Abstract
BackgroundInflammation plays an important role in the pathogenesis of atherosclerosis. The link between rheumatoid arthritis (RA) and an increased risk of cardiovascular disease and mortality is well established; however, the association between inflammatory bowel disease (IBD) and cardiovascular risk is controversial. Arterial stiffness is both a marker and risk factor for atherosclerosis. Here we aimed to 1) compare circulating markers of inflammation and endothelial dysfunction, traditional cardiovascular risk factors, and arterial stiffness between RA and IBD to help to understand their different associations with cardiovascular disease; 2) assess the impacts of circulating markers of inflammation and endothelial dysfunction, and traditional risk factors on arterial stiffness.MethodsPatients with RA (n = 43) and IBD (n = 42), and control subjects (n = 73) were recruited. Plasma inflammatory markers and von Willebrand factor (vWF) were measured by Multiplex assays or ELISA. Arterial stiffness was determined by brachial-ankle pulse wave velocity (baPWV) and ankle-brachial index (ABI) was measured. Framingham Risk Score (FRS) was calculated, and other traditional risk factors were also documented.ResultsPlasma levels of several inflammatory markers and vWF were significantly but comparably elevated in RA and IBD compared with controls, except for a higher level of C-reactive protein (CRP) in RA than IBD. Compared to controls, FRS, body mass index, waist circumference, and triglycerides were increased in RA, but not in IBD. baPWV did not significantly differ among 3 groups, while ABI was modestly but significantly lower in IBD than controls. Circulating markers (macrophage migration inhibitory factor, tumour necrosis factor-α, CRP, and vWF) were significantly associated with baPWV. However, traditional risk factors (age, systolic blood pressure, body mass index, diabetes and triglycerides) were the parameters associated with baPWV in multiple regression analyses (overall r = 0.866, p < 0.001).ConclusionsRA has a higher level of CRP and more pronounced traditional cardiovascular risk factors than IBD, which may contribute to the difference in their associations with cardiovascular disease and mortality. Traditional risk factors, rather than inflammation markers, are major predictors of arterial stiffness even in subjects with inflammatory disorders. Our results point to the importance of modifying traditional risk factors in patients with inflammatory disorders.
Highlights
It is well known that inflammation plays a pivotal role in the pathogenesis and progression of atherosclerosis and that measures of systemic inflammation, such as circulating C-reactive protein (CRP) and interleukin (IL)-6, provide useful prognostic information for atherosclerosis [1,2,3,4]
Framingham Risk Score (FRS) was significantly elevated in rheumatoid arthritis (RA) group but not in Inflammatory bowel disease (IBD) compared with the control group (Table 1)
Whilst ankle-brachial index (ABI) was modestly but significantly lower in IBD compared to controls, there were no significant differences in brachial-ankle pulse wave velocity (baPWV) amongst the 3 groups. baPWV was mainly associated with traditional risk factors, with age and systolic blood pressure making the most significant contribution to baPWV
Summary
It is well known that inflammation plays a pivotal role in the pathogenesis and progression of atherosclerosis and that measures of systemic inflammation, such as circulating C-reactive protein (CRP) and interleukin (IL)-6, provide useful prognostic information for atherosclerosis [1,2,3,4]. Chronic inflammatory diseases such as rheumatoid arthritis (RA) have been strongly linked to accelerated atherosclerosis and increased incidence of cardiovascular events and mortality [5,6,7,8]. We aimed to 1) compare circulating markers of inflammation and endothelial dysfunction, traditional cardiovascular risk factors, and arterial stiffness between RA and IBD to help to understand their different associations with cardiovascular disease; 2) assess the impacts of circulating markers of inflammation and endothelial dysfunction, and traditional risk factors on arterial stiffness
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