Systemic inflammation and cardiovascular risk factors predict rapid progression of atherosclerosis in rheumatoid arthritis

Abstract

Objective To estimate atherosclerosis progression and identify influencing factors in rheumatoid arthritis (RA). Methods We used carotid ultrasound to measure intima-media thickness (IMT) in RA patients, and ascertained cardiovascular (CV) risk factors, inflammation markers and medications. A second ultrasound was performed approximately 3 years later. We calculated the progression rate by subtracting the baseline from the follow-up IMT, divided by the time between the two scans. We used logistic regression to identify baseline factors predictive of rapid progression. We tested for interactions of erythrocyte sedimentation rate (ESR) with CV risk factors and medication use. Results Results were available for 487 RA patients. The mean (SD) common carotid IMT at baseline was 0.571 mm (0.151). After a mean of 2.8 years, the IMT increased by 0.050 mm (0.055), p≤0.001, a progression rate of 0.018 mm/year (95% CI 0.016 to 0.020). Baseline factors associated with rapid progression included the number of CV risk factors (OR 1.27 per risk factor, 95% CI 1.01 to 1.61), and the ESR (OR 1.12 per 10 mm/h, 95% CI 1.02 to 1.23). The ESR×CV risk factor and ESR×medication product terms were significant, suggesting these variables modify the association between the ESR and IMT progression. Conclusions Systemic inflammation and CV risk factors were associated with rapid IMT progression. CV risk factors may modify the role of systemic inflammation in determining IMT progression over time. Methotrexate and antitumour necrosis factor agents may influence IMT progression by reducing the effect of the systemic inflammation on the IMT.

Incident Heart Failure in Patients With Rheumatoid Arthritis: A Nationwide Cohort Study

“…In patients with RA, the excess cardiovascular disease risk appears to be comparable with that found in patients with type 2 diabetes mellitus 6, 7. Both conventional cardiovascular risk factors (eg, hypertension, obesity, dyslipidemia, and diabetes mellitus) and increased systemic inflammation play a contributory role 4, 8, 9…”

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

“…Studies on IMT in RA patients also demonstrated that systemic inflammation and CV risk factors were associated with rapid IMT progression. MTX and anti-TNFα agents may influence IMT progression by reducing the effect of the systemic inflammation on the IMT [41]. Creactive protein (CRP) and erythrocyte sedimentation rate (ESR) were similarly associated with higher risk of myocardial infarction as well as stroke, reflecting the prominent role of inflammation in CHD risk in RA [42].…”

Calcification of vascular smooth muscle cells is induced by secondary calciprotein particles and enhanced by tumor necrosis factor-α

“…Interestingly, CPP have been found in the blood of patients with CKD and in the dialysate obtained from patients receiving peritoneal dialysis [6,16,36]. CPP have also been detected in the blood of patients with inflammatory rheumatoid diseases but normal renal function, a population at increased risk for the development of atherosclerosis [3,9].…”