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Published on: October 22, 2014
Subclinical markers of atherosclerosis and cardiovascular risk factors in early arthritis
Carla Andrea Gobbi1, Patricia Asbert, Paula Beatriz Alba
1Universidad Nacional de Córdoba. carlaandreagobbi@hotmail.com.
Insights
Subclinical atherosclerosis markers were not found in early rheumatoid arthritis patients. This suggests that subclinical atherosclerosis may develop later in the disease process, beyond one year of diagnosis.
Area of Science:
- Rheumatology
- Cardiology
- Vascular Ultrasound
Background:
- Cardiovascular disease (CVD) mortality is elevated in rheumatoid arthritis (RA), exceeding risks from traditional factors, indicating inflammation's role.
- Subclinical atherosclerosis (SA), indicated by carotid intima-media thickness (cIMT) and plaque, is linked to CVD and may develop early in inflammatory conditions.
Purpose of the Study:
- To assess sonographic markers of subclinical atherosclerosis and cardiovascular risk factors in patients with early arthritis (EA).
Main Methods:
- A case-control study compared 30 EA patients (swollen joints, <1 year symptom duration) with matched healthy controls.
- Carotid ultrasound measured cIMT and plaque presence in the Common Carotid Artery (CCA) and Carotid Bulb (BC).
- Laboratory tests assessed lipids, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and RA-specific antibodies. Disease activity was measured using DAS 28.
Main Results:
- No significant differences in cIMT (CCA and BC) or carotid plaque presence were observed between EA patients and controls.
- Lipid profiles, including total cholesterol, triglycerides, HDL, and LDL, were similar between groups.
- cIMT CCA and BC showed no association with rheumatoid factor (RF), anti-citrullinated peptide (ACCP), CRP, DAS 28, or smoking status.
Conclusions:
- This study found no ultrasound evidence of subclinical atherosclerosis in early arthritis patients.
- The findings suggest that subclinical atherosclerosis markers may not be present within the first year of EA diagnosis.
- Further longitudinal studies are needed to determine the timeline of atherosclerosis development in RA.
Background:
Mortality from cardiovascular disease (CVD) is increased in rheumatoid arthritis, not explained by traditional cardiovascular risk factors (CVRF), suggesting a role of inflammation. This process would occur early. The common sonographic markers of subclinical atherosclerosis (SA), are increased carotid intima-media thickness (cIMT) or the presence of carotid atherosclerotic plaque and they are closely related to CVD.
Aims:
To evaluate sonographic markers and cardiovascular risk factors in early Arthritis (EA).
Methods:
A case control study of patients with EA, defined by 3 joints swollen with <1 year of evolution, served consecutively from January 2011 to may 2013, matched with healthy controls, by sex, age and cardiovascular risk factors (hypertension, diabetes mellitus, cardiovascular disease -IAM and ACV, dyslipidemia, family history of CVD) was conducted. We studied demographics data, cardiovascular risk factors, carotid ultrasound measuring increased cIMT or the presence of carotid atherosclerotic plaque in Common Carotid Artery (CCA) and Carotid Bulb (BC), laboratory test that included cholesterol, LDL, HDL, triglycerides in mg%, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR ), anti citrullinated peptide (ACCP), rheumatoid factor (RF), antinuclear antibodies (ANA). EA activity was measured by DAS 28, considering high disease activity (HDA) 5.1; moderate (MDA) from 5.1 to 3.2; and low (LDA) <3.2. Statistics: test Mann-Whitney and chi-square were used, p <0.05 was significant.
Results:
25 women, 5 men, average age 43 years (DS 14.7) and 30 controls were included. The average DAS 28 was 4, 8 ± 1. 8; 47% had HDA, 33%MDA and 20%BDA. Both groups had similar values cIMT CCA (0, 57 ± 0.10 mm vs. 0.58 ± 0.15 mm, respectively, P = 0.82) and cIMT BC (0.18mm ± 0.67 vs 0.62 ± 0.15 mm respectively, P = 0.47). There were no carotid plaques. The median total cholesterol was 181,5 vs 183,5 (p = 0.35); triglycerides 99 vs 92,5 (p = 0.68); HDL 54,5 vs 52,5 (p = 0.921 and LDL 105 vs 110 (p = 0.27) in EA and controls respectively. The cIMT CCA and CB were not related to RF, ACCP, CRP, DAS 28 and smoking (NS). There was no difference in other cardiovascular risk factors
Conclusions:
Ultrasound evidence of atherosclerosis subclinical markers was not found in this study, suggesting that this process may occur after a year of diagnosis.
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