) disease than the general population (1).Objectives:The aim of this study was to compare the echocardiographic findings in patients with SLE and controls.Methods:This was a cross-sectional, observational, and comparative study. A total of 38 patients with SLE according to the 2019 EULAR/ACR classification criteria, ≥18 years old and 38 matched controls by age (±5 years) and gender, were recruited for this study. Exclusion criteria were a poor echocardiographic window, patients with a previous CV event, such as myocardial infarction, cerebrovascular event or peripheral arterial disease, and pregnant women. A transthoracic echocardiogram, including speckle tracking technique, was performed, by two certified echocardiographers, in all study subjects. Distribution was evaluated with Kolmogorov-Smirnov test. Comparisons were done with χ2 and Fisher´s Exact test for qualitative variables, and Student’s t test and Mann-Whitney´s U test for quantitative variables. A p-value Results:When comparing demographic characteristics there were no significant differences in age, gender, and comorbidities between SLE patients and controls. In the echocardiographic findings a significant difference was found in the left ventricular ejection fraction (LVEF), lower in SLE patients compared to controls (57.02% vs 61.89%, p=0.001), in the global longitudinal strain (GLS), reduced in SLE patients (-19.55% vs -22.00%, p=0.001), in the tricuspid annular plane systolic excursion (TAPSE), lower in SLE patients (22.00mm vs 24.00mm, p=0.011), in the left atrial volume index, higher in SLE patients (28.44ml/m2 vs 22.29ml/m2, p=0.014) and in the presence of mitral regurgitation, more prevalent in SLE patients (31.6% vs 10.5%, p=0.024) (Table 1).Conclusion:Patients with SLE have a worse left ventricular function, evaluated by LVEF and GLS, a worse right ventricular systolic function, evaluated by TAPSE, an increased left atrial volume index and a higher prevalence of mitral regurgitation, which are associated with a higher risk of CV death. It is important to consider including a transthoracic echocardiogram as part of the CV evaluation in patients with SLE, which may result in an early detection of CV abnormalities and an opportune treatment.References:[1]Avina-Zubieta JA, To F, Vostretsova K, et al. Risk of Myocardial Infarction and Stroke in Newly Diagnosed Systemic Lupus Erythematosus: A General Population-Based Study. Arthritis Care Res (Hoboken) 2017;69(6):849-56. doi: 10.1002/acr.23018Table 1.Demographic characteristics and echocardiographic findings.SLE patients(n=38)Controls(n=38)pAge years, median (p25-p75)37.5 (24.5-43.2)45.0 (24.0-50.0)NSWomen, n (%)34 (89.5)37 (97.4)NST2DM, n (%)1 (2.6)3 (7.9)NSHTN, n (%)9 (23.7)3 (7.9)NSDyslipidemia, n (%)3 (7.9)3 (7.9)NSObesity, n (%)1 (2.6)5 (13.2)NSActive smoking, n (%)7 (18.4)3 (7.9)NSEchocardiographic findingsLeft ventricle indexed mass g/m2, median (p25-p75)64.00 (50.66-87.09)60.30 (52.97-76.74)0.009RWT, median (p25-p75)0.37 (0.30-0.46)0.38 (0.33-0.45)NSLeft ventricular ejection fraction %, mean ± SD57.02 ± 7.3761.89 ± 5.230.001Global longitudinal strain %, median (p25-p75)-19.55 (-21.02 –-15.95)-22.00 (-21.00 –-20.00)0.001Left atrium indexed volume ml/m2, median (p25-p75)28.44 (20.34-33.56)22.29 (17.97-27.13)0.014TAPSE mm, median (p25-p75)22.00 (20.00-24.00)24.00 (21.00-25.00)0.011Valvular abnormalitiesAortic regurgitation, n (%)2 (5.3)1 (2.6)NSMitral regurgitation, n (%)12 (31.6)4 (10.5)0.024Tricuspid regurgitation, n (%)16 (42.1)17 (44.7)NSSLE, systemic lupus erythematosus; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; RWT, relative wall thickness; TAPSE, tricuspid annular plane systolic excursion.Acknowledgements:We have no acknowledgements to declare.Disclosure of Interests:None declared

