Cardiovascular organ damage in patients with psoriasis and rheumatoid arthritis: associations with hypertension, obesity and disease modifying treatment
PhD candidate: Anja Linde
Supervisors: Associate professor Helga Midtbø and Professor Eva Gerdts.
Background
Autoimmune diseases predominately affect women and are established as risk factors for cardiovascular disease. Chronic inflammation is central in the pathogenesis of atherosclerosis, but also promote damage of the of the heart and lead to change in its shape and size. These conditions (left ventricular hypertrophy and increased left ventricular mass) are conditions that do not give symptoms, but that are strong predictors of future clinical cardiovascular events. However, whether patients with chronic inflammatory diseases have different size and shape of the heart compared to controls, if this change is associated with higher levels of inflammatory biomarkers and whether it is improved by immunomodulating therapy, has been little studied.
About the project
The first part of the study (paper I), consisted of 53 patients with moderate to severe psoriasis receiving infliximab treatment, included from the Dermatology department at Haukeland University Hospital. These patients were matched to 99 control subjects from the FAT associated CardiOvasculaR dysfunction (FATCOR) study, established at the Department of Heart Disease, Haukeland University Hospital. FATCOR was an observational, cross-sectional study of 620 women and men aged 30–65 years with a body mass index (BMI) >27.0 kg/m2 without known cardiovascular disease.
The second part of this project, The JointHeart study (paper II & III), included patients with RA who were accepted for initiation or change in their immunomodulating treatment at department of Rheumatology, Haukeland University Hospital. Baseline investigations were performed from 2018 to 2020 and follow-up investigations from 2019-2021. A total of 89 patients did both baseline and follow-up investigations.
Criteria of exclusion for all three studies were known heart disease, current severe psychiatric illness, and expected low compliance. The patients were thoroughly investigated with conventional and advanced echocardiography, arterial stiffness measurements and 24h blood pressure measurements.
Goal
In this project, we wanted to identify clinical risk factors and variables associated with the development of subclinical heart disease in patients with chronic inflammatory conditions. We further wanted to investigate whether immunomodulated treatment reduces this risk. These studies will hopefully add to new knowledge regarding subclinical cardiovascular disease in patients with chronic inflammation. If factors that are associated with early development of heart disease are identified in these patients, we can start treatment earlier and better prevent its development to clinical disease.
Cooperation
These studies has received funding from the Western Regional Health Authorities of Norway and Revmatikernes Forskningsfond Marit Hanssens Minnefond.
The project is a cooperation between University in Bergen and Center for Research on Cardiac Disease in Women, and Department of Heart Disease, Department of Dermatology and Department of Rheumatology at Haukeland University Hospital.