Predictive Value of Arterial Stiffness and Subclinical Carotid Atherosclerosis for Cardiovascular Disease in Patients with Rheumatoid Arthritis.
We evaluated the predictive value of these vascular biomarkers for cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA): aortic pulse wave velocity (aPWV), augmentation index (AIx), carotid intima-media thickness (cIMT), and carotid plaques (CP). They are often used as risk markers for CVD.



In 2007, 138 patients with RA underwent clinical examination, laboratory tests, blood pressure testing, and vascular biomarker measurements. Occurrence of CVD events was recorded in 2013. Predictive values were assessed in Kaplan-Meier plots, log-rank, and crude and adjusted Cox proportional hazard (PH) regression analyses.



Baseline median age and disease duration was 59.0 years and 17.0 years, respectively, and 76.1% were women. CVD events occurred in 10 patients (7.2%) during a mean followup of 5.4 years. Compared with patients with low aPWV, AIx, cIMT, and without CP, patients with high aPWV (p < 0.001), high AIx (p = 0.04), high cIMT (p = 0.01), and CP (p < 0.005) at baseline experienced more CVD events. In crude Cox PH regression analyses, aPWV (p < 0.001), cIMT (p < 0.001), age (p = 0.01), statin (p = 0.01), and corticosteroid use (p = 0.01) were predictive of CVD events, while AIx was nonsignificant (p = 0.19). The Cox PH regression estimates for vascular biomarkers were not significantly altered when adjusting individually for demographic variables, traditional CVD risk factors, RA disease-related variables, or medication. All patients who developed CVD had CP at baseline.



CP, aPWV, and cIMT were predictive of CVD events in this cohort of patients with RA. Future studies are warranted to examine the additive value of arterial stiffness and carotid atherosclerosis markers in CVD risk algorithms. Regional Ethical Committee approval numbers 2009/1582 and 2009/1583.
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital. eirik.ikdahl@medisin.uio.no.
Eirik
E
Ikdahl
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Silvia
S
Rollefstad
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Grunde
G
Wibetoe
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Inge C
IC
Olsen
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Inger-Jorid
IJ
Berg
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Jonny
J
Hisdal
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Till
T
Uhlig
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Glenn
G
Haugeberg
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Tore K
TK
Kvien
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Sella A
SA
Provan
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
Anne Grete
AG
Semb
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000503:physiopathology; D050197:Atherosclerosis / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D001794:Blood Pressure / Q000502:physiology; D002318:Cardiovascular Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D002340:Carotid Artery Diseases / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D059289:Vascular Stiffness / Q000502:physiology*
ARTERIAL STIFFNESS; CARDIOVASCULAR DISEASE; CAROTID ARTERY PLAQUE; CAROTID INTIMA-MEDIA THICKNESS; PROJECTIONS AND PREDICTIONS; RHEUMATOID ARTHRITIS