title: Predictors of new atherosclerotic carotid plaque development in patients with rheumatoid arthritis: a longitudinal study.
abstract: BACKGROUND
  Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality attributed to both classical risk factors and chronic inflammation. We assessed longitudinally the factors associated with new carotid plaques in nondiabetic RA patients and apparently healthy individuals.
  
  
  METHODS
  In our present prospective observational study, carotid plaques were identified by ultrasonography at baseline and follow-up end, separated by an average of 3.6 ± 0.2 years, in 64 patients (mean age 59.2 ± 12.0 and disease duration at baseline 7.8 ± 6.2 years, 83% women, clinical and laboratory evaluation every 3 to 6 months). In a substudy, 35 of the patients were matched 1:1 for traditional cardiovascular risk factors with 'healthy' controls and were studied in parallel.
  
  
  RESULTS
  New atherosclerotic plaques formed in 30% of patients (first plaque in 9%) who were significantly older than the remaining patients. Tobacco use, blood pressure, body mass index, average cumulative low-density lipoprotein, high-sensitivity C-reactive protein, erythrocyte sedimentation rate level, RA stage, functional class, disease duration and treatment modalities during follow-up did not differ significantly between subgroups after application of the Bonferroni correction. RA was in clinical remission, on average, for approximately 70% of the follow-up time and was not different between subgroups. Multivariate analysis including all the above parameters revealed that age (P = 0.006), smoking (P = 0.009) and duration of low-dose corticosteroid use (P = 0.016) associated independently with new plaque formation. RA patients displayed similar numbers of newly formed carotid plaques to the tightly matched for traditional cardiovascular risk factors 'healthy' controls, although more patients than controls had carotid plaques at baseline.
  
  
  CONCLUSIONS
  Formation of new atherosclerotic plaques in this small cohort of patients with well-controlled RA depended mainly on traditional cardiovascular risk factors and corticosteroid use, whereas an adverse effect of residual systemic inflammation was not readily detectable.
authors.affiliation: First Department of Propaedeutic and Internal Medicine, Laikon Hospital, Athens University Medical School, Ag Thoma, 17, GR-11527 Athens, Greece.
authors.forename: Evangelia
authors.initials: E
authors.lastname: Zampeli
authors.forename: Athanase
authors.initials: A
authors.lastname: Protogerou
authors.forename: Kimon
authors.initials: K
authors.lastname: Stamatelopoulos
authors.forename: Kalliopi
authors.initials: K
authors.lastname: Fragiadaki
authors.forename: Christina G
authors.initials: CG
authors.lastname: Katsiari
authors.forename: Katerina
authors.initials: K
authors.lastname: Kyrkou
authors.forename: Christos M
authors.initials: CM
authors.lastname: Papamichael
authors.forename: Myron
authors.initials: M
authors.lastname: Mavrikakis
authors.forename: Peter
authors.initials: P
authors.lastname: Nightingale
authors.forename: George D
authors.initials: GD
authors.lastname: Kitas
authors.forename: Petros P
authors.initials: PP
authors.lastname: Sfikakis
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000473:pathology*; D002340:Carotid Artery Diseases / Q000453:epidemiology / Q000473:pathology; D017536:Carotid Artery, Common / Q000473:pathology*; D002343:Carotid Artery, Internal / Q000473:pathology*; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000453:epidemiology* / Q000473:pathology*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012307:Risk Factors