Carotid intima media thickness in rheumatoid arthritis as compared to control subjects: a meta-analysis.
OBJECTIVE
Rheumatoid arthritis (RA) is associated with increased risk of cardiovascular disease. Carotid intima media thickness (cIMT) is frequently used to identify populations at elevated cardiovascular risk. A systematic literature search and meta-analysis were performed to evaluate cIMT difference between RA and controls.


METHODS
The literature was screened to identify all available studies comparing cIMT in RA patients and controls. Random effects meta-analysis was performed to estimate the overall mean cIMT difference between both groups. Meta-regression was performed to assess the influence of age and the degree of comparability regarding established cardiovascular risk factors on cIMT difference. Potential publication bias was examined by a funnel plot and Egger test.


RESULTS
From 22 studies, cIMT data were available from 1384 RA patients and 1147 controls. In 17 of the studies, RA patients had a statistically significantly greater cIMT. The overall mean cIMT difference was 0.09 mm (95%CI: 0.07-0.11 mm). Heterogeneity was observed (I(2) 72.5%, P < 0.001). A likely source of heterogeneity was the difference in cardiovascular risk factors between RA patients and controls at baseline, but not age. The funnel plot did not show a skewed or asymmetrical shape, which was supported by the Egger's test (P = 0.87).


CONCLUSIONS
Our observations support the current evidence base for an increased cardiovascular burden in RA and support the use of cIMT in observational studies in RA patients. The next step is to determine its utility as a surrogate cardiovascular risk marker in RA in prospective studies.
van Sijl
Alper M
AM
Department of Rheumatology, VU University Medical Center, Amsterdam, the Netherlands.
Peters
Mike J
MJ
Knol
Dirk K
DK
de Vet
Henrica C
HC
Gonzalez-Gay
Miguel A
MA
Smulders
Yvo M
YM
Dijkmans
Ben A
BA
Nurmohamed
Michael T
MT
D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging*; D002318:Cardiovascular Diseases / Q000453:epidemiology; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D016022:Case-Control Studies; D006801:Humans; D012307:Risk Factors; D017539:Tunica Intima / Q000000981:diagnostic imaging*; D017540:Tunica Media / Q000000981:diagnostic imaging*; D014463:Ultrasonography