Cardiovascular risk assessment in patients with rheumatoid arthritis: a correlative study of noninvasive arterial health testing
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This study aimed to determine the relationship between noninvasive measures of arterial health and both estimated 10-year cardiovascular risk and measures of disease activity over time in established rheumatoid arthritis. Fifty rheumatoid arthritis patients underwent noninvasive arterial health testing (brachial artery reactivity, aortic augmentation index [AIx], pulse wave velocity, carotid artery intima-media thickness, and carotid artery plaque presence) and assessment of clinical disease activity (tender or swollen joint counts, Clinical Disease Activity Index [CDAI], and Health Assessment Questionnaire II [HAQ-II]). Clinical measures during 3 years before the study visit were averaged. Arterial health testing was compared with the American Heart Association/American College of Cardiology (AHA/ACC) Pooled Cohort Equation. Spearman methods identified correlations between disease activity measures, cardiac biomarkers, and arterial health parameters. Among the patients (mean age, 57.5 years), disease activity was moderate (mean [SD] CDAI, 16.9 [15.3]). At the study visit, corrected aortic augmentation index correlated with CDAI (r = 0.37, P = .009) and HAQ-II (r = 0.33, P = .02). AIx correlated with time-averaged tender joint count (r = 0.37, P = .008), CDAI (r = 0.36, P = .01), HAQ-II (r = 0.36, P = .01), swollen joint count (r = 0.36, P = .10), patient global assessment (r = 0.33, P = .02), physician global assessment (r = 0.35, P = .01), and pain score (r = 0.38, P = .007). The AHA/ACC low-risk group (<5% 10-year risk) had highest prevalence of carotid plaques. Arterial health testing may identify increased risk of cardiovascular disease compared with risk obtained through AHA/ACC Pooled Cohort Equation. Measures of arterial stiffness correlate with the burden of disease activity over time.
KeywordsBrachial artery reactivity testing Carotid artery intima-media thickness Endothelial dysfunction Flow-mediated dilation Rheumatic disease Swollen joint count Tender joint count
Aortic augmentation index
American College of Cardiology
American Heart Association
Anti-citrullinated protein antibody
Aortic pulse wave velocity
Atherosclerotic cardiovascular disease
Clinical Disease Activity Index
Carotid artery intima-media thickness
Disease Activity Score 28 using C-reactive protein
Disease-modifying anti-rheumatic drug
Health Assessment Questionnaire II
Swollen joint count
Tender joint count
This project was supported by the 2015 Mayo Clinic Department of Medicine Team Science Award, Grant Number R01 AR46849 from the National Institute for Arthritis Musculoskeletal and Skin Diseases (NIAMS) and CTSA Grant Number UL1 TR000135 from the National Center for Advancing Translational Science (NCATS). Its content are solely the responsibility of the authors and do not necessarily represent the official views of the National Institutes of Health. The study sponsors had no role in the study design; in the collection, analysis, or interpretation of the data; in the drafting of the manuscript; or in the decision to submit the manuscript for publication.
Compliance with ethical standards
All patients provided written informed consent for study participation, which was approved by the institutional review board and in accordance with the Declaration of Helsinki.
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