title: Remission is the goal for cardiovascular risk management in patients with rheumatoid arthritis: a cross-sectional comparative study.
abstract: OBJECTIVE
  To compare markers of cardiovascular disease (CVD) risk between patients with rheumatoid arthritis (RA) in an active disease state and those with RA in remission, and to compare both groups with community controls.
  
  
  METHODS
  113 patients with RA and 86 community controls were assessed across a panel of biomarkers for CVD. RA in remission was defined as Clinical Disease Activity Index ≤2.8. Community controls were selected at random by Statistics Norway, and controls were matched with patients in the cohorts in strata using details of age, sex and residential area. A panel of biomarkers (N-terminal pro-brain natriuretic peptide (NT-proBNP), total cholesterol, reactive hyperaemia index (RHI), pressure measurements, measures of arterial stiffness and intima-media thickness) were compared between patients with active RA and those with RA in remission. Both groups were compared with controls. In addition, biomarker levels were compared across subgroups based on anticyclic citrullinated peptide status, level of joint destruction and presence of extra-articular manifestations.
  
  
  RESULTS
  Patients with active RA had significantly higher levels of NT-proBNP, brachial systolic pressure, augmentation index and central systolic pressure but lower cholesterol than patients in remission and controls. In addition, patients with active RA had significantly higher levels of pulse wave velocity and worse RHI than patients in remission. Comparison across other subgroups gave less consistent differentiations in levels of CVD risk markers.
  
  
  CONCLUSIONS
  Patients with active RA, but not those in remission, had significantly increased levels of CVD risk markers. These results link inflammatory activity to markers of CVD risk in patients with RA and may indirectly support the notion that remission in RA confers diminished cardiovascular morbidity.
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, PB.23 Vindern, N-0319 Oslo, Norway.sellaprovan@mail.com
authors.forename: Sella A
authors.initials: SA
authors.lastname: Provan
authors.forename: Anne Grete
authors.initials: AG
authors.lastname: Semb
authors.forename: Jonny
authors.initials: J
authors.lastname: Hisdal
authors.forename: Einar
authors.initials: E
authors.lastname: Stranden
authors.forename: Stefan
authors.initials: S
authors.lastname: Agewall
authors.forename: Hanne
authors.initials: H
authors.lastname: Dagfinrud
authors.forename: Kristin
authors.initials: K
authors.lastname: Angel
authors.forename: Dan
authors.initials: D
authors.lastname: Atar
authors.forename: Tore K
authors.initials: TK
authors.lastname: Kvien
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D001323:Autoantibodies / Q000097:blood; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000517:prevention & control; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010456:Peptides, Cyclic / Q000276:immunology; D012074:Remission Induction; D012308:Risk Management / Q000379:methods
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D015415:Biomarkers; D010456:Peptides, Cyclic; C487763:cyclic citrullinated peptide