Predictors of heart rate recovery following exercise in patients with rheumatoid arthritis

A. Osailan, G. Metsios, P. Rouse, J. Duda, N. Ntoumanis, G. Kitas, J. V. Zanten

Research output: Contribution to journalMeeting abstract

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Abstract

Background Cardiovascular disease (CVD) is a major cause of death in rheumatoid arthritis patients (RA). The underlying mechanisms for the CVD increase risk in RA are not fully understood. However, poor parasympathetic function, a risk factor for cardiac mortality in the general population, has been implicated in RA. Little is known about the predictors of parasympathetic function in RA, which is most commonly assessed by heart rate recovery following maximal exercise testing. Objectives To explore the association of multiple factors including traditional CVD risk factors, global CVD risk score, maximal oxygen uptake (VO2max), quality of life, and inflammatory markers with heart rate recovery (ΔHRR) following an exercise tolerance test, a marker of parasympathetic function. Methods 106 RA (54.5±12.3 years, 68% women) patients completed an exercise tolerance test on a treadmill, during which heart rate (HR) was monitored via 12 lead ECG. ΔHRR was quantified as the difference between maximal HR during exercise and HR one minute post exercise. Cardiorespiratory fitness (VO2 max) was assessed via breath by breath gas analyses. A fasted blood sample was taken to examine levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen and white blood cells (WBC), lipids profile, and markers of insulin sensitivity (HOMA, QUICKI). Quality of life was assessed using the EuroQol questionnaire.The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD. Results The average drop in HRR was 29±13 beats per minute. Partial correlation (controlling for gender) analyses revealed that age (r = -0.25, p=0.03), resting HR (r = -0.34, p=0.003), triglycerides (r = -0.25, p=0.03), fibrinogen (r = -0.33, p=0.004), ESR (r = -0.24, p=0.03), WBC (r = -0.26, p=0.02), FRS (r = -0.28, p=0.01) were inversely associated with ΔHRR, whereas EuroQol (r =0.26, p=0.02) and VO2 max (r =0.28, p=0.01) were positively associated with ΔHRR. To identify independent predictors of parasympathetic activity in RA, stepwise linear regression was conducted. This revealed that fibrinogen (p=0.03), resting HR (p=0.001), FRS (p=0.009) and EuroQol (p=0.01) were independently associated with ΔHRR. Conclusions Even though several individual CVD risk factors, such as inflammatory markers, fitness level, and quality of life were associated with parasympathetic activity, only fibrinogen, global CVD risk and quality of life were independently associated with parasympathetic activity in RA. These findings suggest that parasympathetic reactivation is predicted by overall CVD risk rather than individual risk factors. Longitudinal studies should explore how a reduction in CVD risk factors - achieved via exercise - may impact on parasympathetic activity in RA.
Original languageEnglish
Article numberOP0163
Pages (from-to)123
Number of pages1
JournalAnnals of the Rheumatic Diseases
Volume73
Issue number2
DOIs
Publication statusPublished - 1 Jun 2014
EventAnnual European Congress of Rheumatology - Paris, UK United Kingdom
Duration: 11 Jun 201414 Jun 2014

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Rheumatoid Arthritis
Cardiovascular Diseases
Heart Rate
Exercise
Recovery
Fibrinogen
Quality of Life
Exercise Tolerance
Blood Sedimentation
Exercise Test
Blood
Leukocytes
Sedimentation
C-Reactive Protein
Longitudinal Studies
Insulin Resistance
Exercise equipment
Cause of Death
Linear Models
Electrocardiography

Keywords

  • fibrinogen
  • marker
  • C reactive protein
  • triacylglycerol
  • lipid
  • heart rate
  • exercise
  • patient
  • human
  • rheumatoid arthritis
  • rheumatology
  • rheumatic disease
  • risk factor
  • risk
  • parasympathetic tone
  • quality of life
  • parasympathetic function
  • leukocyte
  • exercise tolerance
  • fitness
  • breathing
  • longitudinal study
  • linear regression analysis
  • treadmill
  • Framingham risk score
  • insulin sensitivity
  • oxygen consumption
  • exercise test
  • cardiovascular disease
  • population
  • erythrocyte sedimentation rate
  • mortality
  • gender
  • blood sampling
  • female
  • gas analysis
  • cause of death
  • Quantitative Insulin Sensitivity Check Index
  • electrocardiogram

Cite this

Predictors of heart rate recovery following exercise in patients with rheumatoid arthritis. / Osailan, A.; Metsios, G.; Rouse, P.; Duda, J.; Ntoumanis, N.; Kitas, G.; Zanten, J. V.

In: Annals of the Rheumatic Diseases, Vol. 73, No. 2, OP0163, 01.06.2014, p. 123.

