Preclinical carotid atherosclerosis in patients with rheumatoid arthritis.
BACKGROUND
Rheumatoid arthritis is associated with increased morbidity and mortality because of cardiovascular disease, independent of traditional risk factors.


OBJECTIVE
To determine the prevalence of preclinical atherosclerosis in patients with rheumatoid arthritis and to identify clinical and biological markers for atherosclerotic disease in this patient population.


METHODS
Matched, cross-sectional study.


METHODS
Hospital for Special Surgery in New York City.


METHODS
98 consecutive outpatients with rheumatoid arthritis who were followed by rheumatologists and 98 controls matched on age, sex, and ethnicity.


METHODS
Cardiovascular risk factor ascertainment and carotid ultrasonography in all participants; disease severity, disease treatment, and inflammatory markers in patients with rheumatoid arthritis.


RESULTS
Despite a more favorable risk factor profile, patients with rheumatoid arthritis had a 3-fold increase in carotid atherosclerotic plaque (44% vs. 15%; P < 0.001). The relationship between rheumatoid arthritis and carotid atherosclerotic plaque remained after accounting for age, serum cholesterol levels, smoking history, and hypertensive status; adjusted predicted prevalence was 7.4% (95% CI, 3.4% to 15.2%) for the control group and 38.5% (CI, 25.4% to 53.5%) for patients with rheumatoid arthritis. Age (P < 0.001) and current cigarette use (P < 0.014) were also significantly associated with carotid atherosclerotic plaque. Among patients with rheumatoid arthritis, atherosclerosis was related to age, hypertension status, and use of tumor necrosis factor-alpha inhibitors (a possible marker of disease severity).


CONCLUSIONS
The study had a cross-sectional design, and inflammatory markers were determined only once.


CONCLUSIONS
Patients with rheumatoid arthritis have a high prevalence of preclinical atherosclerosis independent of traditional risk factors, suggesting that chronic inflammation and, possibly, disease severity are atherogenic in this population.
Division of Cardiology, Weill Medical College of Cornell University, Hospital for Special Surgery, and The Rogosin Institute, New York, New York 10021, USA. mroman@med.cornell.edu
Mary J
MJ
Roman
Elfi
E
Moeller
Adrienne
A
Davis
Stephen A
SA
Paget
Mary K
MK
Crow
Michael D
MD
Lockshin
Lisa
L
Sammaritano
Richard B
RB
Devereux
Joseph E
JE
Schwartz
Daniel M
DM
Levine
Jane E
JE
Salmon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001172:Arthritis, Rheumatoid / Q000150:complications*; D050197:Atherosclerosis / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015415:Biomarkers / Q000097:blood; D002340:Carotid Artery Diseases / Q000097:blood / Q000000981:diagnostic imaging / Q000453:epidemiology*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012307:Risk Factors; D014463:Ultrasonography
D015415:Biomarkers