Left Ventricular Hypertrophy Predicts Cardiovascular Events in Normotensive, Normoglycemic Patients With RA

Illustration showing a heart overlaid with a normal electrocardiogram (ECG).
This study examined whether LVH in patients with RA who are normotensive and normoglycemic is associated with increased cardiovascular events.

Left ventricular hypertrophy (LVH) was found in 1 in 6 patients with rheumatoid arthritis (RA) who were normotensive and normoglycemic and strongly predicted cardiovascular events, according to study data published in the International Journal of Rheumatic Diseases.

In the general population, LVH is associated with hypertension and hyperglycemia and is predictive of poorer cardiovascular outcomes. In patients with RA, LVH is often detected in the absence of hypertension and hyperglycemia. In these cases, the observed LVH is possibly due to the chronic inflammation that occurs in RA. This study examined whether LVH in patients with RA who are normotensive and normoglycemic is associated with increased cardiovascular events.

This was an observational prospective study that included patients aged 18 and older with RA who had normal blood pressure and serum glucose levels and were not taking medications for high blood pressure or diabetes. Clinical, laboratory, and echocardiographic evaluations were conducted during 40 months as part of a primary prevention program for cardiovascular disease. LVH was defined as 49.2 g/m2.7 or greater for men and 46.7 g/m2.7  or greater for women. The primary outcome was cardiovascular death or hospitalization.

Of 241 patients, 16% had LVH. Risk factors for LVH included older age (older than 53 years), higher body mass index, longer duration of RA, anti-citrullinated protein antibody (ACPA) positivity, and concentric left ventricular geometry. During the follow-up period, 31% patients with LVH and 11% of patients without LVH experienced a cardiovascular event (P <.001). The variables associated with cardiovascular events included LVH (hazards ratio [HR] 3.28; 95% CI, 1.03-9.20; P = .03), C-reactive protein (HR 1.08; 95% CI, 1.02-1.14; P = .004), and ACPA positivity (HR 5.09; 95% CI, 1.20-15.22; P = .03).

The limitations of the study included the relatively small number of cardiovascular events that occurred during the study period, the inability to track changes in the participants’ medications, and the use of standard echocardiography to detect LVH instead of cardiac magnetic resonance imaging (MRI).

The researchers concluded, “LVH is not uncommon and strongly predicts cardiovascular events in normotensive normoglycemic RA patients which can be recognized at an early stage of disease by standard echocardiography, a reliable, well proven, flexible, low cost, environmentally safe, and easy to manage diagnostic technique.”


Cioffi G, Viapiana O, Orsolini G, et al. Left ventricular hypertrophy predicts poorer cardiovascular outcome in normotensive normoglycemic patients with rheumatoid arthritis. Int J Rheum Dis. Published online March 14, 2021. doi:10.1111/1756-185X.14082.