Background:Psoriatic Arthritis (PsA) is a chronic inflammatory arthropathy that affects 14%-30% of patients with skin and/or nail psoriasis. Patients with psoriatic arthritis (PsA) have a higher prevalence of traditional cardiovascular (CV) risk factors and an increased risk of developing cardiovascular diseases (1), such as acute myocardial infarction, cerebrovascular accident, peripheral vascular disease and heart failure. Despite the evidence patients with PsA are inadequately screened and undertreated for CV risk factors (CVRF), highlighting a gap in preventive medicine to adjust cardiovascular therapies(2).Objectives:The aim of the study is to determine the main CVRF in Mexican Mestizo patients with a diagnosis of PsA and to compare it with healthy controls. Additionally, to assess the impact of the diagnosis of PsA on the presence on these cardiovascular comorbidities.Methods:A cross-sectional, observational, and comparative study of ninety-six patients with PsA between 40-75 years who fulfilled CASPAR criteria 2006. Patients were matched by age and gender with non-PsA subjects. A medical history and physical exam were performed, also a blood sample was collected during the first visit. Chi square and Student´s t test were used for comparations between groups. A binary logistic regression was performed including the traditional CVRF (type 2 diabetes mellitus, hypertension, obesity, and active smoking), age and the diagnosis of PsA. A p value Results:There were 58 (60.4%) women in each group with a mean of 53 years. Patients with PsA showed a higher prevalence of hypertension (HTN) compared to healthy controls (35.4% vs 19.8%, respectively, p = 0.015). Additionally, there was a significant difference in the diagnosis of dyslipidemia (42.7% vs 22.9%, p = 0.003).We found no statistically difference between the two groups in type 2 diabetes mellitus, active smoking and, obesity (Table 1. below).Table 1.Comparison of cardiovascular risk factors between Psoriatic Arthritis and controls.PsA(n=96)Control(n=96)pAge, years ± SD53.19 ± 11.1353.34 ± 8.4NSWomen, n (%)58 (60.4)58 (60.4)NST2DM, n (%)21 (21.9)12 (12.5)NSHTN, n (%)34 (35.4)19 (19.8)0.015Active smoking, n (%)21 (21.9)20 (20.8)NSDyslipidemia, n (%)41 (42.7)22 (22.9)0.003Obesity, n (%)36 (37.5)25 (26.0)NSNS, no significative; SD, standard deviation; HTN, hypertension; T2DM, type2 diabetes mellitus.The binary logistic regression showed that the diagnosis of PsA (OR 2.235, 95% CI 1.141-4.375, p = 0.019) and active smoking (OR 2.429 95%, CI 1.137-5.186, p = 0.022) are independent risk factors for the presence of dyslipidemia.Conclusion:Patients with PsA have a higher prevalence of HTN and dyslipidemia. The diagnosis of PsA seems to be an independent factor for the presence of dyslipidemia. It is important for rheumatologists to identify those patients who could benefit from adjust antirheumatic and cardiovascular therapies due to their impact on morbidity and mortality.References:[1]Peluso R, Caso F, Tasso M, et al. Cardiovascular Risk Markers and Major Adverse Cardiovascular Events in Psoriatic Arthritis Patients. Rev Recent Clin Trials 2018;13(3):199-209. doi: 10.2174/1574887113666180314105511[2]Takeshita J, Grewal S, Langan SM, et al. Psoriasis and comorbid diseases: Implications for management. J Am Acad Dermatol 2017;76(3):393-403. doi: 10.1016/j.jaad.2016.07.065Disclosure of Interests:None declared.

