title: Carotid artery plaque in women with rheumatoid arthritis and low estimated cardiovascular disease risk: a cross-sectional study.
abstract: BACKGROUND
  We previously reported that most patients with rheumatoid arthritis (RA) and moderate cardiovascular disease (CVD) risk according to the Systematic COronary Evaluation score (SCORE) experience carotid artery plaque. In this study, we aimed to identify patient characteristics that can potentially predict carotid plaque presence in women with RA and a concurrent low CVD risk according to the SCORE.
  
  
  METHODS
  A cohort of 144 women with an evaluated low risk of CVD (SCORE value of zero) was assembled amongst 550 consecutive patients with RA that underwent CVD risk factor recording and carotid artery ultrasound. Participants had no established CVD, moderate or severe chronic kidney disease, or diabetes. We assessed carotid plaque(s) presence and its associated patient characteristics.
  
  
  RESULTS
  Carotid artery plaque was present in 35 (24.3%) of women with RA. Age, the number of synthetic disease-modifying agents (DMARDs) and total cholesterol concentrations were independently associated with plaque in multivariable stepwise backward regression analysis (odds ratio (95% confidence interval)=1.15 (1.07 to 1.24), P<0.0001, 1.51 (1.05 to 2.17), P=0.03 and 1.66 (1.00 to 2.73) P=0.04), respectively). The area under the curve (AUC) of the receiver operating curve (ROC) for the association with plaque was 0.807 (P<0.0001), 0.679 (P=0.001) and 0.599 (P=0.08) for age, total cholesterol concentrations and number of synthetic DMARDs used, respectively. The optimal cutoff value in predicting plaque presence for age was 49.5 years with a sensitivity and specificity of 74% and 75%, respectively, and for total cholesterol concentration, it was 5.4 mmol/l with a sensitivity and specificity of 63% and 70%, respectively. The plaque prevalence was 37.5% in patients (n=80; 55.6%) with age>49.5 years or/and total cholesterol concentration of >5.4 mmol/l, respectively, compared to only 7.8% in those (n=64; 44.4%) with age≤49.5 years or/and total cholesterol concentration of ≤5.4 mmol/l, respectively.
  
  
  CONCLUSIONS
  Approximately one-third of women with RA who experience a low SCORE value and are aged >49.5 years or/and have a total cholesterol concentration of >5.4 mmol/l, experience high-risk atherosclerosis, which requires intensive CVD risk management.
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain. afcorralesm@hotmail.com.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Corrales
authors.affiliation: Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. dessein@telkomsa.net.|School of Physiology, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. dessein@telkomsa.net.
authors.forename: Patrick H
authors.initials: PH
authors.lastname: Dessein
authors.affiliation: Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. lindadessein1@telkomsa.net.
authors.forename: Linda
authors.initials: L
authors.lastname: Tsang
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain. alicantrino@hotmail.com.
authors.forename: Trinitario
authors.initials: T
authors.lastname: Pina
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain. rblanco@humv.es.
authors.forename: Ricardo
authors.initials: R
authors.lastname: Blanco
authors.affiliation: Cardiology Division, Hospital Lucus Augusti, Calle Dr. Ulises Romero 1, 27003, Lugo, Spain. carlos.gonzalez.juanatey@sergas.es.
authors.forename: Carlos
authors.initials: C
authors.lastname: Gonzalez-Juanatey
authors.affiliation: Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Avenida Cardenal Herrera Oria s/n, 39011, Santander, Spain. llorcaj@unican.es.
authors.forename: Javier
authors.initials: J
authors.lastname: Llorca
authors.affiliation: Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, IDIVAL, Avenida Cardenal Herrera Oria s/n, Santander, 39011, Spain. miguelaggay@hotmail.com.|Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown 2193, Johannesburg, South Africa. miguelaggay@hotmail.com.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gonzalez-Gay
mesh_terms: D000328:Adult; D001172:Arthritis, Rheumatoid / Q000150:complications*; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D016893:Carotid Stenosis / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D005260:Female; D006801:Humans; D015994:Incidence; D016017:Odds Ratio; D058226:Plaque, Atherosclerotic / Q000150:complications / Q000453:epidemiology* / Q000503:physiopathology; D015995:Prevalence; D012039:Regional Blood Flow / Q000502:physiology*; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology