title: The Extent of Subclinical Atherosclerosis Is Partially Predicted by the Inflammatory Load: A Prospective Study over 5 Years in Patients with Rheumatoid Arthritis and Matched Controls.
abstract: OBJECTIVE
  This prospective followup study investigated subclinical atherosclerosis in relation to traditional cardiovascular disease (CVD) risk factors and inflammation in patients with rheumatoid arthritis (RA) recruited at diagnosis compared with controls.
  
  
  METHODS
  Patients diagnosed with early RA were consecutively recruited into a prospective study. From these, a subgroup aged ≤ 60 years (n = 71) was consecutively included for ultrasound measurement of intima-media thickness (IMT) and flow-mediated dilation (FMD) at inclusion (T0) and after 5 years (T5). Age- and sex-matched controls (n = 40) were also included.
  
  
  RESULTS
  In the Wilcoxon signed-rank test, both IMT and FMD were significantly aggravated at T5 compared to baseline in patients with RA, whereas only IMT was significantly increased in controls. In univariate linear regression analyses among patients with RA, the IMT at T5 was significantly associated with age, systolic blood pressure (BP), cholesterol, triglycerides, Systematic Coronary Risk Evaluation (SCORE), and Reynolds Risk Score at baseline (p < 0.05). Similarly, FMD at T5 was significantly inversely associated with age, smoking, systolic BP, SCORE, and Reynolds Risk Score (p < 0.05). A model with standardized predictive value from multiple linear regression models including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of IMT after 5 years. When also including the area under the curve for the 28-joint Disease Activity Score over 5 years, the observed value of IMT was predicted to a large extent.
  
  
  CONCLUSIONS
  This prospective study identified an increased subclinical atherosclerosis in patients with RA. In the patients with RA, several traditional CVD risk factors at baseline significantly predicted the extent of subclinical atherosclerosis 5 years later. The inflammatory load over time augmented this prediction.
authors: From the Department of Public Health and Clinical Medicine/Rheumatology, and the Department of Surgical and Perioperative Sciences, University of Umeå, Umeå; Department of Rheumatology, Östersund Hospital, Östersund; and Department of Rheumatology, Sunderby Hospital, Luleå, Sweden.A. Södergren, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; K. Karp, MD, PhD, Department of Surgical and Perioperative Sciences, University of Umeå; C. Bengtsson, MD, Department of Public Health and Clinical Medicine, University of Umeå, and Department of Rheumatology, Östersund Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; S. Rantapää-Dahlqvist, MD, PhD; S. Wållberg-Jonsson, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå. anna.sodergren@umu.se.
authors: Anna
authors: A
authors: Södergren
authors: From the Department of Public Health and Clinical Medicine/Rheumatology, and the Department of Surgical and Perioperative Sciences, University of Umeå, Umeå; Department of Rheumatology, Östersund Hospital, Östersund; and Department of Rheumatology, Sunderby Hospital, Luleå, Sweden.A. Södergren, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; K. Karp, MD, PhD, Department of Surgical and Perioperative Sciences, University of Umeå; C. Bengtsson, MD, Department of Public Health and Clinical Medicine, University of Umeå, and Department of Rheumatology, Östersund Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; S. Rantapää-Dahlqvist, MD, PhD; S. Wållberg-Jonsson, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå.
authors: Kjell
authors: K
authors: Karp
authors: From the Department of Public Health and Clinical Medicine/Rheumatology, and the Department of Surgical and Perioperative Sciences, University of Umeå, Umeå; Department of Rheumatology, Östersund Hospital, Östersund; and Department of Rheumatology, Sunderby Hospital, Luleå, Sweden.A. Södergren, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; K. Karp, MD, PhD, Department of Surgical and Perioperative Sciences, University of Umeå; C. Bengtsson, MD, Department of Public Health and Clinical Medicine, University of Umeå, and Department of Rheumatology, Östersund Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; S. Rantapää-Dahlqvist, MD, PhD; S. Wållberg-Jonsson, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå.
authors: Christine
authors: C
authors: Bengtsson
authors: From the Department of Public Health and Clinical Medicine/Rheumatology, and the Department of Surgical and Perioperative Sciences, University of Umeå, Umeå; Department of Rheumatology, Östersund Hospital, Östersund; and Department of Rheumatology, Sunderby Hospital, Luleå, Sweden.A. Södergren, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; K. Karp, MD, PhD, Department of Surgical and Perioperative Sciences, University of Umeå; C. Bengtsson, MD, Department of Public Health and Clinical Medicine, University of Umeå, and Department of Rheumatology, Östersund Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; S. Rantapää-Dahlqvist, MD, PhD; S. Wållberg-Jonsson, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå.
authors: Bozena
authors: B
authors: Möller
authors: From the Department of Public Health and Clinical Medicine/Rheumatology, and the Department of Surgical and Perioperative Sciences, University of Umeå, Umeå; Department of Rheumatology, Östersund Hospital, Östersund; and Department of Rheumatology, Sunderby Hospital, Luleå, Sweden.A. Södergren, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; K. Karp, MD, PhD, Department of Surgical and Perioperative Sciences, University of Umeå; C. Bengtsson, MD, Department of Public Health and Clinical Medicine, University of Umeå, and Department of Rheumatology, Östersund Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; S. Rantapää-Dahlqvist, MD, PhD; S. Wållberg-Jonsson, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå.
authors: Solbritt
authors: S
authors: Rantapää-Dahlqvist
authors: From the Department of Public Health and Clinical Medicine/Rheumatology, and the Department of Surgical and Perioperative Sciences, University of Umeå, Umeå; Department of Rheumatology, Östersund Hospital, Östersund; and Department of Rheumatology, Sunderby Hospital, Luleå, Sweden.A. Södergren, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; K. Karp, MD, PhD, Department of Surgical and Perioperative Sciences, University of Umeå; C. Bengtsson, MD, Department of Public Health and Clinical Medicine, University of Umeå, and Department of Rheumatology, Östersund Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; S. Rantapää-Dahlqvist, MD, PhD; S. Wållberg-Jonsson, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå.
authors: Solveig
authors: S
authors: Wållberg-Jonsson
mesh_terms: D000328:Adult; D019540:Area Under Curve; D001172:Arthritis, Rheumatoid / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D050197:Atherosclerosis / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D002340:Carotid Artery Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D059168:Carotid Intima-Media Thickness; D016022:Case-Control Studies; D018450:Disease Progression; D005260:Female; D006801:Humans; D018836:Inflammation Mediators / Q000378:metabolism; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013548:Sweden
chemical_list: D018836:Inflammation Mediators; D002097:C-Reactive Protein
keywords: ATHEROSCLEROSIS; CARDIOVASCULAR DISEASE; INFLAMMATION; PROSPECTIVE; RHEUMATOID ARTHRITIS