Background The association of chronic inflammatory rheumatic disorders with an increased risk of vascular disease, especially cardiovascular and cerebrovascular disease, is a consolidated matter, but data on polymyalgia rheumatica (PMR) are still inconsistent.
Objectives The aim of our cross-sectional study was to investigate the presence of vascular damage in patients with PMR by analyzing subclinical vascular disease through validated, non-invasive cardiovascular disease markers.
Methods We enrolled patients with PMR diagnosed according to the EULAR classification criteria and, as controls, patients with major cardiovascular risk factors (MCVRF) including hypertension, diabetes, hypercholesterolemia, cigarette smoking, and obesity. In all of them we performed color Doppler ultrasound to evaluate the common carotid intima-media thickness (IMT), the prevalence of carotid artery stenosis and of anterior-posterior abdominal aortic diameter (APAD); we also assessed the cardio-ankle vascular index (CAVI) to measure arterial stiffness and contextually the ankle-brachial index (ABI) to investigate the presence of lower-extremity peripheral arterial disease.
Results Forty-eight patients with PMR and 56 with MCVRF were included. Demographic parameters were balanced between groups. A significant increase of IMT (1.03±0.23 vs 0.89±0.20; p=0.02), CAVI (8.59±1.23 vs 7.59±0.93; p=0.01) and APAD values (22.03±4.86 vs 19.14±4.65; p=0.03) was found in PMR patients with respect to MCVRF controls. No differences were reported with regards to the prevalence of carotid artery stenosis or ABI values between the two groups. No significant correlation between disease duration or duration of glucocorticoid treatment and IMT or CAVI values was found in PMR patients. Results of bivariate analysis showed a significant correlation between IMT and CAVI in both PMR and MCVRF patients (r2=0.845 and 0.556, respectively; p<0.001).
Conclusions Our study adds new information on cardiovascular risk in PMR patients, showing an increase in subclinical cardiovascular lesions and paving the way for further studies to define the utility and modality of cardiovascular screening for primary prevention in these patients.
Hancock AT et al. Risk of vascular events in patients with polymyalgia rheumatica. CMAJ 2014; 186: E495–501.
Shirai K et al. A novel blood pressure–independent arterial wall stiffness parameter; cardio-ankle vascular index (CAVI). J Atheroscler Thromb 2006; 13101–7.
Masugata H et al. Cardio-ankle vascular index for evaluating immunosuppressive therapy in a patient with aortitis syndrome. Tohoku J Exp Med 2010; 222:77–81.
Disclosure of Interest None declared
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