Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects

Abstract

Objective. To examine the relationship between markers of systemic inflammation and carotid atherosclerosis in patients with rheumatoid arthritis (RA) and healthy controls.Methods. Carotid artery intima-media thickness (IMT) and carotid plaque were measured using highresolution B-mode ultrasound in 204 patients with RA, ages 40-85, and 102 age-and sex-matched healthy persons. No subject in either group had ever smoked cigarettes. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were used to measure systemic inflammation. The relationship of the carotid artery IMT and carotid plaque to inflammation markers was examined, adjusting for age, sex, RA versus control status, and the cardiovascular (CV) risk factors hypercholesterolemia, systolic blood pressure, diabetes mellitus, and body mass index (BMI).Results. A significant linear trend for increased carotid artery IMT was associated with increasing ESR and CRP categories (r ‫؍‬ 0.16, P ‫؍‬ 0.004 for ESR, and r ‫؍‬ 0.13, P ‫؍‬ 0.02 for CRP). These trends did not differ among RA cases and controls, and were independent of age, sex, and CV risk factors. The difference in carotid artery IMT between the lowest and highest categories of ESR was 0.221 mm (95% confidence interval [95% CI] 0.767-1.020, P ‫؍‬ 0.02). The difference between extreme CRP categories was 0.275 mm (95% CI 0.039-0.509, P ‫؍‬ 0.02). Both remained significant after CV risk factor adjustment. Carotid plaque displayed a similar relationship to markers of inflammation.Conclusion. Increased carotid artery IMT and the presence of carotid plaque are associated with markers of systemic inflammation in patients with RA and in healthy subjects. This observation is consistent with hypotheses that assign a role to systemic inflammation in atherosclerosis, and may have implications regarding RA and other chronic inflammatory diseases.

Atherosclerosis in Rheumatoid Arthritis: What to Look for in Studies Using Carotid Ultrasound: Figure 1.

“…We reported the composite common and internal carotid IMT as a single value per subject, which we obtained by averaging 16 IMT measurements of the internal and external carotid arteries. We found a difference of 0.055 mm between RA patients and controls, also not significant 14 .…”

“…Many of the studies have included modest sample sizes, detracting from conclusions derived from them. Here, I will limit my comments to studies of North American patients [13][14][15] , as these have included larger study samples, and may be more relevant to Kobayashi and colleagues' study, as the CV risk factor pattern and ethnic mix in North America may differ from those of other regions. In the first of these studies, my colleagues and I studied 204 RA patients and 102 controls matched for age and sex, all nonsmokers 14 .…”

“…The above 3 studies reported variable associations between the carotid US findings and inflammation markers or CV risk factors used as covariates [13][14][15] . It should be noted, however, that these case-control comparisons are not ideally suited to study of association between atherosclerosis and covariates.…”

Cholesterol and Triglyceride Concentrations in Lipoproteins as Related to Carotid Intima-Media Thickness

“…On the basis of a systematic review and meta-analysis, it was concluded that carotid IMT is a distinct predictor of future vascular events, although the relative risk for prediction is slightly higher for stroke than for myocardial infarction. 14) Furthermore, other cardiovascular disease risk factors such as diabetes, 15) inflammatory diseases, 16,17) and sleep apnea have been associated with thicker carotid IMT. 18) However, cardiovascular events are not determined only by increased carotid IMT, as 75% of thrombi in the carotid are caused by rupture, and 30% to 35% of coronary thrombi are caused by erosion.…”

Do we have markers to define the cardiovascular risk in rheumatoid arthritis patients?

“…Il stessa indicano un rischio CV di circa tre volte rispetto alla popolazione generale. Del Rincòn et al (10) inoltre hanno dimostrato che i valori elevati di PCR, ma anche di VES correlano con l'ispessimento dell'intima e della media. La VES è un marcatore non specifico di infiammazione, il suo valore dipende dal livello delle immunoglobuline, delle proteine e del fibrinogeno, le quali modificando le cariche elettrostatiche dei globuli rossi ne favoriscono la loro aggregazione e sedimentazione.…”