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Traditional cardiovascular risk factors and residual disease activity are associated with atherosclerosis progression in rheumatoid arthritis patients

Hypertension Research volume 43, pages 922–928 (2020)Cite this article

Abstract

Patients with rheumatoid arthritis (RA) have an increased incidence of cardiovascular events. Ultrasound examination of the carotid arteries can show the presence of plaques and detect the atherosclerotic subclinical process through the evaluation of intima-media thickness (cIMT) and carotid segmental distensibility (cCD). The aim of the present study was to identify which factors could independently influence the evolution of atherosclerosis (plaques, cIMT, and cCD) after 1 year of follow-up in a sample of patients with RA. A total of 137 patients with RA without previous cardiovascular (CV) events were enrolled at baseline, and 105 (M/F: 21/84, age 59.34 ± 11.65 years) were reassessed after one year using ultrasound of carotid arteries to detect atheromatous plaques and to measure cIMT and cCD. After one year, all the indices of subclinical atherosclerosis worsened with respect to baseline (Δ-cIMT = 0.030 ± 0.10 mm, p = 0.005; Δ-cCD = −1.64 ± 4.83, 10–3/KPa, p = 0.005; Δ-plaques = 8.6%, p = 0.035). Traditional CV risk factors (age, mean arterial pressure, and diabetes) and corticosteroid therapy were independently associated with the worsening of subclinical atherosclerosis. Interestingly, when considering RA patients divided according to the degree of disease activity score 28 with C-reactive protein (DAS28 [CRP] ≥2.6), the worsening of subclinical atherosclerosis indices was detectable exclusively in the group of patients with active disease. Our longitudinal study supports the hypothesis of a key role of both traditional CV risk factors and the inflammatory activity of arthritic disease in the progression of subclinical atherosclerosis in RA patients. In addition, corticosteroids might have a deleterious effect.

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Acknowledgements

We thank our colleagues in the Medical Unit of Rheumatology and General Internal Medicine for their assistance and comments that greatly improved the paper.

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  1. These authors contributed equally: Cristiano Fava, Ombretta Viapiana

Authors and Affiliations

  1. Division of General Medicine and Hypertension, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

    Andrea Dalbeni, Michele Bevilacqua, Angela Tagetti, Filippo Cattazzo, Pietro Minuz & Cristiano Fava

  2. Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy

    Alessandro Giollo, Giovanni Cioffi, Giovanni Orsolini, Federica Ognibeni, Maurizio Rossini & Ombretta Viapiana

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  1. Andrea Dalbeni
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Correspondence to Andrea Dalbeni.

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Dalbeni, A., Giollo, A., Bevilacqua, M. et al. Traditional cardiovascular risk factors and residual disease activity are associated with atherosclerosis progression in rheumatoid arthritis patients. Hypertens Res 43, 922–928 (2020). https://doi.org/10.1038/s41440-020-0441-1

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