Different type of carotid arterial wall remodeling in rheumatoid arthritis compared with healthy subjects: a
Alper M Van Sijl1, Katja Van Den Hurk, Mike J L Peters
1Department of Rheumatology, Jan van Breemen Research Institute - Reade, The Netherlands. Alper.vanSijl@vumc.nl
Insights
Rheumatoid arthritis (RA) patients show outward carotid arterial remodeling, indicating a potential new pathway for cardiovascular risk beyond traditional factors. This maladaptive remodeling may increase plaque instability and rupture risk.
Area of Science:
- Cardiovascular Science
- Rheumatology
- Vascular Biology
Background:
- Rheumatoid arthritis (RA) is linked to higher cardiovascular (CV) risk, but underlying mechanisms require further elucidation.
- Carotid arterial remodeling, a structural adaptation to hemodynamic factors, can become maladaptive when arterial wall stress exceeds limits.
Purpose of the Study:
- To investigate if maladaptive carotid arterial remodeling is present in rheumatoid arthritis (RA) patients compared to healthy controls.
- To explore potential alternative pathways for amplified CV risk in RA.
Main Methods:
- Cross-sectional study of 96 RA patients and 274 healthy subjects.
- Carotid intima-media thickness (cIMT) and interadventitial diameter (IAD) measured via B-mode ultrasonography.
- Lumen diameter (LD), circumferential wall stress (CWS), and circumferential wall tension (CWT) calculated; linear regression used for analysis.
Main Results:
- RA patients exhibited greater LD (9.3%) and IAD (7.8%) compared to controls.
- RA was associated with 10% higher CWS and 8% higher CWT.
- Carotid intima-media thickness (cIMT) was comparable between groups; findings persisted after adjustments.
Conclusions:
- Rheumatoid arthritis is associated with maladaptive outward carotid arterial remodeling.
- This remodeling may contribute to plaque instability and rupture, amplifying CV risk.
- Identifies a potential pathway for increased CV risk in RA beyond traditional risk factors.
Objective:
Rheumatoid arthritis (RA) is associated with an increased cardiovascular (CV) risk, but mechanisms behind this increased risk have not been fully elucidated. Carotid arterial remodeling is the change of structural properties in response to hemodynamic or metabolic factors aimed at keeping wall stress within certain limits. This process might become maladaptive when stress on the arterial wall increases beyond these limits. We investigated whether maladaptive carotid arterial remodeling is present in RA compared with control subjects.
Methods:
The 2 cohorts were 96 patients with RA and 274 healthy subjects, who were investigated cross-sectionally. Carotid intima-media thickness (cIMT) and interadventitial diameter (IAD) were assessed by B-mode carotid ultrasonography. Lumen diameter (LD), circumferential wall stress (CWS), and circumferential wall tension (CWT) were calculated. Linear regression analyses were used to investigate the association between presence of RA and carotid arterial remodeling.
Results:
Compared with healthy subjects, RA was associated with a 0.40 mm (9.3%) greater LD, 0.41 mm (7.8%) greater IAD, 10% higher CWS, and 8% higher CWT. The groups had comparable cIMT. Associations remained similar after exclusion of patients with prior CV disease and after adjustment for demographic factors and CV risk factors.
Conclusion:
RA is associated with maladaptive outward carotid arterial remodeling. These results are relevant because maladaptive outward remodeling is associated with plaque instability and rupture. These results indicate an alternative pathway, beyond the traditional CV risk factors, in RA that amplifies the CV risk.
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