Background Patients with rheumatoid arthritis (RA) have a high risk of cardiovascular (CV) morbidity and mortality. Arterial stiffness (AS) is a known predictor of CVD. Relationships between inflammation and arterial stiffness in patients with RA are not well understood.
Objectives The aim of the study was to evaluate parameters of (AS) and their associations with inflammatory activity in patients with RA.
Methods 62 patients with RA (EULAR 2010) without known CVD were examined (73% females,age 58,5±15,4 (M±SD) years, 13% smokers, 61% with AH, 34% with dyslipidemia). Median duration of RA was 8 years (IQR 3–17). Seropositive RA was diagnosed in 69% of patients. Median hsCRP was 12,1 mg/dl (IQR 2,2;23,4 mg/dl), median rheumatoid factor (RF) was 32,5 IU/ml (IQR 8,3;173 IU/ml). Mean DAS-28 (ESR) was 4,7±1,2. All patients received disease-modifying antirheumatic drugs, 22 (38%) - biological treatment. Parameters of AS were assessed by applanation tonometry (SphygmoCor, AtCor). Cardio-ankle vascular index (CAVI), ankle-brachial index (ABI) and vascular age were measured by VaSera 1500. Carotid intima-media thickness (CIMT) was evaluated by ultrasound. Pulse wave velocity>10,0 m/s and CAVI>9,0 were considered as AS increase. ABI<0,9 and CIMT>0,9 were considered as markers of subclinical atherosclerosis. p<0.05 was significant.
Results Mean PWV was 9,3±3,2 m/s. PWV>10m/s was observed in 32,3% patients, CAVI>9,0 - in 25,8%, ABI<0,9 – in 6,5% and CIMT>0,9 – in 21%. Patients with PWV>10m/s were older (69,8±8,5 vs 53,2±15,1 years), had higher BMI (29,3±6,5 vs 24,7±4,8 kg/m2), longer duration of AH (median 11,5 [IQR 5,5;17] vs 0 [IQR 0;5] years), higher BP levels (144±20/85±9 vs 123±14/77±10 mmHg), lower level of GFR (64±17 vs 89±19 ml/min/1,73m2), higher levels of LDL-C (3,7±0,9 vs 3,2±1,0 mmol/l), plasma glucose (5,6±0,9 vs 4,8±0,7 mmol/l), hs-CRP (median 22 [IQR 13,3;60] vs 6,7 [IQR 1,6;17,2] mg/dl), higher CAVI (9,5±1,1 vs 7,6±1,4), vascular age (71±8,4 vs 53,4±17,5 years) and CIMT (1,01±0,3 vs 0,7±0,2 mm), p<0,05 for trend. Spearmen analysis revealed significant positive correlations between PWV and age (r=0,7), BMI (r=0,4), duration of AH (r=0,6), SBP (r=0,6), DBP (r=0,4), plasma glucose (r=0,3), hs-CRP (r=0,3), vascular age (r=0,6), CIMT (r=0,7), CAVI (r=0,6) and negative correlations with eGFR (r=-0,6). hsCRP correlated with PWV, aortic pulse pressure (r=0,3), CAVI (r=0,5), vascular age (r=0,5) and ABI (r=-0,5). Multiple regression analysis confirmed that AH duration (β=0,2, p=0.03), SBP (β=0,6, p<0.0001), GFR (β=-0,3, p=0,005) and hs-CRP-level (β=0,3, p=0.000009) were independent predictors of AS increase.
Conclusions High prevalence of AS increase is observed in patients with RA without known CVD. Elevation of hsCRP as well as other traditional risk factors is an independent predictor of PWV increase in patients with RA.
Ambrosino P. et al. Subclinical atherosclerosis in patients with rheumatoid arthritis. a meta-analysis of literature studies. Thromb Haemost 2015;113:916–930.
Crilly M. et al. Arterial stiffness and cumulative inflammatory burden in rheumatoid arthritis:a dose–response relationship independent of established cardiovascular risk factors Rheumatology 2009;48:1606–1612.
Silem H., Nasr G. Change of the aortic elasticity in rheumatoid arthritis: Relationship to associated cardiovascular risk factors J Cardiovasc Dis Res. 2010;1:110–115.
Disclosure of Interest None declared