Non-invasive assessment of arterial stiffness in patients with rheumatoid arthritis: a systematic review and meta-analysis of literature studies.
BACKGROUND
Patients with rheumatoid arthritis (RA) have an increased cardiovascular (CV) morbidity and mortality. Pulse-wave velocity (PWV) and augmentation index (AIx) are non-invasive methods to assess arterial stiffness, a marker of CV risk. We performed a meta-analysis evaluating the impact of RA on aortic-PWV, brachial-PWV, brachial-ankle (ba-) PWV, AIx, and AIx normalized to a 75 beats/minute heart rate (AIx@75).


METHODS
Studies evaluating the relationship between RA and aortic-PWV, brachial-PWV, ba-PWV, AIx, and AIx@75 were systematically searched. A total of 25 studies (1,472 RA patients, 1,583 controls) were included.


RESULTS
Compared to controls, RA patients showed a significantly higher aortic-PWV (mean difference 1.32 m/s; 95% CI 0.77, 1.88; P < 0.00001), ba-PWV (MD 198.42 cm/s; 95% CI 45.79, 342.76; P = 0.01), AIx (MD 11.50%; 95% CI 5.15, 17.86; P = 0.0004), and AIx@75 (MD 6.99%; 95% CI 4.92, 9.06; P < 0.00001), with a trend toward a higher brachial-PWV (MD 0.34 m/s; 95% CI -0.03, 0.70; P = 0.07). When analyzing studies on early RA, the difference in aortic-PWV among RA patients and controls was even higher (MD 2.30 m/s; 95% CI 1.15, 3.45; P < 0.0001).


CONCLUSIONS
Meta-regression showed that a more severe inflammatory status impacted on aortic-PWV, AIx, and AIx@75. Arterial stiffness, a recognized marker of CV risk, is increased in RA patients. This alteration is associated with the severity of the inflammatory status and is present even in early-stage disease.
a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy.
Pasquale
P
Ambrosino
a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy.
Marco
M
Tasso
a Department of Clinical Medicine and Surgery , Federico II University , Naples , Italy.
Roberta
R
Lupoli
b Centro Cardiologico Monzino, IRCCS , Milan , Italy.
Alessandro
A
Di Minno
b Centro Cardiologico Monzino, IRCCS , Milan , Italy.
Damiano
D
Baldassarre
b Centro Cardiologico Monzino, IRCCS , Milan , Italy.
Elena
E
Tremoli
b Centro Cardiologico Monzino, IRCCS , Milan , Italy.
Matteo Nicola Dario
MN
Di Minno
D001172:Arthritis, Rheumatoid / Q000473:pathology* / Q000503:physiopathology; D001916:Brachial Artery / Q000503:physiopathology; D002339:Carotid Arteries / Q000503:physiopathology; D006801:Humans; D063177:Pulse Wave Analysis / Q000379:methods; D012307:Risk Factors; D059289:Vascular Stiffness / Q000502:physiology*
Arterial stiffness; augmentation index; cardiovascular risk; pulse-wave velocity; rheumatoid arthritis