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Lipids and cardiovascular/metabolic health

Arterial dysfunction in patients with rheumatoid arthritis and the consumption of daily fruits and daily vegetables

European Journal of Clinical Nutrition volume 66, pages 345–352 (2012)Cite this article

Abstract

Background/Objectives

:Rheumatoid arthritis (RA) is associated with increased arterial dysfunction and increased risk of cardiovascular disease. Regular fruit and vegetable consumption prevents cardiovascular disease, but their influence on arterial dysfunction in RA has not been investigated. We assessed the relationship between daily fruit–vegetable consumption and arterial dysfunction in this high-risk group.

Subjects/Methods:

Participants were recruited from a consecutive series of RA patients aged 40–65 years without overt cardiovascular disease attending rheumatology clinics. Standardised research nurse assessment included SphygmoCor pulse wave analysis using radial applanation tonometry (a higher augmentation index (AIX%) indicates arterial dysfunction), fasting blood sample, patient questionnaire and medical record review. Multivariable analysis was used to adjust for age, sex, cholesterol, mean arterial blood pressure, smoking habit, alcohol consumption, physical activity, cumulative inflammatory burden, rheumatoid nodules, disability and education.

Results:

We recruited 114 RA patients: 81% female, mean age 54 years, median arthritis duration 10 years and mean AIX% 31.5 (s.d. 7.7). Fruit and vegetable consumption were significantly correlated (Spearman's rho 0.54, P≪0.0001) and on unadjusted analysis daily fruit and vegetable consumption was associated with a lower AIX% (−3.2; 95% CI −6.4 to −0.1, P=0.05). On adjusted analysis AIX% was lower with daily vegetable (−4.2; 95% CI −7.9 to −0.5; P=0.003), but not with daily fruit (−0.02; 95% CI −3.9 to 3.8; P=0.99) consumption.

Conclusions:

Daily vegetable consumption, but not daily fruit consumption, was independently associated with more favourable arterial function in patients with RA. These findings are consistent with the enterosalivary circulation of nitrate having an influence on arterial function.

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References

  • Avalos I, Chung CP, Oeser A, Gebretsadik T, Shintani A, Kurnik D et al. (2007). Increased augmentation index in rheumatoid arthritis and its relationship to coronary artery atherosclerosis. J Rheumatol 34, 2388–2394.

    PubMed  Google Scholar 

  • Avina-Zubieta JA, Choi HK, Sadatsafavi M, Etminan M, Esdaile JM, Lacaille D (2008). Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthritis Rheum 59, 1690–1697.

    Article  PubMed  Google Scholar 

  • Bjelakovic G, Nikolova D, Gluud LL, Simonetti RG, Gluud C (2007). Mortality in randomized trials of antioxidant supplements for primary and secondary prevention: systematic review and meta-analysis. JAMA 297, 842–857.

    Article  CAS  PubMed  Google Scholar 

  • Bruce B, Fries JF (2003). The Stanford health assessment questionnaire: dimensions and practical applications. Health Qual Life Outcomes 1, 20.

    Article  PubMed  PubMed Central  Google Scholar 

  • Crilly M, Coch C, Bruce M, Clark H, Williams D (2007). Indices of cardiovascular function derived from peripheral pulse wave analysis using radial applanation tonometry: a measurement repeatability study. Vasc Med 12, 189–197.

    Article  PubMed  Google Scholar 

  • Crilly MA, Clark HJ, Kumar V, Scott NW, MacDonald AG, Williams DJ (2010). Relationship between arterial stiffness and Stanford Health Assessment Questionnaire disability in rheumatoid arthritis patients without overt arterial disease. J Rheumatol 37, 946–952.

    Article  PubMed  Google Scholar 

  • Crilly MA, Kumar V, Clark HJ, Scott NW, MacDonald AG, Williams DJ (2009). Arterial stiffness and cumulative inflammatory burden in rheumatoid arthritis: a dose-response relationship independent of established cardiovascular risk factors. Rheumatology (Oxford) 48, 1606–1612.

    Article  CAS  Google Scholar 

  • Cypiene A, Laucevicius A, Venalis A, Ryliskyte L, Dadoniene J, Petrulioniene Z et al. (2007). Non-invasive assessment of arterial stiffness indices by applanation tonometry and pulse wave analysis in patients with rheumatoid arthritis treated with TNF-alpha blocker remicade (infliximab). Proc West Pharmacol Soc 50, 119–122.

    CAS  PubMed  Google Scholar 

  • El Assaad MA, Topouchian JA, Asmar RG (2003). Evaluation of two devices for self-measurement of blood pressure according to the international protocol: the Omron M5-I and the Omron 705IT. Blood Press Monit 8, 127–133.

    Article  PubMed  Google Scholar 

  • Godin G, Shephard RJ (1985). A simple method to assess exercise behavior in the community. Can J Appl Sport Sci 10, 141–146.

    CAS  PubMed  Google Scholar 

  • He FJ, Nowson CA, Lucas M, MacGregor GA (2007). Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens 21, 717–728.

    Article  CAS  PubMed  Google Scholar 

  • Iqbal R, Anand S, Ounpuu S, Islam S, Zhang X, Rangarajan S et al. (2008). Dietary patterns and the risk of acute myocardial infarction in 52 countries: results of the INTERHEART study. Circulation 118, 1929–1937.

