Predictors of endothelial dysfunction and atherosclerosis in rheumatoid arthritis in Indian population

Area of Science:

• Cardiovascular Research
• Rheumatology
• Vascular Biology

Background:

• Rheumatoid arthritis (RA) is a significant risk factor for cardiovascular (CV) disease, the leading cause of mortality in RA patients.
• Endothelial dysfunction, a precursor to atherosclerosis, is a key feature in conditions associated with CV complications.
• Identifying predictive biomarkers for CV risk in RA is crucial for timely intervention and personalized treatment strategies.

Purpose of the Study:

• To assess endothelial function and atherosclerosis in Indian RA patients using flow-mediated dilation (FMD) and carotid intima-media thickness (CIMT).
• To evaluate the association of clinical and laboratory markers, including inflammatory markers and endothelial progenitor cells (EPCs), with CV complications in RA.
• To identify predictive biomarkers for endothelial dysfunction and accelerated atherosclerosis in the RA population.

Main Methods:

• A prospective study involving 35 RA patients and 25 healthy controls, excluding individuals with traditional CV risk factors.
• Assessment of endothelial function via FMD and atherosclerosis via CIMT.
• Measurement of disease-specific and inflammatory markers, serum cytokines (e.g., TNF-α, IL-6), serum nitrite, lipids, and endothelial progenitor cells (EPCs).

Main Results:

• RA patients exhibited significantly lower FMD (6.53%±1.81%) and significantly increased CIMT (0.62±0.17 mm) compared to controls (p<0.001 and p=0.003, respectively).
• In RA patients, FMD inversely correlated with CIMT, CRP, DAS-28, TNF-α, and serum nitrite, and positively correlated with EPCs.
• CIMT correlated with age, DAS-28, IL-6, HDL, LDL, and inversely correlated with EPCs.

Conclusions:

• Endothelial dysfunction and accelerated atherosclerosis are prevalent in RA patients, as indicated by impaired FMD and increased CIMT.
• Biomarkers including CRP, TNF-α, serum nitrite, DAS-28, and depleted EPCs are predictive of endothelial dysfunction in RA.
• Accelerated atherosclerosis in RA is predicted by age, IL-6, HDL, LDL, and depleted EPC populations, highlighting potential targets for risk stratification and management.