Background:Rheumatoid arthritis (RA) is characterized by elevated cardiovascular morbimortality. RA patients have a higher risk to develop cardiovascular comorbidities when compared to the general population, being the main cause of mortality in these patients. Cardiovascular risk factors (CVRF) are well known, but their management is not optimal, increasing the risk of having a major heart disease (1).Objectives:To assess the prevalence of the main causes of morbimortality and development of CVRF in RA patients during a five-year follow-up period.Methods:A longitudinal and prospective study of a RA cohort from 2014-2019 was performed in a Cardio Rheumatology outpatient clinic at the University Hospital “Dr. Jose E. Gonzalez”, UANL. Patients aged 40-75 years with RA according to ACR/EULAR 2010 criteria were recruited. At both visits, demographic, clinical variables, and lipid profile were recorded. Outcomes included the development of cardiovascular comorbidity: hypertension, diabetes mellitus (DM), dyslipidemia, myocardial infarction, stroke. Survival probabilities and outcomes cumulative frequencies were calculated according to the Kaplan-Meier lifetime analysis method. Descriptive analysis: frequencies (%), mean (SD), or median (q25-q75). Comparisons with McNemar and Student’s t test.Results:A follow-up was done in a total of 92 patients. During the follow-up, 9 patients (9.8%) died, 3 died of cardiovascular death (one myocardial infarction and two strokes). The mean age of death was 67.2 ± 10.5 years. CVRF at baseline (T0) and after five years (T5) are shown in table 1. Of the remain 83 patients, 11 patients (13.3%) developed hypertension (p=0.001), 8 (9.6%) patients developed DM (p=0.031). The number of patients with dyslipidemia decreased significantly to 14 (16.9%) (p=0.031), 4 (4.8%) developed a stroke. A survival probability of 95.7% was found at the five-year follow-up from the time of entry into the cardio rheumatology clinic (Figure 1 next page) and a 30.1% probability of developing cardiovascular comorbidity.Conclusion:This long-term study provides updated information on RA morbimortality characteristics in our population. Patients with RA still develop significant cardiovascular comorbidities despite current treatment. In this cohort, hypertension and DM became more prevalent, and a 96% cardiovascular death-free survival was found. Is imperative to increase the effort in determining optimal markers and therapeutic measures to continue with the prevention of these comorbidities.References:[1]Semb AG, Ikdahl E, Wibetoe G, et al. Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol 2020;16(7):361-79. doi: 10.1038/s41584-020-0428-y.Table 1.Demographic and clinical characteristics at the time of inclusion and at 5 years.T0(n=83)T5(n=83)pAge years, mean ± SD56.0 ± 8.9-Female, n (%)75 (90.4)-Disease duration years median (q25-q75)10.4 (4.4-15.7)-CVRF, n (%) Hypertension27 (32.5)38 (45.8)0.001 Dyslipidemia25 (30.1)16 (19.3)0.041 DM6 (7.2)14 (16.9)0.008 Active smoking8 (9.6)6 (7.2)NS Overweight/Obesity67 (81.7)63 (81.9)NS Stroke04 (4.8)-Clinical characteristics BMI kg/m2, mean ± SD28.1 ± 4.128.5± 4.3NS SBP mmHg, mean ± SD123.7 ± 18.4126.9± 16.8NS Total cholesterol mg/dl, mean ± SD180.8 ± 29.0173.9± 34.2NS Triglycerides mg/dl, mean ± SD136.1 ± 56.1146.1± 64.2NS HDL-C mg/dl, mean ± SD55.2 ± 16.355.1± 15.9NS Statins, n (%)9 (10.8)13(15.7)NS Methotrexate, n (%)71 (85.5)63 (75.9)0.039 Glucocorticoids, n (%)49 (59)40 (48.2)NSNS, non-significant; CVRF, cardiovascular risk factors; DM, diabetes mellitus; BMI, body mass index; SBP, systolic blood pressure; HDL-C, high density lipoprotein cholesterol.Disclosure of Interests:None declared

