Rheumatology International

, Volume 32, Issue 11, pp 3455–3461

The major determinants of arterial stiffness in Korean patients with rheumatoid arthritis are age and systolic blood pressure, not disease-related factors

  • Young-Sam Kim
  • Yoon-Kyoung Sung
  • Chan-Bum Choi
  • Wan-Sik Uhm
  • Tae-Hwan Kim
  • Jin-Ho Shin
  • Jae-Bum Jun
Original Article


Patients with rheumatoid arthritis are at increased risk of cardiovascular morbidity and mortality. This study was undertaken to investigate the prevalence of peripheral arterial disease, and to identify factors, especially those related to rheumatoid arthritis, influencing arterial stiffness in Korean patients with rheumatoid arthritis. A total of 262 patients with rheumatoid arthritis managed in a tertiary clinic were included. Ankle–brachial index and brachial–ankle pulse wave velocity were measured. Rheumatoid arthritis-related factors were determined, as well as the traditional cardiovascular risk factors. The prevalence of peripheral arterial disease was only 1.5%. Mean pulse wave velocity was 1,559 ± 354 cm/s. Age, body mass index, blood pressure, lipid profile, and glucose, not rheumatoid arthritis-related factors such as disease duration, seropositivity and disease activity, were significantly correlated with pulse wave velocity. Moreover, stepwise multiple regression analysis revealed that only age over 65 (OR = 9.1, 95% CI 4.3–19.1, P < 0.001), systolic blood pressure over 140 mmHg (OR = 15.7, 95% CI 7.4–33.1, P < 0.001), and corticosteroid use (OR = 2.1, 95% CI 1.03–4.3, P = 0.04) were independent risk factors for high pulse wave velocity. The prevalence of peripheral arterial disease in Korean patients with rheumatoid arthritis is very low. Among the many factors related to arterial stiffness, only old age, high systolic blood pressure, and, to a certain extent, corticosteroid use appear to be major determinants, especially in clinical setting with relatively well controlled patients with rheumatoid arthritis.


Rheumatoid arthritis Arterial stiffness Ankle–brachial index Peripheral arterial disease Pulse wave velocity 


