Preclinical Carotid Atherosclerosis in Patients with Rheumatoid Arthritis

21 February 2006 | Volume 144 Issue 4 | Pages 249-256

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- 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.

Editors' Notes Context Patients with rheumatoid arthritis are prone to premature death from coronary heart disease despite few risk factors. Researchers have wondered if chronic inflammation is a trigger. Content The authors measured inflammatory markers and risk factors for coronary heart disease in 98 matched case-patients and controls (mean age, 48 years). Carotid ultrasonography revealed that 44% of case-patients and 15% of controls had atherosclerotic plaque. Independent predictors of plaque were age, smoking, and rheumatoid arthritis. In patients with rheumatoid arthritis, inflammatory mediators did not predict plaque. Limitations This cross-sectional study cannot prove that rheumatoid arthritis accelerates atherosclerosis. Interpretation Carotid atherosclerotic plaque is much more common in patients with rheumatoid arthritis than in controls. The mechanism remains unknown. —The Editors

 

Author and Article Information

From Weill Medical College of Cornell University, Hospital for Special Surgery, and The Rogosin Institute, New York, New York, and SUNY-Stony Brook, Stony Brook, New York.

Grant Support: By the National Institutes of Health (grants AR 45591 and M10RR0047).

Potential Financial Conflicts of Interest: Stock ownership or options (other than mutual funds): M.K. Crow (Johnson & Johnson, Pfizer Inc.).

Requests for Single Reprints: Mary J. Roman, MD, Division of Cardiology, Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021; e-mail, mroman{at}med.cornell.edu.

Current Author Addresses: Drs. Roman and Devereux and Ms. Davis: Weill Medical College of Cornell University, 525 East 68th Street, New York, NY 10021.

Ms. Moeller: P.O. Box 415, Ridgefield, CT 06877.

Drs. Paget, Crow, Lockshin, Sammaritano, and Salmon: Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021.

Dr. Schwartz: Department of Psychiatry, SUNY-Stony Brook, 129 Putnam Hall, Stony Brook, NY 11794-8790.

Dr. Levine: The Rogosin Institute, The Rockefeller University, 1230 York Avenue, New York, NY 10021.

Author Contributions: Conception and design: M.J. Roman, S.A. Paget, M.K. Crow, M.D. Lockshin, L. Sammaritano, J.E. Salmon.

Analysis and interpretation of the data: M.J. Roman, S.A. Paget, J.E. Schwartz, D.M. Levine, J.E. Salmon.

Drafting of the article: M.J. Roman.

Critical revision of the article for important intellectual content: M.J. Roman, S.A. Paget, M.K. Crow, M.D. Lockshin, L. Sammaritano, R.B. Devereux, D.M. Levine, J.E. Salmon.

Final approval of the article: M.J. Roman, E. Moeller, A. Davis, S.A. Paget, M.K. Crow, M.D. Lockshin, L. Sammaritano, R.B. Devereux, J.E. Schwartz, D.M. Levine, J.E. Salmon.

Provision of study materials or patients: S.A. Paget, M.D. Lockshin, L. Sammaritano, J.E. Schwartz, J.E. Salmon.

Statistical expertise: J.E. Schwartz.

Obtaining of funding: M.J. Roman, M.K. Crow, J.E. Salmon.

Administrative, technical, or logistic support: A. Davis, J.E. Salmon.

Collection and assembly of data: M.J. Roman, E. Moeller, A. Davis, L. Sammaritano, J.E. Schwartz, J.E. Salmon.

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