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Cardiovascular Risk Assessment in Women With Rheumatoid Arthritis Through Carotid and Femoral Artery Doppler
Nathália de Carvalho Sacilotto1, André Ozela Augusto1, Dayrana Alves Lucena1
1From the Disciplina de Reumatologia.
Insights
Rheumatoid arthritis patients classified as low cardiovascular risk show increased arterial changes. Doppler ultrasound detects subclinical cardiovascular disease in rheumatoid arthritis, even when standard scores indicate low risk.
Area of Science:
- Cardiovascular Medicine
- Rheumatology
- Medical Imaging
Background:
- Rheumatoid arthritis (RA) is associated with increased cardiovascular disease (CVD) risk.
- Traditional risk scores may underestimate CVD in RA patients.
- European League Against Rheumatism (EULAR) guidelines suggest a 1.5 multiplication factor for CVD risk assessment in RA.
Purpose of the Study:
- To evaluate cardiovascular risk in RA patients initially classified as low-risk using the Framingham score.
- To assess the impact of the EULAR 1.5 multiplication factor on cardiovascular risk stratification.
- To utilize carotid and femoral Doppler ultrasound (DUS) for detecting subclinical atherosclerosis in RA patients.
Main Methods:
- A randomized study comparing 35 female RA patients and 35 healthy controls, all initially low-risk by Framingham score.
- Carotid and femoral Doppler ultrasound (DUS) examinations were performed on all participants.
- Cardiovascular risk was reassessed after applying the EULAR 1.5 multiplication factor.
Main Results:
- 46% of RA patients exhibited carotid and/or femoral DUS abnormalities, compared to 14% in controls (p=0.004).
- Intima-media thickness and/or atherosclerotic plaques were observed in 31% of carotid and 81% of femoral DUS in RA patients.
- After applying the EULAR 1.5 factor, 66% of RA patients remained low-risk, yet 35% of these showed DUS abnormalities.
Conclusions:
- The EULAR criteria effectively identify high cardiovascular risk in RA.
- Carotid and femoral DUS are valuable clinical tools for detecting asymptomatic CVD in RA patients.
- Doppler ultrasound enhances cardiovascular risk assessment beyond traditional scores in rheumatoid arthritis.
Objective:
The aims of this study were to assess cardiovascular risk in patients with rheumatoid arthritis (RA) classified as low-risk by the Framingham score, before and after the multiplication by 1.5 recommended by the European League Against Rheumatism (EULAR), and to stratify them using carotid and femoral Doppler ultrasound (DUS) in order to optimize the assessment of the asymptomatic cardiovascular disease incidence.
Methods:
Thirty-five female patients with RA and 35 healthy women (control group), both with low cardiovascular risk by Framingham score, were enrolled in the study (randomized). All of them underwent carotid and femoral DUS studies.
Results:
The mean age at diagnosis was 44.57 years, the mean disease duration was 12.11 years and the mean disease activity score according to the Disease Activity Score 28 was 1.91, whereas according to the Clinical Disease Activity Index, it was 6.176. The sample was homogeneous. Within the RA group, 46% showed changes in the carotid and/or femoral DUS, compared with 14% in the control group (p = 0.004). Of the DUS with abnormalities, in the RA group, 31% of the carotid DUS and 81% of the femoral DUS (p = 0.005) showed intima-media thickness and/or atherosclerotic plaques. After EULAR 1.5 multiplication factor, 66% remained low cardiovascular risk. Of these, 35% of the patients showed changes in the carotid and/or femoral DUS, compared with 14% of the control group (p = 0.07).
Conclusions:
The EULAR criteria are effective at identifying patients with high cardiovascular risk. Carotid DUS and, especially, femoral DUS are tools that can be used in clinical practice as ways to detect CVD even in its asymptomatic form.
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