OP0167 SYMPTOMATIC HEART FAILURE AND NT-PRO-BNP LEVELS OF RA PATIENTS WITH AND WITHOUT ANTI-TNFA THERAPY - A PROSPECTIVE COMMUNITY BASED STUDY

M. Gottwald ¹C. Bielecke ¹S. Glocke ¹R. Lange ²I. Fischer ³M. Zaenker ^1,*

¹KH Bernau, ²Laborverbund BB, Rheumazentrum Nord-Brandenburg, Bernau, ³Biostatistik, Tuebingen, Germany

Background: The role of anti-TNFa therapy in RA is well documented in contrast to heart failure (HF). Large clinical trials failed to show significant improvement in patients with HF without concomittant RA. However, incidence of HF is 2-fold higher in patients with RA compared to general population and association of RA with increased left ventricular mass and diastolic dysfunction has been demonstrated. While some traditional risk factors for chronic HF are overrepresented in RA patients, they do not explain all the increased HF risk observed. The chronic elevation of inflammatory cytokines is a likely contributor to myocardial dysfunction in RA patients.

Objectives: In order to address the question whether TNFa inhibition promotes or prevents HF in RA-patients rates and degree of symptomatic HF as well as levels of NT-proBNP were investigated in patients with and without anti TNFa-therapy.

Methods: Within a 3-month period all RA-patients fulfilling ACR-criteria from our outpatient clinic were included consecutively in this prospective study. Written consent for study participation was obtained. Patients were interviewed using a questionnaire to assess risk factors, cardiovascular (cv) disease and symptomatic HF. Symptoms as dyspnea and edema as well as NT-proBNP were evaluated.

Results: 133 RA-patients were included (n=90 female, mean age (±SD) 60.3 (±13.6) years) with median disease duration of 8.0 years, a median DAS₂₈ of 2.7 and median FFbH 82%. CV risk factors were hypertension in 52%, hypercholesteremia in 24%, current smoker in 23% and diabetes in 17% of patients. Previous diseases included TIA/stroke in 4%, peripheral artery disease in 9%, CHD in 22% and myocardial infarction in 8%. 36% (n=48) had anti-TNFa therapy, 64% (n=85) other treatment with methotrexate and/or leflunomide, rituximab (n=5) or abatacept (n=2). Dyspnea was reported in 57% (n=76) classified NYHA II in 42% (n=56), NYHA III in 9% (n=12) and NYHA IV in 4% (n=5). While edema were reported in 50 % (n=67), elevated NT-proBNP levels were found in only 29% of patients. Analysis of patients with and without anti-TNFa therapy revealed no significant differences for mean age, DAS, ESR, rate of increased NT-proBNP (68.7 vs. 70.6 %), mean NT-proBNP (244 vs. 263 ng/ml, rate of dyspnea (54.2 vs. 58.8 %), rate of NYHA II (41.6 vs. 42.3 %), NYHA III (10.4 vs. 8.2 %), NYHA IV (2.0 vs. 4.7 %). Patients under anti-TNFa therapy had longer disease duration (14.5 vs. 6.0 years, p<0.001), lower mean FFbH (76 vs. 85% p=0.008, higher rate of hypercholesterolemia (33.3 vs. 18.8% p=0.033) with mean cholesterol (6.0±1.0 vs. 5.6±1.1,  p=0.02), mean LDL (3.6±0.5 vs. 3.1±0.5, p=0.026) but no significantly different rates of hypertension (58.3 vs. 48.2%), diabetes (22.9 vs. 14.1%), apoplex/TIA (0 vs. 6%), myocardial infarction (6 vs. 9%). Both groups had comparable treatment with ß-blockers, diuretics, ACE-I/ARB, and statines.

Conclusion: Our prospective study in an unselected community based cohort reveals neither increased rates of symptomatic heart failure nor elevated NT-proBNP levels in RA-patients under anti-TNFa therapy compared to DMARD-therapy alone suggesting no increasing risk of symptomatic CHF caused by anti-TNFa-therapy. Further ongoing investigations of this cohort will address left ventricular mass and diastolic dysfunction.

Disclosure of Interest: M. Gottwald: None DeclaredC. Bielecke: None DeclaredS. Glocke: None DeclaredR. Lange: None DeclaredI. Fischer: None DeclaredM. Zaenker Grant / Research Support from: Abbott Immunology