Background:Psoriatic arthritis (PsA) patients have a higher risk of developing a cardiovascular (CV) event than the general population due to an increased prevalence of traditional CV risk factors and to disease characteristics such as disease duration and activity. The carotid ultrasound (US) is a non-invasive diagnostic tool that can detect the presence of subclinical atherosclerosis which is directly associated with the risk of developing a CV event.Objectives:The aim of this study is to compare the prevalence of subclinical atherosclerosis detected by carotid US in PsA patients and controls.Methods:This is a cross-sectional, observational, and comparative study. A total of seventy-five PsA patients aged 40-75 years old, who fulfilled the 2006 CASPAR criteria and seventy-five matched controls by age (±5 years), gender and comorbidities were recruited for this study. Patients with history of a previous CV event and pregnant women were excluded from this study. A high-resolution B mode carotid US was performed in all study subjects by a certified radiologist. Subclinical atherosclerosis was defined as the presence of a carotid plaque (CP) or an increased carotid intima media thickness (cIMT). The presence of CP was defined as a cIMT ≥1.2mm or a focal narrowing ≥0.5mm in the surrounding lumen. An increased cIMT was considered as a value ≥0.8mm. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with χ2 test for qualitative variables and Student´s t test and Mann-Whitney’s U test for quantitative variables. A p value Results:There were no differences when comparing the demographic characteristics between both groups (Table 1). When comparing the carotid US findings, a statistically significant difference was found in the prevalence of CP, which was higher in the PsA group (44.0% vs 26.7%, p=0.026), in the presence of unilateral CP (25.3% vs 10.7%, p=0.019) and in the presence of subclinical atherosclerosis (52.0% vs 34.7%, p=0.032) (Figure 1).Conclusion:The prevalence of subclinical atherosclerosis was higher in PsA patients than controls, and this could be attributed to an increase in the inflammatory burden of these patients. The carotid US should be considered as part of the CV evaluation in all PsA patients, identifying those who would benefit from an opportune treatment preventing the development of a CV event.References:[1]Yim KM, Armstrong AW. Updates on cardiovascular comorbidities associated with psoriatic diseases: epidemiology and mechanisms. Rheumatol Int. 2017;37(1):97–105.Table 1.Demographic and clinical characteristics of psoriatic arthritis patients and controls.PsA(n=75)Controls(n=75)pAge years, mean ± DE53.89 ± 10.5954.25 ± 7.08NSFemale gender, n (%)43 (57.3)43 (57.3)NST2DM, n (%)16 (21.3)15 (20.0)NSHTN, n (%)28 (37.3)21 (28.0)NSDyslipidemia, n (%)33 (44.0)28 (37.3)NSObesity, n (%)31 (41.3)32 (42.7)NSActive smoking, n (%)14 (18.7)18 (24.0)NSBMI kg/m2, median (p25-p75)29.32 (26.23-32.03)28.9 (25.4-33.5)NSDisease duration years, median (p25-p75)5.0 (3.0-10.0)--DAPSA, median (p25-p75)12.6 (5.3-22.9)--Glucocorticoids, n (%)10 (13.3)--MTX, n (%)51 (68.0)--bDMARD, n (%)28 (37.3)--PsA, psoriatic arthritis; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; BMI, body mass index; DAPSA, disease activity for psoriatic arthritis; MTX, methotrexate; bDMARD, biological disease modifying antirheumatic drug.Disclosure of Interests:None declared

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:Psoriatic arthritis (PsA) is a chronic inflammatory arthropathy associated with cardiovascular abnormalities (1). The echocardiography is a non-invasive tool useful in the detection of cardiac abnormalities, which may be the only manifestation of cardiac involvement preceding a global dysfunction. However, echocardiographic differences between PsA patients, rheumatoid arthritis (RA) patients, and controls have not yet been well described.Objectives:To analyze the echocardiographic parameters in PsA patients and to compare them with RA patients and controls.Methods:This cross-sectional, observational and comparative study, included thirty-six patients (nineteen in each group), aged 40-75 years, with PsA and RA who fulfilled the CASPAR (Classification criteria for Psoriatic Arthritis) and ACR/EULAR 2010 classification criteria, respectively, matched by age, gender and comorbidities with nineteen healthy controls. Exclusion criteria were a poor echocardiographic window, patients with a previous atherosclerotic cardiovascular disease (ischemic heart disease, cerebrovascular accident or peripheral arterial disease), and pregnancy. Transthoracic echocardiogram was performed and reviewed by 2 board-certified cardiologists, in all study subjects. Comparisons were done with X2, Kruskall Wallis or ANOVA.Results:There were not differences in the demographic