Cardiovascular
Carotid Intima-Media Thickness Predicts the Development of Cardiovascular Events in Patients with Rheumatoid Arthritis

https://doi.org/10.1016/j.semarthrit.2008.01.012Get rights and content

Objective

To establish whether carotid intima-media wall thickness (IMT) may be a good predictor for the development of cardiovascular (CV) events in patients with rheumatoid arthritis (RA).

Methods

A series of 47 RA patients who at the time of recruitment did not have traditional CV risk factors or CV disease were assessed by carotid ultrasonography. Carotid IMT and carotid plaques were measured in the right common carotid artery. Then, a prospective assessment of the CV outcome was performed over a 5-year period. Logistic regression models and receiver operating characteristic curves were performed to evaluate the ability of different variables to predict CV events.

Results

Carotid IMT was greater in RA patients who over the extended follow-up experienced CV events (1.01 ± 0.16 mm) compared with the remaining RA patients who did not have CV complications (0.74 ± 0.12 mm) (P < 0.001). Also, carotid IMT categorized in quartiles was strongly associated with CV events. In this regard, none of the patients with carotid IMT less than 0.77 mm had CV events. However, 6 of the 10 patients with carotid IMT greater than 0.91 mm experienced CV events (P value for the trend <0.001). Carotid IMT yielded a high predictive power for the development of CV events over the 5-year follow-up period. The area under the receiver operating characteristic curve was 0.93 for a model that only included carotid IMT and 0.90 for carotid plaque.

Conclusions

The results from the present study support the use of carotid ultrasonography as a predictor of CV events in RA.

Section snippets

Patients

The cohort assessed in this study constituted a series of RA patients attending hospital outpatient clinics and seen at Hospital Xeral-Calde, Lugo, Northwest Spain in May 2001. Clinical information about these patients has been reported elsewhere (14, 15). RA patients seen during the period of recruitment who had hypertension (systolic blood pressure >150 mm Hg and/or diastolic blood pressure >90 mm Hg), diabetes mellitus (fasting overnight venous plasma glucose concentration >110 mg/dL),

Results

Eight (17%) of the 47 patients experienced CV events over the 5-year follow-up period of study. Four (9%) of them had ischemic heart disease, 3 (6%) cerebrovascular accidents, and 1 (2%) peripheral arteriopathy. At the end of the study 3 (6%) patients had died because of CV events.

The main clinical and ultrasonographic differences between RA patients who experienced CV events and those who did not have these complications are shown in Table 1. As expected, patients who had CV events were older.

Discussion

The results from the present study show that carotid artery IMT has a high predictive power for the development of CV events over a 5-years follow-up period in patients with RA. The presence of subclinical atherosclerosis, manifested by increased values of carotid IMT in the this series of patients without clinically evident CV disease at the time of the carotid ultrasonographic study, is consistent with the high rate of silent ischemic heart disease and sudden cardiac death observed in RA

Acknowledgment

This study was supported by a grant from Fondo de Investigaciones Sanitarias PI06-0024 (Spain).

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