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Cancer in adult patients with inflammatory arthritis is associated with high ascending aortic stiffness and left ventricular hypertrophy and diastolic dysfunction

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Abstract

Inflammatory arthritis, including rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), are associated with both cancer and cardiovascular (CV) adverse events. Cancer and CV abnormalities have coincident etiologic and pathophysiologic pathways in RA/PsA/AS patients. However, a comprehensive evaluation of CV system has never been performed in these patients in relation to the presence of cancer. This study was designed to assess the possible relationships between CV abnormalities and cancer among RA/PsA/AS patients. Between March 2014 and March 2015, 414 patients (214 RA, 125 PsA, and 75 SA) in sinus rhythm without known cardiac disease underwent clinical and color Doppler echocardiographic evaluation and were prospectively followed up. Patients had a mean age of 58 ± 12 years, 64% women. Forty-two patients (10.1%) had a diagnosis of cancer (made before enrollment in 24 cases and in 18 cases during the 36 months of follow-up). Skin cancer was the most frequent malignancy found, followed by thyroid, colon, pancreas, and breast cancer. Patients who had cancer were older with higher systolic blood pressure, more frequent hypertension and moderate/high disease activity, left ventricular (LV) hypertrophy, diastolic dysfunction, and higher ascending aortic stiffness index (AOSI) than those who had not. At multivariate logistic regression analysis, LV diastolic dysfunction and abnormally high AOSI emerged as conditions associated with cancer together with older age and hypertension. Cancer in RA/PsA/AS adults without history of CV disease is closely associated with specific asymptomatic CV abnormalities, such as LV diastolic dysfunction and reduced vascular elasticity, which are independent of age and hypertension.

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Authors and Affiliations

  1. Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

    Giovanni Cioffi, Ombretta Viapiana, Federica Ognibeni, Giovanni Orsolini, Angelo Fassio, Davide Gatti, Maurizio Rossini & Alessandro Giollo

  2. Division of Cardiology, San Martino Hospital, Belluno, Italy

    Luigi Tarantini

  3. Rheumatology Unit, Policlinico Borgo Roma, Piazzale Scuro 10, Verona, Italy

    Giovanni Cioffi

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  1. Giovanni Cioffi
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  2. Ombretta Viapiana
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Correspondence to Giovanni Cioffi.

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Giovanni Cioi declared that this study was approved by Ethical Committees of the Verona University and conforms to the ethical guidelines of the declaration of Helsinki in 2000.

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Cioffi, G., Viapiana, O., Tarantini, L. et al. Cancer in adult patients with inflammatory arthritis is associated with high ascending aortic stiffness and left ventricular hypertrophy and diastolic dysfunction. Intern Emerg Med 16, 73–81 (2021). https://doi.org/10.1007/s11739-020-02310-6

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