characteristics between groups (Table 1). When comparing echocardiographic findings a statistically significant difference was found in the prevalence of diastolic dysfunction, being more prevalent in PsA and RA patients compared with controls (52.6% vs 52.6% vs 5.3%, p=0.002), likewise the presence of mild mitral valve regurgitation was higher (84.2% vs 53.6% vs 10.5%, p=0.001) and mild pulmonary valve regurgitation (68.4% vs 10.5% vs 0%, p=0.001). Prevalence of abnormal left ventricular geometry was higher in PsA and RA patients than controls (68.4% vs 63.2% vs 21.1%, p=0.006).Table 1.Comparison of demographic characteristics and echocardiographic findings between patients with PsA, RA and controls.PsA(n=19)RA(n=19)Controls(n=19)pAge, years ± SD54.7 ± 7.755.4 ± 9.955.3 ± 5.9NSFemale, n (%)11 (57.9)11 (57.9)11 (57.9)NSDiabetes Mellitus4 (21.1)3 (15.8)2 (10.5)NSHypertension10 (52.6)8 (42.1)7 (36.8)NSDyslipidemia10 (52.6)4 (21.1)7 (36.8)NSActive smoking4 (21.1)2 (10.5)5 (26.3)NSDisease duration, years (p25-p75)6 (4-14)7 (5-18)-NSDAS28-CRP, mean ± SD2.2 ± 0.83.1 ± .8-0.003Echocardiographic findigsDiastolic dysfunction, n (%)10 (52.6)10 (52.6)1 (5.3)0.002LV mass index, g/m2 (p25-p75)78.9 (55.9-86.9)73.7 (61.0-85.7)69.5 (52.0-98.7)NSLVEF, ± mean SD62.3 ± 6.159.7 ± 8.662.9 ± 6.1NSTAPSE, cm ± SD21.8 ± 2.722.4 ± 2.723.7 ± 3.1NSMild aortic regurgitation, n (%)5 (26.3)4 (21.1)1 (5.3)NSMild mitral regurgitation, n (%)16 (84.2)10 (52.6)2 (10.5)Mild pulmonary regurgitation, n (%)13 (68.4)2 (10.5)0 (0)Mild tricuspid regurgitation, n (%)15 (83.3)13 (76.5)11 (57.9)NSLV geometry alterations, n (%)13 (68.4)12 (63.2)4 (21.1)0.006Concentric remodeling, n (%)12 (63.2)10 (52.6)4 (21.1)0.025NS, non-significant; DAS28-CRP, disease activity score using 28 joints and C reactive protein; LV, left ventricular; LVEF, left ventricular ejection fraction; TAPSE, tricuspid annular plane systolic excursion.Conclusion:This study shows the high prevalence of echocardiographic alterations in PsA patients compared to the general population, of the same magnitude as patients with RA. We emphasize the value of an echocardiogram for a complete cardiovascular evaluation and early detection of cardiac abnormalities in these patients.References:[1]Shang Q, Tam LS, Yip GW, et al. High prevalence of subclinical left ventricular dysfunction in patients with psoriatic arthritis. J Rheumatol 2011;38(7):1363-70. doi: 10.3899/jrheum.101136Disclosure of Interests:None declared

Background:Patients with rheumatoid arthritis (RA) have a higher risk of developing a cardiovascular (CV) event than the general population, due to an accelerated process of atherosclerosis (1), which has been documented to begin in early stages of the disease and is directly associated with systemic inflammation (2).Objectives:The aim of this study was to compare the prevalence of subclinical atherosclerosis detected by carotid ultrasound (US) in patients with RA in the first five years of diagnosis and healthy controls.Methods:This was a cross-sectional, observational, and comparative study. A total of 53 patients aged 40-75 years old, with RA diagnosis, in the previous five years, according to the 2010 ACR/EULAR classification criteria, and 53 controls matched by age (±5 years), gender and comorbidities were included in this study. Subjects with a previous CV event, such as myocardial infarction, cerebrovascular event and peripheral arterial disease, another connective tissue disease and pregnant women were excluded from this study. A high-resolution B-mode carotid US was performed in all study subjects. Subclinical atherosclerosis was evaluated as the presence of carotid plaque (CP) or an increased carotid intima media thickness (cIMT). CP was defined as a cIMT ≥1.2mm or a focal narrowing ≥0.5mm of the surrounding lumen, and an increased cIMT was defined as a value ≥0.8mm. