Traditional cardiovascular risk factors and diastolic function in myositis and myositis-associated conditions
M O’Sullivan, S Cuddy, A Curran, A Gsel, V Tormey, J Carey, C Sullivan
Galway University Hospitals.
Accelerated cardiovascular disease (CVD) is now well recognised in rheumatoid arthritis and SLE. Traditional cardiovascular risk factors contribute to this excess risk. Less is known about the burden of cardiovascular disease in patients with idiopathic inflammatory myopathies (IIM). These patients often have a high inflammatory burden and require prolonged use of corticosteroids, both of which increase cardiovascular risk. Treatment of traditional CV risks is challenging in IIM patients particularly with regard to the use of statin therapy. Diastolic dysfunction occurs frequently without clinical symptoms and is associated with an increase in mortality and incident congestive heart failure. Clinical conditions responsible for primary diastolic dysfunction include hypertension, coronary artery disease and cardiomyopathy.
To identify and treat traditional cardiovascular risk factors in patients with IIM and to screen for presence of diastolic dysfunction.
Patients with a diagnosis of polymyositis (PM), dermatomyositis (DM), anti-synthetase syndrome (ASS) or myositis- scleroderma overlap syndrome under active follow-up were screened for traditional cardiovascular risk factors during their routine rheumatology review. They had a blood pressure recorded, serum glucose and lipid profile measured. They completed a questionnaire regarding smoking and family history. A subset of this cohort also had a transthoracic echocardiography, including tissue Doppler imaging, to screen for diastolic dysfunction.
23 patients were studied. The mean age was 52 years (SD +/- 18) and 73% were female. 26% were smokers. 52% (12/23) had evidence of high blood pressure on 2 separate readings and 5 patients had a prior diagnosis of hypertension. 34% (8/23) of the group had LDL concentrations higher than guideline recommendations for primary prevention of CVD, however, only 2 of these patients were on a lipid lowering medication. 12 patients had a transthoracic echocardiogram performed. 3 patients had evidence of diastolic dysfunction. This was grade 1 (mild) in all 3 cases.
In this cohort we have found that a number of traditional CVD risk factors were prevalent. There is concern amongst clinicians with respect to statin use in the setting of IIM and further research regarding their safety is required. Diastolic dysfunction exists in a small proportion of our group of patients. Further cardiac investigation in large scale studies is required to elucidate whether diastolic dysfunction represents subclinical myocardial involvement in IIM or is a consequence of coronary atherosclerosis and uncontrolled hypertension.