Subclinical Carotid Atherosclerosis in Patients with Rheumatoid Arthritis at Low Cardiovascular Risk

Abstract

Objective: To evaluate the rate of subclinical carotid atherosclerosis and clinical significance of immunoinflammatory markers in patients with rheumatoid arthritis (RA) at low cardiovascular risk. Materials and Methods: The study included 275 RA patients and a control group of 100 participants without autoimmune diseases. All study participants were at low cardiovascular risk, calculated by the QRISK3 scale (<20%), and free of cardiovascular disease. Ultrasound examination of carotid arteries was performed to measure cIMT and to detect atherosclerotic plaques (ASP) in carotid arteries. sIСАМ-1, sVСАМ, and sCD40L levels were determined by enzyme immunoassay. Results: Carotid ASP was observed more frequently in RA patients (27%) than in the control group (17%), p = 0.03. The frequency of ASP in RA patients did not depend on the disease’s stage or activity. There was a significant correlation between cIMT and age, cardiovascular risk determined by QRISK3, level of total cholesterol, LDL, and blood pressure in RA patients, p < 0.05 in all cases. No correlation between cIMT and blood levels of sCD40L, sVCAM, and sICAM was found. In RA patients, a higher concentration of sVCAM was detected in the carotid ASP group compared to the non-atherosclerotic group. sCD40L was associated with cIMT and total cholesterol in the ASP group and with total cholesterol and blood pressure in non-atherosclerotic patients. Conclusions: Subclinical atherosclerotic lesions of the carotid arteries were observed significantly more frequently in RA patients with low cardiovascular risk than in the control group. The results of the study demonstrate the association between cIMT, traditional cardiovascular risk factors, and immunoinflammatory markers in RA patients.

A systematic review and meta-analysis of circulating adhesion molecules in rheumatoid arthritis

“…Therefore, 39 studies were selected for analysis (Fig. 1 and Table 1 ) [ 72 , 81 – 118 ]. The initial level of certainty was rated as low (rating 2) given the cross-sectional design of all studies.…”

“…Twenty-four studies investigated ICAM-1 in a total of 1857 RA patients (mean age 52 years, 84% females) and 1476 healthy controls (mean age 48 years, 81% females) [ 81 – 86 , 88 , 89 , 91 , 92 , 94 , 97 , 100 , 101 , 103 – 105 , 107 , 109 , 111 , 114 – 116 , 118 ]. Eighteen studies were conducted in Europe [ 82 – 86 , 88 , 89 , 91 , 94 , 100 , 103 , 104 , 109 , 111 , 114 – 116 , 118 ], 4 in America [ 81 , 101 , 105 , 107 ], 1 in Asia [ 92 ], and 1 in Africa [ 97 ]. ICAM-1 was measured using an enzyme-linked immunosorbent assay (ELISA) in all but one study, which did not provide relevant details regarding the analytical method used [ 100 ].…”

“…ICAM-1 was measured using an enzyme-linked immunosorbent assay (ELISA) in all but one study, which did not provide relevant details regarding the analytical method used [ 100 ]. Eighteen studies measured ICAM-1 in serum [ 81 – 86 , 88 , 89 , 91 , 92 , 94 , 105 , 107 , 109 , 111 , 114 , 116 , 118 ], 2 in plasma [ 104 , 115 ], while the remaining 4 did not provide relevant information [ 97 , 101 , 103 , 113 ]. RA duration was reported in 18 studies and ranged between 0.25 and 23 years [ 81 , 82 , 84 , 85 , 88 , 89 , 92 , 94 , 97 , 100 , 101 , 103 , 105 , 109 , 111 , 114 , 115 , 118 ], whereas DAS-28, reported in six studies, ranged between 2.8 and 6.23 [ 103 , 105 , 109 , 114 , 116 , 118 ].…”

“…Eighteen studies measured ICAM-1 in serum [ 81 – 86 , 88 , 89 , 91 , 92 , 94 , 105 , 107 , 109 , 111 , 114 , 116 , 118 ], 2 in plasma [ 104 , 115 ], while the remaining 4 did not provide relevant information [ 97 , 101 , 103 , 113 ]. RA duration was reported in 18 studies and ranged between 0.25 and 23 years [ 81 , 82 , 84 , 85 , 88 , 89 , 92 , 94 , 97 , 100 , 101 , 103 , 105 , 109 , 111 , 114 , 115 , 118 ], whereas DAS-28, reported in six studies, ranged between 2.8 and 6.23 [ 103 , 105 , 109 , 114 , 116 , 118 ]. Eleven studies reported data on methotrexate treatment [ 85 , 86 , 88 , 91 , 92 , 94 , 104 , 111 , 114 , 116 , 118 ], 18 on glucocorticoid treatment [ 81 , 84 , 86 , 88 , 91 , 92 , 94 , 97 ,…”

“…RA duration was reported in 18 studies and ranged between 0.25 and 23 years [ 81 , 82 , 84 , 85 , 88 , 89 , 92 , 94 , 97 , 100 , 101 , 103 , 105 , 109 , 111 , 114 , 115 , 118 ], whereas DAS-28, reported in six studies, ranged between 2.8 and 6.23 [ 103 , 105 , 109 , 114 , 116 , 118 ]. Eleven studies reported data on methotrexate treatment [ 85 , 86 , 88 , 91 , 92 , 94 , 104 , 111 , 114 , 116 , 118 ], 18 on glucocorticoid treatment [ 81 , 84 , 86 , 88 , 91 , 92 , 94 , 97 , 100 , 101 , 103 – 105 , 109 , 114 , 116 , 118 ], and 14 on DMARDs treatment [ 81 , 84 , 86 , 88 , 89 , 91 , 94 , 97 , 100 , 103 , 105 , 109 , 116 , 1...…”