Abstract
ObjectivePatients with rheumatoid arthritis (RA) are almost twice as likely to develop cardiovascular disease (CVD) as those without. However, traditional CVD risks have been shown to underperform in RA patients; thus, we aimed to identify new surrogate risk factors to better reflect their atherosclerotic burden.MethodsA total of 380 RA patients with carotid atherosclerosis data were analyzed in this prospective cohort study. The primary outcome was carotid plaque progression over the 3-year follow-up period. Risk parameters assessed for the progression of carotid plaque were categorized as demographics, traditional CVD risks, RA-related risks, and bone parameters.ResultsThe progression of carotid plaque was associated with the level of rheumatoid factor (p = 0.025), serum C-terminal telopeptide of type-I collagen (CTX-I) (p = 0.014), and femur and distal radius bone mass density (BMD) (p = 0.007 and 0.004, respectively), as well as traditional CVD risk factors. In multivariable analyses, the bone parameters of serum CTX-I and distal radius BMD proved to be independent predictors of the progression of carotid plaque along with hyperlipidemia, smoking, and baseline carotid plaque (all, p < 0.05). Adding both serum CTX-I and distal radius BMD increased the carotid plaque progression prediction model’s percentage of explained variance from 24 to 30%.ConclusionHigh serum CTX-I and lower radius BMD, reflecting high bone turnover, were independent risk factors for the progression of carotid plaque in RA patients, implicating the direct or indirect role of bone metabolism on the atherosclerotic burden.
Highlights
Patients with rheumatoid arthritis (RA) are nearly twice as likely to die before the age of 75 compared with people without the disease
When we compared the baseline demographic and clinical characteristics of the total cohort, the following factors were significantly associated with the progression of carotid plaque in the univariate models: male sex, age, Waist-hip ratio (WHR), hypercholesterolemia, smoking, LDLcholesterol, and serum uric acid level
Among the RArelated factors, only the level of rheumatoid factor was associated with the progression of carotid plaque after 3 years (p = 0.025), the current erythrocyte sedimentation rate (ESR) was marginally associated (p = 0.059)
Summary
Patients with rheumatoid arthritis (RA) are nearly twice as likely to die before the age of 75 compared with people without the disease. The leading cause of this excess mortality among all age groups is cardiovascular disease (CVD) [1]. This is mainly mediated by the increased burden of atherosclerosis in RA patients. Identifying RA patients at risk for CVD is challenging since the standard CVD risk stratification tools developed for the general population have been shown to underperform in RA patients [2]. The Framingham risk equation for predicting CVD outcomes failed to predict almost half of the events that would occur in RA patients [2]. Attempts have been made to establish a RA-specific CVD risk prediction equation [3, 4], but external validation has failed to uniformly predict the CVD risk in RA
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