Preclinical carotid atherosclerosis in patients with rheumatoid arthritis.

Abstract:

BACKGROUND:Rheumatoid arthritis is associated with increased morbidity and mortality because of cardiovascular disease, independent of traditional risk factors. OBJECTIVE:To determine the prevalence of preclinical atherosclerosis in patients with rheumatoid arthritis and to identify clinical and biological markers for atherosclerotic disease in this patient population. DESIGN:Matched, cross-sectional study. SETTING:Hospital for Special Surgery in New York City. PATIENTS:98 consecutive outpatients with rheumatoid arthritis who were followed by rheumatologists and 98 controls matched on age, sex, and ethnicity. MEASUREMENTS:Cardiovascular risk factor ascertainment and carotid ultrasonography in all participants; disease severity, disease treatment, and inflammatory markers in patients with rheumatoid arthritis. RESULTS:Despite a more favorable risk factor profile, patients with rheumatoid arthritis had a 3-fold increase in carotid atherosclerotic plaque (44% vs. 15%; P < 0.001). The relationship between rheumatoid arthritis and carotid atherosclerotic plaque remained after accounting for age, serum cholesterol levels, smoking history, and hypertensive status; adjusted predicted prevalence was 7.4% (95% CI, 3.4% to 15.2%) for the control group and 38.5% (CI, 25.4% to 53.5%) for patients with rheumatoid arthritis. Age (P < 0.001) and current cigarette use (P < 0.014) were also significantly associated with carotid atherosclerotic plaque. Among patients with rheumatoid arthritis, atherosclerosis was related to age, hypertension status, and use of tumor necrosis factor-alpha inhibitors (a possible marker of disease severity). LIMITATIONS:The study had a cross-sectional design, and inflammatory markers were determined only once. CONCLUSIONS:Patients with rheumatoid arthritis have a high prevalence of preclinical atherosclerosis independent of traditional risk factors, suggesting that chronic inflammation and, possibly, disease severity are atherogenic in this population.

journal_name

Ann Intern Med

authors

Roman MJ,Moeller E,Davis A,Paget SA,Crow MK,Lockshin MD,Sammaritano L,Devereux RB,Schwartz JE,Levine DM,Salmon JE

doi

10.7326/0003-4819-144-4-200602210-00006

subject

Has Abstract

pub_date

2006-02-21 00:00:00

pages

249-56

issue

4

eissn

0003-4819

issn

1539-3704

pii

144/4/249

journal_volume

144

pub_type

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