title: Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis and Low Cardiovascular Risk: The Role of von Willebrand Factor Activity.
abstract: BACKGROUND
  To evaluate association between von Willebrand factor (vWF) activity, inflammation markers, disease activity, and subclinical atherosclerosis in patients with rheumatoid arthritis (RA) and low cardiovascular risk.
  
  
  METHODS
  Above mentioned parameters were determined in blood samples of 74 non-diabetic, normotensive, female subjects, with no dyslipidemia(42 patients, 32 matched healthy controls, age 45.3±10.0 vs. 45.2±9.8 years). Intima-media thickness (IMT) was measured bilaterally, at common carotid, bifurcation, and internal carotid arteries. Subclinical atherosclerosis was defined as IMT>IMTmean+2SD in controlsat each carotid level and atherosclerotic plaque as IMT>1.5 mm. Majority of RA patients were on methotrexate (83.3%), none on steroids >10 mg/day or biologic drugs. All findings were analysed in the entire study population and in RA group separately.
  
  
  RESULTS
  RA patients with subclinical atherosclerosis had higher vWF activity than those without (133.5±69.3% vs. 95.3±36.8%, p<0.05). Predictive value of vWF activity for subclinical atherosclerosis was confirmed by logistic regression. vWF activity correlated significantly with erythrocyte sedimentation rate, fibrinogen, modified disease activity scores (mDAS28-ESR, mDAS28-CRP), modified Health Assessment Questionnaire (p<0.01 for all), duration of smoking, number of cigarettes/day, rheumatoid factor concentration (p<0.05 for all), and anti-CCP antibodies (p<0.01). In the entire study population, vWF activity was higher in participants with subclinical atherosclerosis (130±68% vs. 97±38%, p<0.05) or atherosclerotic plaques (123±57% vs. 99±45%, p<0.05) than in those without. Duration of smoking was significantly associated with vWF activity (β 0.026, p = 0.039).
  
  
  CONCLUSIONS
  We demonstrated association of vWF activity and subclinical atherosclerosis in low-risk RA patients as well as its correlation with inflammation markers, all parameters of disease activity, and seropositivity. Therefore, vWF might be a valuable marker of early atherosclerosis in RA patients.
authors.affiliation: Department of Rheumatology and Clinical Immunology, Military Medical Academy and Medical Faculty of the Belgrade Defence University, Belgrade, Serbia.
authors.forename: Gorica G
authors.initials: GG
authors.lastname: Ristić
authors.affiliation: Institute of Medical Biochemistry, Military Medical Academy, Belgrade, Serbia.
authors.forename: Vesna
authors.initials: V
authors.lastname: Subota
authors.affiliation: Department of Neurology, Military Medical Academy and Medical Faculty of the Belgrade Defence University, Belgrade, Serbia.
authors.forename: Toplica
authors.initials: T
authors.lastname: Lepić
authors.affiliation: Institute of Medical Statistics, Belgrade University School of Medicine, Belgrade, Serbia.
authors.forename: Dejana
authors.initials: D
authors.lastname: Stanisavljević
authors.affiliation: Department of Rheumatology and Clinical Immunology, Military Medical Academy and Medical Faculty of the Belgrade Defence University, Belgrade, Serbia.
authors.forename: Branislava
authors.initials: B
authors.lastname: Glišić
authors.affiliation: Department of Cardiology, Clinical Centre of Serbia and Belgrade University School of Medicine, Belgrade, Serbia.
authors.forename: Arsen D
authors.initials: AD
authors.lastname: Ristić
authors.affiliation: Department of Rheumatology and Clinical Immunology, Military Medical Academy and Medical Faculty of the Belgrade Defence University, Belgrade, Serbia.
authors.forename: Milan
authors.initials: M
authors.lastname: Petronijević
authors.affiliation: Department of Rheumatology and Clinical Immunology, Military Medical Academy and Medical Faculty of the Belgrade Defence University, Belgrade, Serbia.
authors.forename: Dušan Z
authors.initials: DZ
authors.lastname: Stefanović
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D050197:Atherosclerosis / Q000097:blood / Q000150:complications* / Q000175:diagnosis / Q000276:immunology; D002318:Cardiovascular Diseases / Q000209:etiology; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D012307:Risk Factors; D014841:von Willebrand Factor / Q000032:analysis / Q000276:immunology*
chemical_list: D018501:Antirheumatic Agents; D014841:von Willebrand Factor; D008727:Methotrexate