Abstract
IntroductionRheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality attributed to both classical risk factors and chronic inflammation. We assessed longitudinally the factors associated with new carotid plaques in nondiabetic RA patients and apparently healthy individuals.MethodsIn our present prospective observational study, carotid plaques were identified by ultrasonography at baseline and follow-up end, separated by an average of 3.6 ± 0.2 years, in 64 patients (mean age 59.2 ± 12.0 and disease duration at baseline 7.8 ± 6.2 years, 83% women, clinical and laboratory evaluation every 3 to 6 months). In a substudy, 35 of the patients were matched 1:1 for traditional cardiovascular risk factors with 'healthy' controls and were studied in parallel.ResultsNew atherosclerotic plaques formed in 30% of patients (first plaque in 9%) who were significantly older than the remaining patients. Tobacco use, blood pressure, body mass index, average cumulative low-density lipoprotein, high-sensitivity C-reactive protein, erythrocyte sedimentation rate level, RA stage, functional class, disease duration and treatment modalities during follow-up did not differ significantly between subgroups after application of the Bonferroni correction. RA was in clinical remission, on average, for approximately 70% of the follow-up time and was not different between subgroups. Multivariate analysis including all the above parameters revealed that age (P = 0.006), smoking (P = 0.009) and duration of low-dose corticosteroid use (P = 0.016) associated independently with new plaque formation. RA patients displayed similar numbers of newly formed carotid plaques to the tightly matched for traditional cardiovascular risk factors 'healthy' controls, although more patients than controls had carotid plaques at baseline.ConclusionsFormation of new atherosclerotic plaques in this small cohort of patients with well-controlled RA depended mainly on traditional cardiovascular risk factors and corticosteroid use, whereas an adverse effect of residual systemic inflammation was not readily detectable.
Highlights
Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality attributed to both classical risk factors and chronic inflammation
In RA patients without traditional cardiovascular disease (CVD) risk factors or events, an increased intimamedia thickness (IMT) of the common carotid artery and evidence of focal plaques were each predictive of incident CVD events [6,7]
Study population and design To address the first objective mentioned above, we used a unique prospective cohort comprising RA patients who met the American College of Rheumatology classification criteria [23] and participated in this observational study. This convenience sample was composed of RA patients who initially participated in the cross-sectional study [4], who were asked consecutively to provide informed consent and were willing and available to be reassessed after 3 years
Summary
Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality attributed to both classical risk factors and chronic inflammation. Rheumatoid arthritis (RA) is an independent risk factor for cardiovascular disease (CVD) that is associated with at least a 1.5-fold increased risk for a fatal coronary event compared to the general population [1]. This is based predominantly on data derived from epidemiological ultrasonography of the carotid artery provides a noninvasive, valid and reproducible method for identifying atherosclerotic plaques, which reflect prevalent, clinical or preclinical CVD and may represent predictors of future CVD events [5]. According to a recent study, both traditional CVD risk factors and markers of RA severity at baseline contribute to models predicting cardiovascular (CV) events in the subsequent 22 months [22]
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