Background Brachial artery reactivity is one of the early surrogate markers of atherosclerosis. The association of impaired endothelium-dependent (EDVD) and endothelium-independent vasodilatation (EIVD) with structural measures of subclinical atherosclerosis in patients with rheumatoid arthritis (RA) is uncertain.
Objectives To assess associations of EDVD and EIVD measures with carotid atherosclerosis in patients with RA free from overt cardiovascular disease.
Methods This study included young and middle-aged patients (age 18-60 years) with RA who did not have symptoms of cardiovascular disease. All patients underwent carotid ultrasound examination. EDVD and nitroglycerin-induced EIVD of the brachial artery were assessed using high-resolution vascular ultrasound. Logistic regression models were used to study associations between carotid atherosclerosis and measures of vascular reactivity adjusting for age and sex.
Results 124 patients with RA (35% with early RA) were enrolled in the study. Mean age was 45.7±9.26 years (14% males); 74% rheumatoid factor (RF) positive, DAS28 6,04±1,1, HAQ-DI 1,6±0,6. Atherosclerotic plaques were found in 38 (30,56%) of RA patients including 7 of 43 (16%) patients with early RA. EDVD in RA patients with atherosclerotic plaques (13.4±11.7%) was similar to that in patients without plaques (14±10.9%, p=0.79). However, RA patients with plaques showed significantly reduced EIVD (25.7±11.9%) than those without plaques (32.4±11.4%, p=0.01). Age (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.05-1.28) and reduced EIVD (OR 0.94, 95% CI 0.89-0.99) but not EDVD (OR 1.01, 95% CI 0.95-1.08) were associated with the presence of carotid atherosclerotic plaques. In fact, RA patients with EIVD less than twenty five percent and those older than fifty years were about 3-times more likely to have carotid atherosclerotic plaques than patients with EIVD over twenty five percent and those below fifty years of age (OR 3.0, 95% CI 1.03-8.8 and OR 2.7, 95% CI 1.01-7.44, respectively). The presence of both factors (EIVD of less than twenty five percent and age over fifty years) further increased the likelihood of having carotid plaques (OR 6.6, 95% CI 2.2-19.9). These associations remained significant after adjusting for RA disease activity, RA disease duration and cardiovascular risk factors.
Conclusions Reduced EIVD and older age are associated with the presence of carotid plaques in RA patients independently of RA duration, disease activity and cardiovascular risk factors, and may be considered as indicators for evaluating atherosclerotic burden in patients with RA who do not have overt cardiovascular disease.
Disclosure of Interest None Declared
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