Background Analysis of arterial stiffness is a good marker of early arterial disease, which also has a prognostic value. It can be determined in a simple, non-invasive and reproducible way through the pulse wave velocity (PWV), a measure that has been proved to be useful in the stratification of cardiovascular risk (CVR).
Objectives To determine arterial stiffness by studying PWV in patients with rheumatoid arthritis (RA), and estimate its utility in CVR stratification in these patients.
Methods 134 patients with RA were assessed over a period of one year, excluding those with high CVR (previous cardiovascular events, renal failure and/or diabetes mellitus). Gender, age, duration of RA, extra-articular disease, smoking habit, blood pressure (BP), RF and/or anti-CCP antibodies +, and atherogenic index were collected. These data were used to calculate the SCORE and mSCORE. An ultrasound (US) examination was performed with an Esaote MyLab 70 US system equipped with a linear probe (7- 12MHz) and an automated measurement of intima-media thickness (IMT) by radiofrequency (QIMT). IMT was measured in bilateral common carotid, and the presence of atherosclerotic plaques was recorded in the extracranial carotid arteries according to Mannheim Consensus. PWV measurement was performed using a Mobil O Graph device. Patients were classified as high CVR if the PWV≥10m/s (Mancia G, et al. J Hypertens 2013;31:1281-1357). Statistical analysis was performed using the SPSS 17.0 program.
Results 75.4% of patients were female, the mean age was 60.36 years and 29.1% were smokers. The mean duration of RA was 17.18 years, 20.9% with extra-articular features. The percentage of patients classified as low CVR (mSCORE =0), medium (1≤mSCORE<5) high and very high (mSCORE≥5) was 23.9%, 65.8% and 10.3%, respectively. Plaques were found in 43.6% of the patients, the mean IMT being 0.74 mm. 16.2% of the patients had an IMT >0.9 mm. Patients with IMT>0.9mm and/or presence of plaque accounted for 46.2%. The average PWV was 8.84 m/s and 26.8% of the patients showed a PWV≥10m/s. 52 patients (46%) with mSCORE<5 had atheromatous plaques and/or IMT>0.9mm, and 25 (23.8%) had a PWV≥10m/s. PWV showed a correlation with mSCORE (r0.721, p 0.000) and pathological findings in carotid US (r 0.568, p 0.000). A composite gold standard for high CVR (mSCORE≥5 or mSCORE<5 with IMT>0.9 mm and/or plaque or PWV≥10m/s) was considered (Corrales A, et al. Ann Rheum Dis 2013, 72:1764-70) for the estimation of the sensitivity of the following models:
Conclusions The sensitivity of the PWV is higher than that of the mSCORE, but lower than carotid US in estimating the CVR in patients with RA. However, it is a more fast, simple, objective and reproducible test and, therefore, can be a useful tool for stratifying CVR in clinical practice.
Disclosure of Interest None declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.