Macrovascular damage in polymyalgia rheumatica: integrated vascular phenotyping in the POLYMYACARD cohort

To evaluate, for the first time, a wide combination of oscillometric and sonographic markers of macrovascular damage in patients with polymyalgia rheumatica (PMR), using carotid-femoral pulse wave velocity (cfPWV) and carotid greyscale/colour Doppler ultrasound (GSUS/CDUS). Additionally, to explore associations between these markers, traditional cardiovascular (CV) risk factors, and inflammatory parameters.

Aortic stiffness was assessed by cfPWV. GSUS measured carotid intima-media thickness (cIMT), plaque presence, and cumulative plaque area. CDUS assessed haemodynamic/compliance surrogates, including resistance index (RI), pulsatility index (PI) in the common (CCA), internal (ICA), and external (ECA) carotid arteries. Multivariable linear regression (MLR) and propensity score matching (PSM) adjusted for confounding.

cfPWV was obtained in 72 PMR patients; 26 also underwent GSUS/CDUS. Compared with controls, PMR patients had higher cfPWV (p_adj=0.012), increased RI (p_adj=0.020), and PI (p_adj=0.027) in the ECA after MLR and PSM. PSM further indicated a higher prevalence of subclinical arteriosclerosis in PMR [13/16 (81.3%) vs. 7/16 (43.8%); adjusted p = 0.028]. Plaque area was greater in patients with elevated C-reactive protein [0.41 (0.13-1.07) vs. 0.05 (0.00-0.31); p = 0.016]. cfPWV and carotid markers correlated with age (cfPWV r = 0.588, p < 0.001; cIMT r = 0.542, p = 0.004; plaques r = 0.662, p < 0.001) and mean arterial pressure (cfPWV ρ = 0.247, p = 0.038; cIMT r = 0.515, p = 0.020; plaques r = 0.596, p = 0.006).

Patients with PMR exhibited increased aortic stiffness and elevated carotid pulsatility and resistance in the ECA compared with controls, independent of traditional CV risk factors. These non-invasive vascular markers may help identify PMR patients at increased CV risk and support integrated CV risk assessment in clinical care.