Abstract
IntroductionPatients with rheumatoid arthritis (RA) are at an increased risk for cardiovascular disease (CVD). One of the earliest manifestations of CVD is endothelial dysfunction (ED). ED can occur in both the microcirculation and the macrocirculation, and these manifestations might be relatively independent of each other. Little is known about the association between endothelial function in the microcirculation and the macrocirculation in RA. The objectives of the present study were to examine the relationship between microvascular and macrovascular endothelial function in patients with RA.MethodsNinety-nine RA patients (72 females, mean age (± SD) 56 ± 12 years), underwent assessments of endothelial-dependent (acetylcholine) and endothelial-independent (sodium nitroprusside) microvascular vasodilatory function (laser Doppler imaging with iontophoresis), as well as endothelial-dependent (flow-mediated dilation) and endothelial-independent (glyceryl trinitrate-mediated dilation) macrovascular vasodilatory function. Vasodilatory function was calculated as the percentage increase after each stimulus was applied relative to baseline values.ResultsPearson correlations showed that microvascular endothelial-dependent function was not associated with macrovascular endothelial-dependent function (r (90 patients) = 0.10, P = 0.34). Similarly, microvascular endothelial-independent function was not related to macrovascular endothelial-independent function (r (89 patients) = 0.00, P = 0.99).ConclusionsMicrovascular and macrovascular endothelial function were independent of each other in patients with RA, suggesting differential regulation of endothelial function in these two vascular beds. Assessments of both vascular beds may provide more meaningful clinical information on vascular risk in RA, but this hypothesis needs to be confirmed in long-term prospective studies.
Highlights
Patients with rheumatoid arthritis (RA) are at an increased risk for cardiovascular disease (CVD)
Microvascular and macrovascular endothelial function were independent of each other in patients with RA, suggesting differential regulation of endothelial function in these two vascular beds. Assessments of both vascular beds may provide more meaningful clinical information on vascular risk in RA, but this hypothesis needs to be confirmed in long-term prospective studies
Microvascular and macrovascular endothelial function for RA patients were similar to a healthy control group
Summary
Patients with rheumatoid arthritis (RA) are at an increased risk for cardiovascular disease (CVD). The extent of ED can be characterised by assessing endothelial function in different vascular beds of the peripheral circulation [7]. These assessments are reflective of coronary endothelial function [8,9,10,11] and have been shown to be good predictors of long-term cardiovascular events in individuals with atherosclerosis [12,13,14,15] and peripheral vascular disease [16], as well as in healthy older participants [17]. Studies that have assessed associations between peripheral microvascular and macrovascular endothelial-dependent function in healthy individuals have reported mixed findings, with some reporting an association between microvascular and macrovascular endothelial-dependent function [22,23] and others reporting no association [24,25,26]
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