Cardiovascular risk assessment in patients with rheumatoid arthritis: a correlative study of noninvasive arterial health testing

Abstract

Objectives This study aimed to determine the relationship between noninvasive measures of arterial health and both estimated 10-year cardiovascular risk and measures of disease activity over time in established rheumatoid arthritis. Methods Fifty rheumatoid arthritis patients underwent noninvasive arterial health testing (brachial artery reactivity, aortic augmentation index pulse wave velocity [AIx], carotid artery intima-media thickness, and carotid artery plaque presence) and assessment of clinical disease activity (tender or swollen joint counts, Clinical Disease Activity Index [CDAI], and Health Assessment Questionnaire II [HAQ-II]). Clinical measures during 3 years before the study visit were averaged. Arterial health testing was compared with American Heart Association/American College of Cardiology (AHA/ACC) Pooled Cohort Equation. Spearman methods identified correlations between disease activity measures, cardiac biomarkers, and arterial health parameters. Results Among the patients (mean age, 57.5 years), disease activity was moderate (mean [SD] CDAI, 16.9 [15.3]). At the study visit, corrected aortic augmentation index correlated with CDAI (r=0.37, P=.009) and HAQ-II (r=0.33, P=.02). AIx correlated with time-averaged tender joint count (r=0.37, P=.008), CDAI (r=0.36, P=.01), HAQ-II (r=0.36, P=.01), swollen joint count (r=0.36, P=.10), patient global assessment (r=0.33, P=.02), physician global assessment (r=0.35, P=.01), and pain score (r=0.38, P=.007). AHA/ACC low-risk group (<5% 10-year risk) had highest prevalence of carotid plaques. Conclusions Arterial health testing may identify increased risk of cardiovascular disease compared with risk obtained through AHA/ACC Pooled Cohort Equation. Measures of arterial stiffness correlate with the burden of disease activity over time.

The relationship between epicardial adipose tissue and arterial stiffness in patients with rheumatoid arthritis

“…Temiz et al provided further evidence that EAT correlated with cIMT and FMD in RA patients and suggested that EAT could serve as a surrogate marker for estimating the extent of vascular involvement [36]. However, AS may represent a more accurate marker of disease burden over time than FMD, as recent evidence indicated [47].…”

Characteristics and clinical associations of arterial stiffness and subclinical atherosclerosis in patients with rheumatoid arthritis

“…Вывод о взаимосвязи воспалительной активности при РА (DAS-28 с параметрами артериальной ригидности (СРПВ, ИА) получен и в работе Scanlon E. с соавт. [31]. Связь снижения эластических своиств сосудов (оценка на основании СРПВ) у больных РА с выраженностью и неконтролируемой активностью воспаления, а также с повышением АД продемонстрирована и в ряде отечественных работ [32,33].…”

Practical Management of Cardiovascular Comorbidities in Rheumatoid Arthritis

“…Many imaging tools such as coronary artery calcification by multi-slice computed tomography [39], intima–media thickness by carotid ultrasound [40], arterial stiffness with aortic pulse wave velocity or arterial augmentation index, ankle–brachial index [41–43], and echocardiography [44], have been proposed to measure subclinical vascular damage in RA. Among these, only carotid ultrasound has been included in EULAR recommendations for clinical practice, based on the evidence that carotid plaques in RA are associated with disease duration, disease activity, and ischemic heart disease with poor CVD-free survival [45–47].…”