Research output: Contribution to journalMeeting abstract

Osailan, A. ; Metsios, G. ; Rouse, P. ; Duda, J. ; Ntoumanis, N. ; Kitas, G. ; Zanten, J. V. / Predictors of heart rate recovery following exercise in patients with rheumatoid arthritis. In: Annals of the Rheumatic Diseases. 2014 ; Vol. 73, No. 2. pp. 123.
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abstract = "Background Cardiovascular disease (CVD) is a major cause of death in rheumatoid arthritis patients (RA). The underlying mechanisms for the CVD increase risk in RA are not fully understood. However, poor parasympathetic function, a risk factor for cardiac mortality in the general population, has been implicated in RA. Little is known about the predictors of parasympathetic function in RA, which is most commonly assessed by heart rate recovery following maximal exercise testing. Objectives To explore the association of multiple factors including traditional CVD risk factors, global CVD risk score, maximal oxygen uptake (VO2max), quality of life, and inflammatory markers with heart rate recovery (ΔHRR) following an exercise tolerance test, a marker of parasympathetic function. Methods 106 RA (54.5±12.3 years, 68{\%} women) patients completed an exercise tolerance test on a treadmill, during which heart rate (HR) was monitored via 12 lead ECG. ΔHRR was quantified as the difference between maximal HR during exercise and HR one minute post exercise. Cardiorespiratory fitness (VO2 max) was assessed via breath by breath gas analyses. A fasted blood sample was taken to examine levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen and white blood cells (WBC), lipids profile, and markers of insulin sensitivity (HOMA, QUICKI). Quality of life was assessed using the EuroQol questionnaire.The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD. Results The average drop in HRR was 29±13 beats per minute. Partial correlation (controlling for gender) analyses revealed that age (r = -0.25, p=0.03), resting HR (r = -0.34, p=0.003), triglycerides (r = -0.25, p=0.03), fibrinogen (r = -0.33, p=0.004), ESR (r = -0.24, p=0.03), WBC (r = -0.26, p=0.02), FRS (r = -0.28, p=0.01) were inversely associated with ΔHRR, whereas EuroQol (r =0.26, p=0.02) and VO2 max (r =0.28, p=0.01) were positively associated with ΔHRR. To identify independent predictors of parasympathetic activity in RA, stepwise linear regression was conducted. This revealed that fibrinogen (p=0.03), resting HR (p=0.001), FRS (p=0.009) and EuroQol (p=0.01) were independently associated with ΔHRR. Conclusions Even though several individual CVD risk factors, such as inflammatory markers, fitness level, and quality of life were associated with parasympathetic activity, only fibrinogen, global CVD risk and quality of life were independently associated with parasympathetic activity in RA. These findings suggest that parasympathetic reactivation is predicted by overall CVD risk rather than individual risk factors. Longitudinal studies should explore how a reduction in CVD risk factors - achieved via exercise - may impact on parasympathetic activity in RA.",
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TY - JOUR

T1 - Predictors of heart rate recovery following exercise in patients with rheumatoid arthritis

AU - Osailan, A.

AU - Metsios, G.

AU - Rouse, P.

AU - Duda, J.

AU - Ntoumanis, N.

AU - Kitas, G.

AU - Zanten, J. V.

PY - 2014/6/1

Y1 - 2014/6/1

N2 - Background Cardiovascular disease (CVD) is a major cause of death in rheumatoid arthritis patients (RA). The underlying mechanisms for the CVD increase risk in RA are not fully understood. However, poor parasympathetic function, a risk factor for cardiac mortality in the general population, has been implicated in RA. Little is known about the predictors of parasympathetic function in RA, which is most commonly assessed by heart rate recovery following maximal exercise testing. Objectives To explore the association of multiple factors including traditional CVD risk factors, global CVD risk score, maximal oxygen uptake (VO2max), quality of life, and inflammatory markers with heart rate recovery (ΔHRR) following an exercise tolerance test, a marker of parasympathetic function. Methods 106 RA (54.5±12.3 years, 68% women) patients completed an exercise tolerance test on a treadmill, during which heart rate (HR) was monitored via 12 lead ECG. ΔHRR was quantified as the difference between maximal HR during exercise and HR one minute post exercise. Cardiorespiratory fitness (VO2 max) was assessed via breath by breath gas analyses. A fasted blood sample was taken to examine levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen and white blood cells (WBC), lipids profile, and markers of insulin sensitivity (HOMA, QUICKI). Quality of life was assessed using the EuroQol questionnaire.The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD. Results The average drop in HRR was 29±13 beats per minute. Partial correlation (controlling for gender) analyses revealed that age (r = -0.25, p=0.03), resting HR (r = -0.34, p=0.003), triglycerides (r = -0.25, p=0.03), fibrinogen (r = -0.33, p=0.004), ESR (r = -0.24, p=0.03), WBC (r = -0.26, p=0.02), FRS (r = -0.28, p=0.01) were inversely associated with ΔHRR, whereas EuroQol (r =0.26, p=0.02) and VO2 max (r =0.28, p=0.01) were positively associated with ΔHRR. To identify independent predictors of parasympathetic activity in RA, stepwise linear regression was conducted. This revealed that fibrinogen (p=0.03), resting HR (p=0.001), FRS (p=0.009) and EuroQol (p=0.01) were independently associated with ΔHRR. Conclusions Even though several individual CVD risk factors, such as inflammatory markers, fitness level, and quality of life were associated with parasympathetic activity, only fibrinogen, global CVD risk and quality of life were independently associated with parasympathetic activity in RA. These findings suggest that parasympathetic reactivation is predicted by overall CVD risk rather than individual risk factors. Longitudinal studies should explore how a reduction in CVD risk factors - achieved via exercise - may impact on parasympathetic activity in RA.