  1. 1.
    Van Doornum S, McColl G, Wicks IP (2002) Accelerated atherosclerosis: an extraarticular feature of rheumatoid arthritis? Arthritis Rheum 46:862–873PubMedCrossRefGoogle Scholar
  2. 2.
    Carroll L, Hannawi S, Marwick T, Thomas R (2006) Rheumatoid arthritis: links with cardiovascular disease and the receptor for advanced glycation end products. Wien Med Wochenschr 156:42–52PubMedCrossRefGoogle Scholar
  3. 3.
    Smith FB, Lee AJ, Price JF, van Wijk MC, Fowkes FG (2003) Changes in ankle brachial index in symptomatic and asymptomatic subjects in the general population. J Vasc Surg 38:1323–1330PubMedCrossRefGoogle Scholar
  4. 4.
    Kweon SS, Shin MH, Park KS, Nam HS, Jeong SK, Ryu SY et al (2005) Distribution of the ankle-brachial index and associated cardiovascular risk factors in a population of middle-aged and elderly Koreans. J Korean Med Sci 20:373–378PubMedCrossRefGoogle Scholar
  5. 5.
    Rincón ID, Haas RW, Pogosian S, Escalante A (2005) Lower limb arterial incompressibility and obstruction in rheumatoid arthritis. Ann Rheum Dis 64:425–432PubMedCrossRefGoogle Scholar
  6. 6.
    Pieringer H, Stuby U, Pohanka E, Biesenbach G (2010) Arterial stiffness in a muscular artery in women with longstanding rheumatoid arthritis compared with healthy controls and patients with traditional cardiovascular risk factors. Rheumatol Int 30:1335–1339PubMedCrossRefGoogle Scholar
  7. 7.
    Pieringer H, Pichler M (2011) Cardiovascular morbidity and mortality in patients with rheumatoid arthritis: vascular alterations and possible clinical implications. QJM 104:13–26PubMedCrossRefGoogle Scholar
  8. 8.
    John H, Toms TE, Kitas GD (2011) Rheumatoid arthritis: is it a coronary heart disease equivalent? Curr Opin Cardiol 26:327–333PubMedCrossRefGoogle Scholar
  9. 9.
    Gasparyan AY, Stavropoulos-Kalinoglou A, Mikhailidis DP, Toms TE, Douglas KM, Kitas GD (2010) The rationale for comparative studies of accelerated atherosclerosis in rheumatic diseases. Curr Vasc Pharmacol 8:437–449PubMedCrossRefGoogle Scholar
  10. 10.
    Asmar R (2007) Effects of pharmacological intervention on arterial stiffness using pulse wave velocity measurement. J Am Soc Hypertens 1:104–112PubMedCrossRefGoogle Scholar
  11. 11.
    Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324PubMedCrossRefGoogle Scholar
  12. 12.
    Kim HJ, Nam JS, Park JS, Cho M, Kim CS, Ahn CW et al (2009) Usefulness of brachial-ankle pulse wave velocity as a predictive marker of multiple coronary artery occlusive disease in Korean type 2 diabetes patients. Diabetes Res Clin Pract 85:30–34PubMedCrossRefGoogle Scholar
  13. 13.
    Ku IA, Imboden JB, Hsue PY, Ganz P (2009) Rheumatoid arthritis: a model of systemic inflammation driving atherosclerosis. Circ J 73:977–985PubMedCrossRefGoogle Scholar
  14. 14.
    Rhee SY, Guan H, Liu ZM, Cheng SW, Waspadji S, Palmes P et al (2007) Multi-country study on the prevalence and clinical features of peripheral arterial disease in Asian type 2 diabetes patients at high risk of atherosclerosis. Diabetes Res Clin Pract 76:82–92PubMedCrossRefGoogle Scholar
  15. 15.
    van Halm VP, Peters MJ, Voskuyl AE, Boers M, Lems WF, Visser M et al (2009) Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRE investigation. Ann Rheum Dis 68:1395–1400PubMedCrossRefGoogle Scholar
  16. 16.
    Lim JH, Kim YK, Kim YS, Na SH, Rhee MY, Lee MM (2010) Relationship between serum uric acid levels, metabolic syndrome, and arterial stiffness in Korean. Korean Circ J 40:314–320PubMedCrossRefGoogle Scholar
  17. 17.
    Tanaka K, Inaba M, Goto H, Nagata-Sakurai M, Sakai S, Yamada S et al (2006) Paraarticular trabecular bone loss at the ultradistal radius and increased arterial stiffening in postmenopausal patients with rheumatoid arthritis. J Rheumatol 33:652–658PubMedGoogle Scholar
  18. 18.
    Inaba M, Tanaka K, Goto H, Sakai S, Yamada S, Naka H et al (2007) Independent association of increased trunk fat with increased arterial stiffening in postmenopausal patients with rheumatoid arthritis. J Rheumatol 34:290–295PubMedGoogle Scholar
  19. 19.
    Provan SA, Angel K, Semb AG, Mowinckel P, Agewall S, Atar D et al (2011) Early prediction of increased arterial stiffness in patients with chronic inflammation: a 15-year followup study of 108 patients with rheumatoid arthritis. J Rheumatol 38:606–612PubMedCrossRefGoogle Scholar
  20. 20.
    Mäki-Petäjä KM, Hall FC, Booth AD, Wallace SM, Yasmin S, Bearcroft PW et al (2006) Rheumatoid arthritis is associated with increased aortic pulse-wave velocity, which is reduced by anti-tumor necrosis factor-alpha therapy. Circulation 114:1185–1192PubMedCrossRefGoogle Scholar
  21. 21.
    Wong M, Oakley SP, Young L, Jiang BY, Wierzbicki A, Panayi G et al (2009) Infliximab improves vascular stiffness in patients with rheumatoid arthritis. Ann Rheum Dis 68:1277–1284PubMedCrossRefGoogle Scholar
  22. 22.
    Zacho J, Tybjaerg-Hansen A, Jensen JS, Grande P, Sillesen H, Nordestgaard BG (2008) Genetically elevated C-reactive protein and ischemic vascular disease. N Engl J Med 359:1897–1908PubMedCrossRefGoogle Scholar
  23. 23.
    Tso TK, Huang WN, Huang HY, Chang CK (2005) Association of brachial-ankle pulse wave velocity with cardiovascular risk factors in systemic lupus erythematosus. Lupus 14:878–883PubMedCrossRefGoogle Scholar
  24. 24.
    Ruyssen-Witrand A, Fautrel B, Saraux A, Le Loët X, Pham T (2011) Cardiovascular risk induced by low-dose corticosteroids in rheumatoid arthritis: a systematic literature review. Joint Bone Spine 78:23–30PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Young-Sam Kim
    • 1
  • Yoon-Kyoung Sung
    • 1
  • Chan-Bum Choi
    • 1
  • Wan-Sik Uhm
    • 1
  • Tae-Hwan Kim
    • 1
  • Jin-Ho Shin
    • 2
  • Jae-Bum Jun
    • 1
  1. 1.Hanyang University Hospital for Rheumatic DiseasesSeoulRepublic of Korea
  2. 2.Division of Cardiology, Department of Internal MedicineHanyang University HospitalSeoulRepublic of Korea

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