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with χ2 test and Fisher’s exact test for qualitative variables, and Student’s t test and Mann-Whitney’s U test for quantitative variables. A p-value Results:Comparisons of demographic characteristics showed no differences between the RA group and the control group (Table 1). When comparing carotid US findings there was a difference in the presence of CP, being more prevalent in RA patients (26.4% vs 11.3%, p=0.047), in the presence of an increased cIMT, being more prevalent in RA patients (34.0% vs 3.8%, p=p=p=0.001 in the left carotid artery), and in the presence of subclinical atherosclerosis overall, being more prevalent in RA patients (52.8% vs 18.9%, p=Table 1.Demographic and clinical characteristicsRAControlsp(n=53)(n=53)Age years, mean ± SD54.48 ± 9.0954.86 ± 6.83NSWomen, n (%)49 (92.5)49 (92.5)NST2DM, n (%)8 (15.1)7 (13.2)NSHTN, n (%)17 (32.1)17 (32.1)NSDyslipidemia, n (%)19 (35.8)19 (35.8)NSObesity, n (%)21 (39.6)20 (37.7)NSActive smoking, n (%)3 (5.7)4 (7.5)NSBMI kg/m2, median (p25-p75)28.78 (25.92-33.21)27.59 (24.55-33.34)NSDisease duration, mean ± SD2.48 ± 1.31--DAS28-CRP, median (p25-p75)3.21 (1.89-4.12)--MTX, n (%)39 (73.6)--Glucocorticoids, n (%)29 (54.7)--Conclusion:Patients with RA in the first five years of diagnosis have a higher prevalence of subclinical atherosclerosis than the general population. CV evaluation including a carotid US should be done at the time of diagnosis of RA patients, and subsequently it must be individualized according to the CV risk of each patient, with a maximum of five years to identify those patients who would benefit from an opportune treatment.References:[1]Geraldino-Pardilla L, Russo C, Sokolove J, et al. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017;56(4):534-40. doi: 10.1093/rheumatology/kew436[2]Ahmad S, Garg S, Dhar M, et al. Predictors of atherosclerosis in rheumatoid arthritis. Vasa 2012;41(5):353-9. doi: 10.1024/0301-1526/a000221Disclosure of Interests:None declared

Background:Rheumatoid arthritis (RA) patients have a higher risk of developing left ventricular (LV) geometric abnormalities which can result in the development of heart failure and cardiac death (1). High titers of rheumatoid factor (RF) and anti-cyclic citrullinated peptide (anti-CCP) antibodies are associated with a worse cardiovascular (CV) prognosis in RA patients (2).Objectives:The aim of this study was to assess the association between RF and anti-CCP antibody titers, and the LV geometric abnormalities detected by a transthoracic echocardiogram.Methods:This was a cross-sectional, observational, and comparative study. Patients aged 40-75 years who fulfilled the 2010 ACR/EULAR classification criteria for RA underwent a transthoracic echocardiogram. Patients with RA and an alteration of LV geometry were matched to RA patients with normal LV geometry, by age, gender, comorbidities, and disease characteristics to eliminate confounders. LV geometry was evaluated with LV mass index and relative wall thickness. A blood sample was taken to measure RF and anti-CCP antibody titers. Distribution was evaluated with the Kolmogorov-Smirnov test. Comparisons were done with Chi square test for qualitative variables and Student’s t test and Mann-Whitney’s U test for quantitative variables. A p-value Results:A total of 82 RA patients were included in this study, 41 patients with altered LV geometry and 41 patients with normal LV geometry. Of the 41 patients with LV geometric abnormalities, 37 (90.2%) presented LV concentric remodeling and 4 (9.8%) presented LV concentric hypertrophy. We found no significant differences in the demographic and clinical characteristics between both groups (Table 1). Patients with altered LV geometry showed higher titers of IgA-RF (102.11 U/ml vs 21.70 U/ml, p=0.011) and anti-CCP antibodies (193.04 U/ml vs 18.29 U/ml, p=0.005) (Figure 1).Table 1.Demographic and disease characteristics.RA patients with altered LV geometry(n=41)RA patients with normal LV geometry(n=41)pAge years, mean ± SD53.12 ± 7.6252.34 ± 7.74NSWomen, n (%)39 (95.1)39 (95.1)NST2DM, n (%)7 (17.1)4 (9.8)NSHTN, n (%)13 (31.7)10 (24.4)NSDyslipidemia, n (%)9 (22.0)11 (26.8)NSActive smoking, n (%)4 (9.8)3 (7.3)NSObesity, n (%)11 (26.8)14 (34.1)NSBMI kg/m2, median (p25-p75)27.95 (25.33-31.45)28.42 (25.84-32.00)NSDisease duration years, median (p25-p75)10.37 (2.72-17.80)6.40 (3.43-13.29)NSCDAI, median (p25-p75)14.00 (2.00-22.00)10.00 (3.00-16.50)NSDAS28-CRP, mean ± SD3.52 ± 1.423.09 ± 1.11NSTreatmentMTX, n (%)33 (80.5)34 (82.9)NSGlucocorticoids, n (%)25 (61.0)23 (56.1)NSAntihypertensive, n (%)13 (31.7)8 (19.5)NSStatins, n (%)6 (14.6)4 (9.8)NSRA, rheumatoid arthritis; LV, left ventricular; NS, not significant; T2DM, type 2 diabetes mellitus; HTN, hypertension; BMI, body mass index; CDAI, clinical disease activity index; DAS28, disease activity score using 28 joints; CPR, C-reactive protein; MTX, methotrexate.Conclusion:RA patients with altered LV geometry had higher titers of IgA-RF and anti-CCP antibodies. This suggests an association between antibody titers and CV prognosis in RA patients. Rheumatologists should take these data into account when evaluating CV risk in RA patients, assessing the possibility of performing an echocardiogram for early detection of CV abnormalities and an opportune treatment in this group of patients.References:[1]Myasoedova E, Davis JM, 3rd, Crowson CS, et al. Brief report: rheumatoid arthritis is associated with left ventricular concentric remodeling: results of a population-based cross-sectional study. Arthritis Rheum 2013;65(7):1713-8. doi: 10.1002/art.37949[2]Geraldino-Pardilla L, Russo C, Sokolove J, et al. Association of anti-citrullinated protein or peptide antibodies with left ventricular structure and function in rheumatoid arthritis. Rheumatology (Oxford) 2017;56(4):534-40. doi: 10.1093/rheumatology/kew436Acknowledgements:We have no acknowledgements to declare.Disclosure of Interests:None declared

Background:Wood smoke exposure is a risk factor for the development of chronic obstructive pulmonary disease (COPD), lung cancer and cardiovascular disease and it has also been linked to higher anti-CCP antibodies in patients with rheumatoid arthritis (RA) and COPD (1).Objectives:The objective of the present study is to report the correlation between anti-CCP, IgG, IgM and IgA rheumatoid factor (RF) to wood smoke exposure in patients with RA. Additionally, evaluate the impact of disease activity, biomass exposure, and disease duration on anti-CCP antibody levels.Methods:A cross-sectional, observational study was designed based on a cohort of Hispanic RA patients. All fulfilled the 2010 ACR/EULAR classification criteria for RA. Biomass smoke exposure was expressed using the biomass exposure index (BEI) calculated from the mean of exposed hours per day multiplied by the number of years exposed. Subjects were divided into two groups: those exposed to wood smoke with BEI ≥1 and subjects not exposed to wood smoke. They were matched by age, gender, and comorbidities. Anti-CCP antibodies and RF were measured by ELISA with cutoff points of Results:A total of 318 subjects were included, 159 (50%) of them had a history of exposure to wood smoke. Anti-CCP antibody positivity was present in 102 (64.2%) with a median titer of 97.1 U/mL (1.7-198) in the RA exposed group, and in 89 (56%) with a median titer of 8.5 U/mL (1.1-145) in the RA non-exposed group. A significant difference was found in anti-CCP antibody titers between groups (p=0.003). (Table 1). Spearman’s rho showed a small but statistically significant correlation between BEI and anti-CCP antibody titers (rho= 0.170, p=0.002). Biomass exposure was independently related to higher anti-CCP antibody titers (B=35.4, pConclusion:RA patients who were exposed to wood smoke had higher titers of anti-CCP antibodies than non-exposed RA patients. Furthermore, biomass exposure was shown to be independently related to higher titers of anti-CCP antibodies.References:[1]Fullerton DG, Bruce N, Gordon SB. Indoor air pollution from biomass fuel smoke is a major health concern in the developing world. Trans R Soc Trop Med Hyg. 2008;102(9):843-51.Table 1.Comparison of demographic, seropositivity and clinical characteristic between patients with RA exposed and matched non-exposed RA patients.CharacteristicsRA exposed(n=159)RA not exposed(n=159)pAge years, ± SD56.7 ± 8.755.4 ± 8.1NSFemale, n (%)148 (93.1)148 (93.1)NSBEI years, median (p25-p75)35 (15-90)0Disease duration years, median (p25-p75)9 (3.5-15.1)6.8 (2.8-14.6)NSDAS 28-CRP, median (p25-p75)3.37 (2.11-4.4)3.17 (2.09-4.2)NSDyslipidemia, n (%)50 (31.4)43 (27)NSHypertension, n (%)55 (34.6)48 (30.2)NSDiabetes Mellitus, n (%)24 (15.1)23 (14.5)NSActive smoking, n (%)8 (5)8 (5)NSSeropositivityAnti-CCP antibody positivity, n (%)102 (64.2)89 (56)0.137Anti-CCP antibody titers, median (p25-p75)97.1 (1.7-198)8.5 (1.1-145)0.003IgG RF positivity, n (%)31 (19.5)24 (15.1)0.299IgG RF titers, median (p25-p75)5 (2-13)4.9 (2-13)0.529IgM RF positivity, n (%)136 (85.5)126 (79.2)0.141IgM RF titers, median (p25-p75)198 (41-200)177 (28-200)0.067IgA RF positivity, n (%)98 (61.6)92 (57.9)0.493IgA RF titers, median (p25-p75)52.9 (9.3-193)33(5-159)0.060NS, non-significant; RA, rheumatoid arthritis; BMI, body mass index; BEI, biomass exposure index; DAS28-CRP, disease activity score using 28 joints-C-reactive protein; anti-CCP, anti-cyclic citrullinated peptide; RF, rheumatoid factorDisclosure of Interests:None declared

