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Exercise is Associated With Increased Small HDL Particle Concentration and Decreased Vascular Stiffness in Rheumatoid Arthritis

Byram, Kevin W., MD*; Oeser, Annette M., BS*; Linton, MacRae F., MD*; Fazio, Sergio, MD, PhD; Stein, C. Michael, MBChB*; Ormseth, Michelle J., MD, MSCI*‡

JCR: Journal of Clinical Rheumatology: December 2018 - Volume 24 - Issue 8 - p 417–421
doi: 10.1097/RHU.0000000000000809
Original Articles

Objective Patients with rheumatoid arthritis (RA) have increased cardiovascular (CV) risk. In the general population, exercise improves several CV risk factors. In a cross-sectional study, we examined the hypothesis that more exercise is associated with protective traditional and non-traditional CV risk factor profile in patients with RA.

Methods Patient-reported exercise outside of daily activities was quantified by time and metabolic equivalents per week (METmin/week) and CV risk factors including blood pressure, standard lipid profiles, lipoprotein particle concentrations (NMR spectroscopy), and vascular indices were measured in 165 patients with RA. The relationship between exercise and CV risk factors was assessed according to whether patients exercised or not, and after adjustment for age, race and sex.

Results Over half (54%) of RA patients did not exercise. Among those who did exercise, median value for exercise duration was 113 min/week [IQR: 60, 210], and exercise metabolic equivalent expenditure was 484 METmin/week [IQR: 258, 990]. Disease activity (measured by DAS28 score), C-reactive protein, waist-hip ratio, and prevalence of hypertension were lower in patients who exercised compared to those who did not (all p-values < 0.05) but standard lipid profile and body mass index were not significantly different. Patients who exercised had significantly higher concentrations of HDL particles (p = 0.004) and lower vascular stiffness as measured by pulse wave velocity (p = 0.005).

Conclusions More self-reported exercise in patients with RA was associated with a protective CV risk factor profile including lower waist-hip ratio, higher HDL particle concentration, lower vascular stiffness, and a lower prevalence of hypertension.

From the *Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee;

Center for Preventive Cardiology of the Knight Cardiovascular Institute, Oregon Health & Science University, Portland, Oregon; and

Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee.

Funding: Veterans Health Administration CDA IK2CX001269, NIH Grants: P60AR056116, P01HL116263, K23AR068443, and CTSA award UL1TR000445 from the National Center for Advancing Translational Sciences. Its contents are solely the responsibility of the authors and do not necessarily represent official views of the National Center for Advancing Translational Sciences or the National Institutes of Health.

Disclosures: None.

Correspondence: Michelle J Ormseth MD, MSCI, 1161 21st Ave South, MCN-T3113, Nashville, TN 37232. E-mail: michelle.ormseth@vanderbilt.edu.

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