Factors associated with left ventricular mass during disease modifying antirheumatic drug therapy in patients with rheumatoid arthritis: the Joint Heart study

Anja Linde; Eva Gerdts; Bjørg T Fevang; Arve Ulvik; Per M Ueland; Klaus Meyer; Ester Kringeland; Helga Midtbø

doi:10.1016/j.ijcrp.2025.200521

Factors associated with left ventricular mass during disease modifying antirheumatic drug therapy in patients with rheumatoid arthritis: the Joint Heart study

Int J Cardiol Cardiovasc Risk Prev. 2025 Oct 1:27:200521. doi: 10.1016/j.ijcrp.2025.200521. eCollection 2025 Dec.

Authors

Anja Linde^{1

2}, Eva Gerdts^{1

3}, Bjørg T Fevang^{4

5}, Arve Ulvik⁶, Per M Ueland⁶, Klaus Meyer⁶, Ester Kringeland^{1

3}, Helga Midtbø^{1

3}

Affiliations

¹ Centre for Research on Cardiac Disease in Women, Department of Clinical Science, University of Bergen, Bergen, Norway.
² Norwegian Research Centre for Women's Health, Oslo University Hospital, Oslo, Norway.
³ Department of Heart Disease, Haukeland University Hospital, Bergen, Norway.
⁴ Department of Rheumatology, Haukeland University Hospital, Bergen, Norway.
⁵ Department of Clinical Science, University of Bergen, Bergen, Norway.
⁶ Bevital AS, Bergen, Norway.

Abstract

Background: We explored factors associated with left ventricular (LV) mass index during biological (b) or targeted synthetic (ts) disease modifying antirheumatic drug (DMARD) therapy in patients with rheumatoid arthritis (RA).

Methods: Eighty-three outpatients with RA (age 55 ± 12 years, 71% women) with an indication for b/ts DMARD therapy were examined with echocardiography at baseline and after a mean follow-up of 22 months. LV mass was calculated according to guidelines and indexed for height^2.7.

Results: At baseline, 37% had hypertension, 6% diabetes, 21% obesity, and 100% were using b/ts DMARDs. During follow-up, 17% discontinued b/tsDMARD treatment. The LV mass index remained unchanged during follow-up (33.1 ± 8.1 g/m^2.7 vs. 33.5 ± 7.3 g/m^2.7, p = 0.57, mean change 0.3 ± 4.9 g/m^2.7). Lower LV mass index at follow-up was observed in patients using bDMARDs at follow-up (31.7 ± 6.2 g/m^2.7 vs. 36.6 ± 8.9 g/m^2.7, p = 0.001). In multivariable linear regression analyses, use of bDMARDs (β -0.22, p = 0.03) at follow-up were associated with lower LV mass index at follow-up, independent of C-reactive protein (CRP), age, sex, and obesity at baseline. Obesity at baseline (β 0.39, p < 0.001) was associated with a higher LV mass index both at baseline and follow-up. Higher CRP at baseline was associated with higher LV mass index at baseline (β 0.31, p = 0.001), but not at follow-up.

Conclusion: In patients with RA on DMARD treatment, the mean LV mass index remained stable during 22 months of follow-up. Obesity was the strongest factor associated with higher LV mass index, while use of bDMARD throughout the study period was associated with lower LV mass index.

Keywords: DMARDs; Echocardiography; Inflammatory markers; Left ventricular mass index; Rheumatoid arthritis.