AB - Background Cardiovascular disease (CVD) is a major cause of death in rheumatoid arthritis patients (RA). The underlying mechanisms for the CVD increase risk in RA are not fully understood. However, poor parasympathetic function, a risk factor for cardiac mortality in the general population, has been implicated in RA. Little is known about the predictors of parasympathetic function in RA, which is most commonly assessed by heart rate recovery following maximal exercise testing. Objectives To explore the association of multiple factors including traditional CVD risk factors, global CVD risk score, maximal oxygen uptake (VO2max), quality of life, and inflammatory markers with heart rate recovery (ΔHRR) following an exercise tolerance test, a marker of parasympathetic function. Methods 106 RA (54.5±12.3 years, 68% women) patients completed an exercise tolerance test on a treadmill, during which heart rate (HR) was monitored via 12 lead ECG. ΔHRR was quantified as the difference between maximal HR during exercise and HR one minute post exercise. Cardiorespiratory fitness (VO2 max) was assessed via breath by breath gas analyses. A fasted blood sample was taken to examine levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen and white blood cells (WBC), lipids profile, and markers of insulin sensitivity (HOMA, QUICKI). Quality of life was assessed using the EuroQol questionnaire.The Framingham Risk Score (FRS) was used as an assessment of global risk for CVD. Results The average drop in HRR was 29±13 beats per minute. Partial correlation (controlling for gender) analyses revealed that age (r = -0.25, p=0.03), resting HR (r = -0.34, p=0.003), triglycerides (r = -0.25, p=0.03), fibrinogen (r = -0.33, p=0.004), ESR (r = -0.24, p=0.03), WBC (r = -0.26, p=0.02), FRS (r = -0.28, p=0.01) were inversely associated with ΔHRR, whereas EuroQol (r =0.26, p=0.02) and VO2 max (r =0.28, p=0.01) were positively associated with ΔHRR. To identify independent predictors of parasympathetic activity in RA, stepwise linear regression was conducted. This revealed that fibrinogen (p=0.03), resting HR (p=0.001), FRS (p=0.009) and EuroQol (p=0.01) were independently associated with ΔHRR. Conclusions Even though several individual CVD risk factors, such as inflammatory markers, fitness level, and quality of life were associated with parasympathetic activity, only fibrinogen, global CVD risk and quality of life were independently associated with parasympathetic activity in RA. These findings suggest that parasympathetic reactivation is predicted by overall CVD risk rather than individual risk factors. Longitudinal studies should explore how a reduction in CVD risk factors - achieved via exercise - may impact on parasympathetic activity in RA.

KW - fibrinogen

KW - marker

KW - C reactive protein

KW - triacylglycerol

KW - lipid

KW - heart rate

KW - exercise

KW - patient

KW - human

KW - rheumatoid arthritis

KW - rheumatology

KW - rheumatic disease

KW - risk factor

KW - risk

KW - parasympathetic tone

KW - quality of life

KW - parasympathetic function

KW - leukocyte

KW - exercise tolerance

KW - fitness

KW - breathing

KW - longitudinal study

KW - linear regression analysis

KW - treadmill

KW - Framingham risk score

KW - insulin sensitivity

KW - oxygen consumption

KW - exercise test

KW - cardiovascular disease

KW - population

KW - erythrocyte sedimentation rate

KW - mortality

KW - gender

KW - blood sampling

KW - female

KW - gas analysis

KW - cause of death

KW - Quantitative Insulin Sensitivity Check Index

KW - electrocardiogram

UR - http://dx.doi.org/10.1136/annrheumdis-2014-eular.2884

U2 - 10.1136/annrheumdis-2014-eular.2884

DO - 10.1136/annrheumdis-2014-eular.2884

M3 - Meeting abstract

VL - 73

SP - 123

JO - Annals of the Rheumatic Diseases

JF - Annals of the Rheumatic Diseases

SN - 0003-4967

IS - 2

M1 - OP0163

ER -