Page 172 - THE EVOLUTION OF EARLY ARTHRITIS AND CARDIOVASCULAR RISK Samina A. Turk

CHAPTER 9
increased cardiovascular risk. However, no relationship with disease activity or acute phase proteins was found. This might be explained by the small number of early arthri- tis patients with a low muscle mass for age, as well as that only a single measurement of disease activity is not representative for the (subclinical) inflammation before the onset of arthritis.
In chapter 5 the prevalence of conduction disorders in early arthritis patients was deter- mined, as well as the relationship with inflammation and traditional CV risk factors. As the risk of sudden cardiac death is increased in RA patients, we assessed, using electro- cardiography, whether the prevalence of conduction disorders was already increased at the onset of arthritis. Of the 480 early arthritis patients, 12.5% had a conduction disorder. This prevalence is similar to the general population. This similar prevalence at the onset of arthritis might be explained by the cumulative time of exposure to inflam- mation. Early arthritis patients have been exposed for a shorter period, and it might be that exposure for a longer period of time to inflammation causes conduction disorders (especially QTc prolongation). Conduction times at baseline were not associated with inflammation markers and did not change after one year of anti-rheumatic treatment. However, a higher inflammatory load was associated with an increased heart rate, higher blood pressure, and an atherogenic lipid profile. A higher blood pressure and a more atherogenic lipid profile were also associated with an increased QRS time. CV risk factors improved after anti-rheumatic treatment. Especially the improvement in heart rate with the improvement in disease activity was outstanding. Therefore, the focus in patients with early arthritis should be on CV risk management as well as on optimizing anti-inflammatory treatment.
Next, we determined the role of anti-rheumatic treatment on CV risk, traditional risk factors and the indication for preventive CV treatment. For this, in chapter 6, CV risk was determined retrospectively according to two CV risk scores (Dutch Systemic Coronary Risk Evaluation (SCORE) and European HeartSCORE, both corrected for RA patients), before and after four weeks of anti-rheumatic treatment in 104 early RA patients. Ex- ploratory analyses were performed to determine the effect of inflammation on CV risk score, as well as the relation between inflammation, CV risk scores and the different components of the risk scores. In total 7% of the RA patients already had a history of CV disease at the moment of diagnosis. Comparison between the two different CV risk models revealed only a slight agreement, of which the Dutch SCORE classified 30% of patients as being at high risk for CV disease, and the European HeartSCORE classified 3% as high risk. According to the Dutch CV risk management guideline, all the patients who were scored as high risk using the Dutch SCORE had an indication for (adaptations of) preventive treatment. After anti-rheumatic treatment, the lipid profile and blood pressure improved. In total 13% had a different advice for preventive CV treatment after four weeks of anti-rheumatic treatment. Inconclusive results were found regarding the association between disease activity and CV risk scores. Nevertheless, a higher total cholesterol (TC): high-density lipoprotein (HDL) ratio (implying an increased cardiovas-
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