Preclinical Carotid Atherosclerosis in Patients with Rheumatoid Arthritis

  1. Mary J. Roman, MD;
  2. Elfi Moeller, AB;
  3. Adrienne Davis, AB;
  4. Stephen A. Paget, MD;
  5. Mary K. Crow, MD;
  6. Michael D. Lockshin, MD;
  7. Lisa Sammaritano, MD;
  8. Richard B. Devereux, MD;
  9. Joseph E. Schwartz, PhD;
  10. Daniel M. Levine, PhD; and
  11. Jane E. Salmon, MD
  1. 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.

    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-α 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.

    Article and Author Information

    • 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.

    Responses to this article

    • Authors Respond
      • Mary J. Roman
      Ann Intern Med published online October 26, 2009
    • Preclinical Carotid Atherosclerosis in Rheumatoid Arthritis
      • Hidekatsu Yanai and
      • Hiroshi Yoshida, MD, PhD, Norio Tada, MD, PhD
      Ann Intern Med published online October 26, 2009
    • Carotid atherosclerosis and rheumatoid arthritis.
      • Giovanni Targher
      Ann Intern Med published online October 26, 2009
    • Atherosclerosis in Rheumatoid Arthritis
      • Francisco R. Lafita and
      • Belinda Garcia MD
      Ann Intern Med published online October 26, 2009

    Summary for Patients

    • Summaries for Patients:Asymptomatic Changes in the Carotid Arteries of Patients with Rheumatoid Arthritis Ann Intern Med February 21, 2006 144:I-38
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    1. Ann Intern Med February 21, 2006 vol. 144 no. 4 249-256
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