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Currentmethods for assessing vasomotor endothelial function are impractical for use in large studies. We tested the hypothesis that pulse-wave analysis (PWA) combined with provocative pharmacological testing might provide an alternative method. Radial artery waveforms were recorded and augmentation index (AIx) was calculated from derived aortic waveforms. Thirteen subjects received sublingual nitroglycerin (NTG), inhaled albuterol, or placebo. Twelve subjects received NTG, albuterol, and placebo separately during an infusion of N G -monomethyl- l -arginine (LNMMA) or norepinephrine. Twenty-seven hypercholesterolemic subjects and 27 controls received NTG followed by albuterol. Endothelial function was assessed by PWA and forearm blood flow in 27 subjects. Albuterol and NTG both significantly and repeatably reduced AIx ( P P =0.02). Baseline AIx was higher in the hypercholesterolemic subjects, who exhibited a reduced response to albuterol ( P =0.02) but not to NTG when compared with matched controls. The responses to albuterol and acetylcholine were correlated ( r =0.5, P =0.02). Consistent with an endothelium-dependent effect, the response to albuterol was substantially inhibited by LNMMA. Importantly, the response to albuterol was reduced in subjects with hypercholesterolemia and was correlated to that of intra-arterial acetylcholine. This methodology provides a simple, repeatable, noninvasive means of assessing endothelial function in vivo.

Background Patients with Rheumatoid Arthritis (RA) have an elevated cardiovascular (CV) risk, comparable to the risk in type 2 diabetes mellitus. Recent guidelines suggest strict treatment of CV risk factors. It is well known that adherence to primary preventive interventions is frequently suboptimal (around 50%). Objectives To evaluate the self-reported adherence to CV prevention strategies by patients with RA participating in the FRANCIS study, a long term, randomized, single centre intervention study investigating the need for strict CV prevention strategies in RA. Methods Included RA patients who were randomized to strict CV risk prevention strategies received a validated questionnaire to evaluate adherence to therapy. All patients followed a structured CV risk management program with rheumatologists, vascular specialists, dieticians and specialized nurses for vascular and RA care. Strict treatment targets were defined and lifestyle recommendations, antihypertensive and lipid lowering drugs were prescribed following a pre-specified protocol. Questionnaires were sent to patients who had had at least two visits to our outpatient clinic and a minimum of 6 months follow up. CV risk was assessed using the SCORE algorithm Results Questionnaires were sent to 136 patients (response rate 111 (82%)). A high CV risk (≥20%) was found in 60 (53%) patients, but only 3 (3%) thought that they had an increased CV risk. In total, 65 (69%) patients followed the doctors9 suggestions exactly and 71 (75%) patients found it easy to follow their doctors suggestions exactly. From the 71 (66%) patients who were prescribed medication, 59 (83%) took all prescribed tablets. Dietary measures were advised to 46 (42%) patients and 30 (66%) said to adhere to the diet. Physical exercise was ad vised to 72 (66%) patients and 42 (58%) said to perform specific physical exercise ≥3 days/week. The adherence was not significantly different between patients with a CV risk 20% and/or >20%. Conclusions RA patients tend to underestimate their CV risk. Self-reported treatment adherence is 70%, being suboptimal. The adherence to recommendations is not associated to patients true CV risk. Better patient awareness of their CV risk is necessary to improve adherence. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1634

Background Rheumatoid arthritis (RA) is recognized as an independent cardiovascular risk factor. Guidelines for cardiovascular risk (CVR) management, advise aggressive treatment in RA. Tight treatment for CVR factors in RA is not standard care and there are no prospective data. Objectives To investigate the efficacy of CVR intervention in RA patients participating in the FRANCIS study. FRANCIS is a prospective, randomized, single centre study in RA, initiated before the guidelines advocating CVR treatment in RA patients became available. Methods RA patients ≤70 years old with a CVR score Results In total 318 patients were included of whom 219 patients (69%) had a completed baseline and 1-year follow up data set. 106 patients received standard care and 113 treat-to-target. At baseline there was no difference between usual care and tight control in systolic BP, LDL-C, HDL-C, apoB, triglycerides, glucose cIMT and DAS28. After 1-year of follow up, the LDL-C, apoB levels and systolic BP were lower in both groups. The decrease in LDL-C after one year was significantly greater in the treat-to-target group compared to standard care (-0.7±0.8mmol/L vs.-0.2±1.0mmol/L; P Conclusions This is the first prospective study in RA showing that a structured cardiovascular intervention program leads to lower LDL-C levels, and delayed progression of cIMT after 12 months. Disclosure of Interest None declared DOI 10.1136/annrheumdis-2014-eular.1631