Rheumatoid Arthritis Is Associated With Increased Aortic Pulse-Wave Velocity, Which Is Reduced by Anti–Tumor Necrosis Factor-α Therapy

Abstract

Background— Rheumatoid arthritis (RA) is associated with increased cardiovascular risk, which is not explained by traditional cardiovascular risk factors but may be due in part to increased aortic stiffness, an independent predictor of cardiovascular mortality. In the present study, our aim was to establish whether aortic stiffness is increased in RA and to investigate the relationship between inflammation and aortic stiffness. In addition, we tested the hypothesis that aortic stiffness could be reduced with anti–tumor necrosis factor-α (TNF-α) therapy. Methods and Results— Aortic pulse-wave velocity (PWV), augmentation index, and blood pressure were measured in 77 patients with RA and in 142 healthy individuals. Both acute and chronic inflammatory measures and disease activity were determined. The effect of anti-TNF-α therapy on PWV and endothelial function was measured in 9 RA patients at 0, 4, and 12 weeks. Median (interquartile range) aortic PWV was significantly higher in subjects with RA than in control subjects (8.35 [7.14 to 10.24] versus 7.52 [6.56 to 9.18] m/s, respectively; P =0.005). In multiple regression analyses, aortic PWV correlated independently with age, mean arterial pressure, and log-transformed C-reactive protein ( R 2 =0.701; P <0.0001). Aortic PWV was reduced significantly by anti-TNF-α therapy (8.82±2.04 versus 7.94±1.86 versus 7.68±1.56 m/s at weeks 0, 4, and 12, respectively; P <0.001); concomitantly, endothelial function improved. Conclusions— RA is associated with increased aortic stiffness, which correlates with current but not historical measures of inflammation, suggesting that increased aortic stiffness may be reversible. Indeed, anti-TNF-α therapy reduced aortic stiffness to a level comparable to that of healthy individuals. Therefore, effective control of inflammation may be of benefit in reducing cardiovascular risk in patients with RA.

Changes in vascular function and structure in juvenile idiopathic arthritis

“…These findings probably reflect differences in methods used to assess aortic PWV in various studies. Increased PWV, a marker of adverse cardiovascular prognosis in various adult populations (5), has been demonstrated in adult CID patients (11,32) and children at high cardiovascular risk (7,33). LAEI and SAEI are relatively novel markers of arterial compliance that have been associated with cardiovascular risk factors (34,35) and CID in adults (36), but their value in cardiovascular prognosis is not known.…”

The influence of mean blood pressure on arterial stiffening and endothelial dysfunction in women with rheumatoid arthritis and systemic lupus erythematosus

“…Noninvasive detection of endothelial dysfunction, increased arterial stiffness, the important assessment in the diagnosis of early atherosclerosis, recently have been described widely in patients with RA and SLE (3)(4)(5)(6)(7)(8)(9)(10)(11). Nevertheless, data about damage of arterial function in inflammatory rheumatic diseases are not consistent, and their prognostic value is not well established.…”

Arterial stiffness in a muscular artery in women with longstanding rheumatoid arthritis compared with healthy controls and patients with traditional cardiovascular risk factors

“…Using diVerent methods, higher arterial stiVness could be found in RA patients as compared to controls in previous studies [20,21]. However, little is known of arterial stiVness in a predominately muscular segment of the arterial tree.…”

“…Patients with traditional cardiovascular risk factors (e.g., hypertension, smokers) were allowed to participate in the study. Mäki-Petäjä et al [21] analyzed PWV of the aorta and the upper limb in 77 RA patients (mean age 57 years) and found an increased PWV for both sites as compared with controls. Patients with treated hypertension were included in the study.…”