EARLY PREDICTORS OF CARDIOVASCULAR DISEASE (CVD) RISK: A 15-YEAR FOLLOW-UP STUDY OF 108 PATIENTS WITH RHEUMATOID ARTHRITIS (RA): PP.10.383

Abstract

Background: Patients with RA have increased cardiovascular morbidity and mortality. The objective of this study was to explore whether early markers of RA inflammatory disease activity could predict later increased levels of pulse wave velocity (PWV) and augmentation index (AIx), two measures of arterial stiffness and surrogate markers of CVD. Methods: Two hundred and thirty eight patients from the EURIDISS cohort with early RA were followed longitudinally from 1992, 108 were available for the 15-year follow-up examination. Comprehensive baseline and follow-up demographic, clinical and radiographic data were collected. Arterial stiffness, measured as augmentation index (AIx) and pulse wave velocity (PWV) (Sphygmocor apparatus), was registered at the 15-year follow-up. Variables that were significantly skewed were transformed into the natural logarithm (BMI, CRP) and/or dichotomized at the median (CRP, radiographic Sharp score and Ritchie disease activity score). Adjusted univariate and logistic regression analyses were performed with elevated AIx and PWV (defined as values in the fourth quartile) as the dependent variables and several baseline variables as possible predictors. The validity of the final models was examined by entering possible current confounders successively into the model: use of antihypertensive medication, diabetes, current CRP and current BMI. Results: Baseline hsCRP above the median predicted increased AIx and PWV at the 15-year assessment in both the univariate and multivariate model (OR(CI) 3.52 (1.04-11.90) p = 0.04) Nagelkerke R2 0.61 and (OR (CI) 4.84 (1.34–16.83) p = 0.01) Nagelkerke R2 0.53 respectively. Patients with elevated baseline CRP had significantly higher AIx (β(CI) 2.67 (0.06–5.31) p = 0.045) and lnPWV after 15 years (β(CI) 0.08 (0.01–0.14) p = 0.02) after adjustments for age, sex and MAP Baseline elevated CRP remained a significant predictor of increased AIx and PWV also after adjustments for possible current confounders. Conclusion: Inflammation early in the disease course was associated with an increased arterial stiffness after 15 years. These findings support the importance of early control of the inflammatory process in patients with RA to reduce the risk of CVD during the disease course.