The Additive Value of Femoral Ultrasound for Subclinical Atherosclerosis Assessment in a Single Center Cohort of 962 Adults, Including High Risk Patients with Rheumatoid Arthritis, Human Immunodeficiency Virus Infection and Type 2 Diabetes Mellitus

Abstract

BackgroundPresence of femoral atheromatic plaques, an emerging cardiovascular disease (CVD) biomarker additional to carotid plaques, is poorly investigated in conditions associating with accelerated atherosclerosis such as Rheumatoid Arthritis (RA), Human Immunodeficiency Virus (HIV) infection and Type 2 Diabetes Mellitus (T2DM).Objective/MethodsTo assess the frequency of femoral/carotid subclinical atheromatosis phenotypes in RA, HIV and T2DM and search for each disease-specific probability of either femoral and/or carotid subclinical atheromatosis, we examined by ultrasound a single-center cohort of CVD-free individuals comprised of consecutive non-diabetic patients with RA (n=226) and HIV (n=133), T2DM patients (n=109) and non-diabetic individuals with suspected/known hypertension (n=494) who served as reference group.ResultsSubclinical atheromatosis - defined as local plaque presence in at least on arterial bed - was diagnosed in 50% of the overall population. Among them, femoral plaques only were found in 25% of either RA or HIV patients, as well as in 16% of T2DM patients and 35% of reference subjects. After adjusting for all classical CVD risk factors, RA and HIV patients had comparable probability to reference group of having femoral plaques, but higher probability (1.75; 1.17 - 2.63 (odds ratio; 95% confidence intervals), 2.04; 1.14 - 3.64, respectively) of having carotid plaques, whereas T2DM patients had higher probability to have femoral and carotid plaques, albeit, due to their pronounced dyslipidemic profile.ConclusionRA and HIV accelerate predominantly carotid than femoral. A “two windows” carotid/femoral, rather than carotid alone ultrasound, screening improves substantially subclinical atheromatosis detection in patients at high CVD risk.

Prevalence, Incidence, and Contributors of Subclinical Atheromatosis, Arteriosclerosis, and Arterial Hypertrophy in HIV-Infected Individuals: A Single-Center, 3-Year Prospective Study

“…The finding that vascular pathology has a site-specific predilection for the carotid arteries is consistent with data from endarterectomies that have shown that plaques have a more inflammatory phenotype in the carotid arterial bed compared to the femoral bed. 39,40 This notion is further supported by a pilot study with 3-dimensional positron emission-computed tomography with intravenous 18-fluorodeoxyglucose, which detected differences in vascular inflammation and early arterial damage between HIV-positive adults and HIV-negative controls. 41 Moreover, the incidence of carotid atheromatosis was significantly associated with the baseline levels of inflammatory biomarkers, namely, soluble CD14 and CD163, in a large cohort of HIV-positive individuals who were followed over a 7-year period.…”

Vascular Involvement in Rheumatoid Arthritis

“…Another study, performed by Pope et al, reported a prevalence of carotid atherosclerotic plaque about 35% in RA patients [36]. Protogerou et al highlighted the importance of carotid ultrasonography associated with the femoral one in RA cardiovascular risk assessment [37].…”

Ultrasound Markers of Premanifest Atherosclerosis of Carotid and Femoral Arteries in Assessment of Cardiovascular Risk

“…Несколько исследований свидетельствуют о том, что традиционные факторы риска атеросклероза по-разному ассоциируют с атеросклерозом сонных и бедренных артерий [42]. Согласно исследованию AWHS атеросклероз бедренных артерий (наличие одной и более АСБ) сильнее ассоциирует с факто-рами риска, чем атеросклероз сонных артерий [40].…”