    Article  CAS  PubMed  Google Scholar 

  • Joshipura KJ, Hu FB, Manson JE, Stampfer MJ, Rimm EB, Speizer FE et al. (2001). The effect of fruit and vegetable intake on risk for coronary heart disease. Ann Intern Med 19, 134 (12) 1106–1114.

    Google Scholar 

  • Kapil V, Webb AJ, Ahluwalia A (2010). Inorganic nitrate and the cardiovascular system. Heart 96, 1703–1709.

    Article  CAS  PubMed  Google Scholar 

  • Mente A, de KL, Shannon HS, Anand SS (2009). A systematic review of the evidence supporting a causal link between dietary factors and coronary heart disease. Arch Intern Med 169, 659–669.

    Article  CAS  PubMed  Google Scholar 

  • Morris R, Carstairs V (1991). Which deprivation? A comparison of selected deprivation indexes. J Public Health Med 13, 318–326.

    CAS  PubMed  Google Scholar 

  • Panoulas VF, Douglas KM, Milionis HJ, Stavropoulos-Kalinglou A, Nightingale P, Kita MD et al. (2007). Prevalence and associations of hypertension and its control in patients with rheumatoid arthritis. Rheumatology (Oxford) 46, 1477–1482.

    Article  CAS  Google Scholar 

  • Pauca AL, O’Rourke MF, Kon ND (2001). Prospective evaluation of a method for estimating ascending aortic pressure from the radial artery pressure waveform. Hypertension 38, 932–937.

    Article  CAS  PubMed  Google Scholar 

  • Rabin R, de CF (2001). EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33, 337–343.

    Article  CAS  PubMed  Google Scholar 

  • Ross R (1999). Atherosclerosis—an inflammatory disease. N Engl J Med 340, 115–126.

    Article  CAS  PubMed  Google Scholar 

  • Salminen E, Heikkila S, Poussa T, Lagstrom H, Saario R, Salminen S (2002). Female patients tend to alter their diet following the diagnosis of rheumatoid arthritis and breast cancer. Prev Med 34, 529–535.

    Article  PubMed  Google Scholar 

  • Smulyan H, Siddiqui DS, Carlson RJ, London GM, Safar ME (2003). Clinical utility of aortic pulses and pressures calculated from applanated radial-artery pulses. Hypertension 42, 150–155.

    Article  CAS  PubMed  Google Scholar 

  • Soiza RL, Williams DJ, Crilly MA (2007). Use of pulse wave analysis to measure arterial stiffness in old age. Age Ageing 36, 475–476.

    Article  PubMed  Google Scholar 

  • Stamp LK, James MJ, Cleland LG (2005). Diet and rheumatoid arthritis: a review of the literature. Semin Arthritis Rheum 35, 77–94.

    Article  CAS  PubMed  Google Scholar 

  • Thompson FE, Midthune D, Subar AF, McNeel T, Berrigan D, Kipnis V (2005). Dietary intake estimates in the National Health Interview Survey, 2000: methodology, results, and interpretation. J Am Diet Assoc 105, 352–363.

    Article  PubMed  Google Scholar 

  • Van Bortel LM, Duprez D, Starmans-Kool MJ, Safar ME, Giannattasio C, Cockcroft J et al. (2002). Clinical applications of arterial stiffness, Task Force III: recommendations for user procedures. Am J Hypertens 15, 445–452.

    Article  PubMed  Google Scholar 

  • Weber T, O’Rourke MF, Lassnig E, Porodko M, Ammer M, Rammer M et al. (2010). Pulse waveform characteristics predict cardiovascular events and mortality in patients undergoing coronary angiography. J Hypertens 28, 797–805.

    Article  CAS  PubMed  Google Scholar 

  • Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ (2000). The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 525 (Part 1), 263–270.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Woodward M, Brindle P, Tunstall-Pedoe H (2007). Adding social deprivation and family history to cardiovascular risk assessment: the ASSIGN score from the Scottish Heart Health Extended Cohort (SHHEC). Heart 93, 172–176.

    Article  PubMed  Google Scholar 

  • Ysart G, Miller P, Barrett G, Farrington D, Lawrance P, Harrison N (1999). Dietary exposures to nitrate in the UK. Food Addit Contam 16, 521–532.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgements

The study was funded by NHS Grampian Rheumatology Endowments (charitable source).

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Authors and Affiliations

  1. Department of Clinical Epidemiology, Institute of Applied Health Sciences, Aberdeen University Medical School, Scotland, UK

    M A Crilly

  2. Department of Public Health Nutrition, Institute of Applied Health Sciences, Aberdeen University Medical School, Scotland, UK

    G McNeill

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  1. M A Crilly
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  2. G McNeill
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Correspondence to M A Crilly.

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The authors declare no conflict of interest.

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Ethical approval

Grampian Research Ethics Committee (study reference 04/S0801/67).

Supplementary Information accompanies the paper on European Journal of Clinical Nutrition website

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Crilly, M., McNeill, G. Arterial dysfunction in patients with rheumatoid arthritis and the consumption of daily fruits and daily vegetables. Eur J Clin Nutr 66, 345–352 (2012). https://doi.org/10.1038/ejcn.2011.199

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