Clinical Rheumatology

, Volume 36, Issue 4, pp 763–771 | Cite as

Cardiovascular risk assessment in patients with rheumatoid arthritis: a correlative study of noninvasive arterial health testing

  • Erin M. ScanlonEmail author
  • Rekha Mankad
  • Cynthia S. Crowson
  • Iftikhar J. Kullo
  • Sharon L. Mulvagh
  • Eric L. Matteson
  • Zoran Kvrgic
  • John M. DavisIII
Original Article


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.


Brachial 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


C-reactive protein




Disease Activity Score 28 using C-reactive protein


Disease-modifying anti-rheumatic drug


Flow-mediated dilation


Health Assessment Questionnaire II


Interquartile range


Lipoprotein A2


Rheumatoid arthritis


Rheumatoid factor


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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Copyright information

© International League of Associations for Rheumatology (ILAR) 2016

Authors and Affiliations

  • Erin M. Scanlon
    • 1
    Email author
  • Rekha Mankad
    • 2
  • Cynthia S. Crowson
    • 3
  • Iftikhar J. Kullo
    • 2
  • Sharon L. Mulvagh
    • 2
  • Eric L. Matteson
    • 1
    • 4
  • Zoran Kvrgic
    • 1
  • John M. DavisIII
    • 1
  1. 1.Division of RheumatologyMayo ClinicRochesterUSA
  2. 2.Division of Cardiovascular DiseasesMayo ClinicRochesterUSA
  3. 3.Division of Biomedical Statistics and InformaticsMayo ClinicRochesterUSA
  4. 4.Division of EpidemiologyMayo ClinicRochesterUSA

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