title: Carotid Artery Atherosclerosis in Patients with Active Rheumatoid Arthritis: Predictors of Plaque Occurrence and Progression Over 24 Weeks.
abstract: BACKGROUND
  This study evaluated the prevalence and progression of subclinical carotid artery atherosclerosis in active rheumatoid arthritis (RA).
  
  
  METHODS
  Carotid arteries of RA patients were scanned using 3D ultrasound at baseline and 24 weeks for total plaque area, vessel wall volume, and intima-media thickness (IMT), as well as arterial stiffness measured using pulse wave velocity. Variables related to inflammation, lipids and cardiovascular (CV) risk were assessed for associations with plaque progression. Of 195 screened patients, 31 met inclusion criteria (66 Swollen joint count (SJC) plus 68 Tender joint count (TJC)≥8 OR SJC plus TJC≥4 with elevated acute phase reactants) and were enrolled (27 female; mean age 59.3±9.8years). Patients using lipid lowering drugs and uncontrolled comorbidities were excluded.
  
  
  RESULTS
  Atherosclerotic plaque occurred in 35% and arterial wall hypertrophy (IMT≥0.6mm) in 86% of patients. Most (68%) had an abnormal lipid profile characterized by reduced HDL and/or increased total cholesterol/HDL index, which was adversely affected by disease activity. Stepwise binary logistic regression analysis showed that Framingham risk score (OR=1.155, 95%CI:1.002-1.332, p=0.046) and ESR (OR=1.148, 95%CI:1.015-1.299, p=0.028) predicted plaque burden most strongly. Plaque progression was significantly associated with baseline higher hsCRP, ESR, and heavy smoking, but only hsCRP predicted plaque growth in multivariate regression analysis (p=0.004); and hsCRP was related to higher disease activity (r=0.443, p=0.016), LDL (r=0.544, p=0.007), and smoking (r=0.384, p=0.04).
  
  
  CONCLUSIONS
  RA-related inflammation contributed to augmented CV burden in RA and might mediate its effect on atherosclerosis through hsCRP and modulation of the traditional CV risk factors, such as dyslipidemia.
authors.affiliation: Schulich School of Medicine & Dentistry, Western University, Rheumatology, St. Joseph's Hospital 268 Grosvenor Street London, Ontario, N6A 4V2, Canada.
authors.forename: Janet E
authors.initials: JE
authors.lastname: Pope
authors.affiliation: Schulich School of Medicine & Dentistry, Western University, Rheumatology, St. Joseph's Hospital 268 Grosvenor Street London, Ontario, N6A 4V2, Canada.
authors.forename: Tatiana
authors.initials: T
authors.lastname: Nevskaya
authors.affiliation: Schulich School of Medicine & Dentistry, Western University, Rheumatology, St. Joseph's Hospital 268 Grosvenor Street London, Ontario, N6A 4V2, Canada.
authors.forename: Lillian
authors.initials: L
authors.lastname: Barra
authors.affiliation: Schulich School of Medicine & Dentistry, Western University, Robarts Research Institute,1151 Richmond St. N., London, Ontario, N6A 5B7, Canada.
authors.forename: Grace
authors.initials: G
authors.lastname: Parraga
keywords: Atherosclerosis; Cardiovascular disease; Carotid plaque progression; Rheumatoid arthritis