[Predictors of cardiovascular and cerebral complications in patients with rheumatoid arthritis]

This 5-year long prospective cohort study of 124 young and middle-aged patients with rheumatoid arthritis (RA) initially without signs of cardiovascular diseases (CVD) aimed at estimating the risk and predictors of cardiovascular and cerebrovascular complications. The patients remained under observation till the following end-points were reached: coronary heart disease, chronic heart failure, disturbed cerebral circulation, cardiovascular death. The following predictors of unfavourable outcome were analysed: CVD risk factors, RA inflammatory activity, and markers of preclinical CVD. Ultrasonic scanning, dopplerography of common and internal carotid arteries, echocardiography, and determination of ankle-brachial index were used. 15 patients reached the end-points; specifically 6 cases of CVD, 4 cerebrovascular complications, and 5 deaths were documented. The total proportion of those survived without CVD was 0.88 (an equivalent to 15 (12%) of the observed events). Survival time till the end-points was 2.41+-1.54 years. CRP level 24 mg/l or higher (odd ratio 3.09, 95% CI 1.03-9.29), smoking (odd ratio 6.6, 95% CI 2.05-21.21), presence of atherosclerotic plaques (odd ratio 6.6, 95% CI 2.05-21.21) and calcinated plaques (odd ratio 8.95, 95% CI 1.36-47.03) in carotid arteries, SCORE risk >5% (odd ratio 19.82, 95% CI 3.25-41.75) were predictors of unfavourable prognosis in RA patients for the nearest 5 years. These data emphasize the necessity of thorough examination of RA patients for asymptotic atherosclerosis taking account of inflammatory activity and CVD risk factors for the optimization of early diagnostics and prediction of CVD.