Background Patients with rheumatoid arthritis (RA) with subclinical hypothyroid dysfunction (SHTD) have early mortality due to cardiovascular complications. There for it is necessary to study this problem. Investigation of the SHTD effect on RA in these patients will help to define the prognosis and optimize the efficiency of integrated diagnostic and therapeutic tactics.
Objectives To determine the cardiovascular risk (CVR) level in RA patients with SHTD
Methods 98 patients with RA were examined. All the patients were divided into 2 groups. Group I – 59 (60,2%) patients with RA and SHTD, the second – 39 (39.8%) patients with RA without SHTD. Thyroid gland condition was determined according to international standards of SHTD diagnosis. All subjects were female. Patients in group I and II have not differed by age and RA duration. All patients underwent clinical and functional investigation for RA diagnosis. Blood levels of total cholesterol (TC), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol cholesterol (LDL-C), very low density lipoproteins (VLDL) and atherogenic index (AI) were assessed. All patients underwent ultrasound detection of vascular endothelial dysfunction. CVR is calculated by Score scale. The results were multiplied by 1,5 factor according to the latest European guidelines for CVR in RA patients. The CVR level was also evaluated by Procam scale.
Results CVR factors were significantly higher in the group I, than in group II (respectively 91.7%, 69.6%). Family history of cardiovascular disease was observed in 48.1% of patients I and 35.1% II group, higher BMI – respectively at 88.8% and 27.02% (p<0.001), dyslipidemia – at 79.6% and 43.2% (p<0.001), increased blood pressure – at 62.9% and 37.8% (p=0,003), menopause – at 57.4% and 24.3% (p<0.001). The total risk of cardiovascular death by Score scale in group I patients was 5.7%, in II – 3.2%, and by Procam scale in I – 18.5%, in II – 13.7%, it is significantly different (p<0.001).
Parameters of lipid profile in group I compared with group II showed a significant increase of all investigated indices p<0.001, except for level of HDL cholesterol. In the study of endothelial function in both groups of patients the decrease of endothelium-dependent vasodilation (EDVD) and endothelium-independent vasodilation (EIVD) from standard indicators (EDVD brachial artery is (BA) greater or equal to 10%, and EIVD BA is more than 15%) was found. The average thickness of the complex intima-media (CIM) in patients of group I was 1.11±0.058 mm, and the II – 0.71±0.072 mm (p=0.009), which got statistical significance. Correlations between CIM and total cholesterol levels (r=0.297, p=0.021), LDL cholesterol (r=0.36, p=0.005), AI (r=0.335, p=0.008) in group I patients; and correlations between CIM and the level of LDL cholesterol (r=0.301, p=0.18) and AI (r=0.268, p=0.024) in patients of group II were defined.
Conclusions The results show more significant changes of lipid profile and endothelial function indices in RA patients with concomitant SHTD, increasing CVR in these patients. This raises the need for physicians to pay more attention to thorough survey of RA patients for early diagnosis and correction of comorbid conditions, aggravating RA course
Disclosure of Interest None declared