Background It is widely accepted that patients with rheumatoid arthritis (RA) have increased mortality and morbidity from premature cardiovascular disease. Up to 50% of this mortality excess is secondary to ischemic heart disease closely followed by cerebrovascular disease .
Objectives To investigate intima-media thickness (IMT) and plaque formation with relation to age, disease duration and disease severity, myocardial infarction (MI) and stroke in patients with RA in order to detect and estimate cardio and cerebrovascular risk factors and events.
Methods Forty five patients (female 91.1%) with confirmed RA (aged 20-82) were selected. Carotid artery hemodynamic parameters, IMT and plaques were measured by using high resolution B-mode and Doppler–mode ultrasound to detect blood flow velocities, maximal IMT, size of atherosclerotic plaques. Rheumatoid arthritis severity was measured by DAS28, SDAI, CDAI scores and HAQ questionnaires. For cardiovascular risk detection Framingham risk score and AIP (Atherogenic Index of Plasma (log10 TG/HDLC)) were used. Data analysis was performed using IBM SPSS 21.0.
Results Patients with previous MI were statistically significant older than patients without MI (69.0±10.6 and 52.7±15.7 years, respectively). Previous MI had 13.33% of patients, and previous stroke 4.44% of patients. There were no statistically significant correlations between atherosclerotic plaques on the right and left side of brachiocephalic vessels, IMT dx and sin, and the duration of RA and the age when diagnosis was confirmed (p>0.05). Statistically significant correlation between IMT sin and age of patients was found (r=0.63; p<0.001); IMT dx and age of patient (r=0.62; p<0.001). No statistically significant correlations between IMT dx and sin, atherosclerotic plaques dx and sin and activity markers of RA (p>0.05) were found. The duration of disease was not statistically longer for patient with MI than for patients without MI (p=0.34). Atherosclerotic lesions were not more pronounced to patients with MI than without (p=0.80). Anti CCP levels did not differ between patients with and without MI (p=0.900).
Conclusions Previous MI did not show significant association with BMI, smoking habits, atherosclerotic lesions of vessels (atherosclerotic plaques), disease severity, activity markers and AIP. This preliminary observation indicates the changes of immune system long before appearance of RA, triggering severe cardiovascular events without traditional cardiovascular risk factors.
Wallberg-Jonsson S, Ohman ML, Dahlqvist SR:Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern Sweden. J. Rheumatol 1997;24:445–51.
Disclosure of Interest None declared