Background Patients with rheumatoid arthritis (RA) have increased mortality and morbidity due to premature cardiovascular disease (CVD). Some factors involved in the development of RA-associated CVD have not yet been fully delineated.
Objectives The aim of the study was to verify whether female gender, the reproductive period, smoking history, atherosclerotic lesions in brachiocephalic vessels, carotid intima-media thickness (IMT), traditional CV risk factors, as well as RA disease activity and disease duration influence excess CVD and cerebrovascular disease in patients with RA.
Methods A case-control study was performed within the prospective cohort of 94 RA patients (female: 84%; age: 20–82). Cases were 26 patients who developed their first myocardial infarction (MI) after the diagnosis of RA. Controls and cases had comparable disease duration. Traditional (BMI, smoking history, diabetes mellitus), pulmonary arterial hypertension (PAH) and disease-specific risk factors for MI were assessed. Atherogenic Index of Plasma (AIP; log TG/HDL-C) calculated. Carotid artery hemodynamic parameters, IMT and plaques were assessed using high resolution B-mode and Doppler-mode ultrasound in order to detect blood flow velocities, maximal IMT and size of atherosclerotic plaques, respectively. RA activity and severity were determined by DAS28, CDAI, SDAI scores, ultrasonography of synovitis and HAQ questionnaires. Statistical analysis was performed by using IBM SPSS 21.0
Results Patients with MI were mostly females (96%), with a median age of 61 (54–69) years. The mean disease duration was 3.5 (1–9) years. About 34% of cases were smokers. The risk of MI in RA women was 3.91 (OR). In female patients, who smoked it was 1.36. Patients with MI were not significantly older compared to control RA patients (p=0.316). Interestingly, 88% of RA cases with MI and 100% of non-MI conrtols (p=0.005). High RA disease activity (DAS28 above 4,17) was observed in 46% of patients with MI. Seropositivity was found in 92%, while erosions in small joints in 58% of cases. Joint replacement surgery was necessary in 13% of MI cases. Strokedeveloped in 13% of cases and 10% of controls. PAH was detected in 75%, of patients with MI. No statistically significant difference in IMT between MI cases and controls could be found (p=0.217). Furthermore, atherosclerotic lesions were not more pronounced in RA patients with versus without MI (p=0.874).
Altogether 91,7% patients with MI had atherosclerotic plaques in brachiocephalic vessels resulting in <50% luminal stenosis, while 8,3% of patients had plaques causing >50% lumen obstruction. IMT exerted significant correlation with age (p<0,001), plaques in brachiocephalic vessels (p=0.045), PAH (p=0.001), joint erosions (p<0.05) and symptom onset in RA (p<0.05). PAH also correlated with brachiocephalic vessel plaques (p=0.01). Bivariate logistic regression revealed that in females with late onset menarche (>16 years) and early menopause (<45 years) had lower, while patients with late onset menopause had greater risk for developing MI
Conclusions In our case-control study, brachiocephalic plaques, PAH, the onset of menarche and menopause may be associated with the development of MI in RA patients. These preliminary observations indicate the existence of less evident risk factors, which should be further characterized in future studies
Acknowledgement small acknowledgment of kindness received from RSU lecturer S.Senkane
Disclosure of Interest None declared