Background Chronic inflammation, the basic feature of rheumatoid arthritis (RA), plays a major role in accelerated atherosclerosis. through its influence on insulin resistance, lipid status, and atherothrombogenic factors. such as fibrinogen, D-dimmer and von Willebrand factor (vWF). Nowadays, vWF is considered a reliable indicator of endothelial dysfunction/damage, an initial step in the process of atherosclerosis.
Objectives To evaluate association between vWF activity and subclinical atherosclerosis in patients with RA and low cardiovascular risk.
Methods Intima-media thickness (IMT) was measured by ultrasonography in 42 non-diabetic, normotensive, female RA patients and 32 matched healthy controls (age 45.3±10.0 vs. 45.2±9.8 years) at common carotid, bifurcation, and internal carotid arteries. IMT above mean IMT+2SD of the controls at each carotid level was regarded as subclinical atherosclerosis. The atherosclerotic plaque was defined as IMT>1.5 mm. Clinical work-up included determination of the disease activity and antirheumatic treatment. Laboratory analyses included inflammation markers, lipid status and haemostatic factors.
Results Patients with subclinical atherosclerosis had higher vWF activity than those without (133.5±69.3% vs. 96.1±37.9%, p<0.05) and predictive value of vWF was confirmed in logistic regression analysis (p<0.05). Importantly, vWF activity correlated with inflammation markers (p<0.01), all parameters of disease activity (p<0.01), and concentrations of rheumatoid factor (p<0.05) and anti-CCP antibodies (p<0.01). In subjects with atherosclerotic plaques vWF activity was significantly higher than in those without (123±57% vs. 99±45%, p<0.05). Among traditional risk factor, multivariateanalysis revealed that in RA patients with subclinical atherosclerosis, smoking habits outweighs the importance of age.
Conclusions We confirmed significant association of vWF activity and subclinical atherosclerosis in asymptomatic RA patients as well as its correlation with inflammation markers and all parameters of disease activity. Therefore, vWF might be a valuable systemic marker of early atherosclerosis in RA patients and pathophysiological link between RA activity and endothelial damage.
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Disclosure of Interest None Declared