Background:Cardiovascular disease (CVD) is the main cause of mortality in patients with rheumatoid arthritis (RA) reflected by a higher prevalence of cardiovascular risk factors (CVRFs), a chronic systemic inflammatory state and heart failure compared to the general population (1). Left ventricular diastolic dysfunction (LVDD) is attributable to structural abnormalities such as hypertrophy or interstitial fibrosis and impaired myocyte relaxation resulting from ischemia and is frequently asymptomatic (2). The presence of LVDD it could be considered as the first step to development of heart failure.Objectives:The aim of the study is to identify the association of disease activity and the presence of LVDD in patients with RA.Methods:A cross-sectional, observational, and comparative study of RA subjects that fulfilled ACR / EULAR 2010 classification criteria, aged 40-75 years. Subjects were evaluated by a transthoracic echocardiogram performed and reviewed by two certified echocardiographers. A total of fifty-one RA patients diagnosed with LVDD were included according to the 2016 American Society of Echocardiography (ASE). Distribution was evaluated with the Kolmogorov-Smirnov test. Descriptive analysis was done using measures of central tendency. Chi square, Student´s t test and Mann-Whitney U test were used for comparations between groups. A p value Results:We found no statistical difference between groups regarding age, gender, comorbidities (type 2 diabetes mellitus, hypertension, dyslipidemia and, active smoking) and body mass index. Patients with LVDD demonstrated a higher disease activity evaluated by disease activity score using 28 joints-C reactive protein (DAS28-PCR) (4.88 vs 3.56, p= 0.004) (Table 1). It was observed that patients with LVDD have a higher prevalence of being in the high disease activity category (41.2% vs. 13.7%, p= 0.002) (Figure 1). When performing a binary logistic regression, it was found that a high disease activity was the only independent predictor for the presence of LVDD, with an OR 4.70, (95% CI 1.63-13.50, p= 0.004).Table 1.Demographic and disease characteristicsRA patients with LVDD(n=51)RA patients without LVDD(n=51)pWomen, n (%)50 (98)47 (92.2)NSAge, years ± SD56.12 ± 8.7653.91 ± 5.61NSHTN, n (%)17 (33.3)13 (25.5)NST2DM, n (%)6 (11.8)10 (19.6)NSDyslipidemia, n (%)17 (33.3)11 (21.6)NSActive smoking, n (%)5 (9.8)5 (9.8)NSBMI kg/m2 ± SD28.20 ± 4.8929.40 ± 5.13NSDisease duration, years (p25-p75)10.70 (5.16-17.87)5.66 (2.67-15.64)0.033DAS28-CRP, median (p25-p75)4.88 (3.53-5.45)3.56 (3.00-4.69)0.004NS, no significative; HTN, hypertension; T2DM, type 2 diabetes mellitus; BMI, body mass index; DAS28, disease activity score using 28 joints; CPR, C reactive proteinConclusion:Patients with RA and LVDD have a higher disease activity, so emphasis should be placed on strict antirheumatic treatment and cardiovascular therapies to avoid the risk of developing CVD and the progression to heart failure. Logistic regression demonstrates that inadequate disease control is an independent factor from traditional CVRFs for the presence of LVDD.References:[1]Dal Piaz EC, Cioffi G, Ognibeni F, et al. Incidence and predictors of new onset left ventricular diastolic dysfunction in asymptomatic patients with rheumatoid arthritis without overt cardiac disease. Monaldi Arch Chest Dis 2019;89(3) doi: 10.4081/monaldi.2019.1053[2]Abdul Muizz AM, Mohd Shahrir MS, Sazliyana S, et al. A cross-sectional study of diastolic dysfunction in rheumatoid arthritis and its association with disease activity. Int J Rheum Dis 2011;14(1):18-30. doi: 10.1111/j.1756-185X.2010.01593.xDisclosure of Interests:None declared