RESEARCH - Cardiovascular risk factors are associated with atherosclerosis in RA

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J Rheumatol. 2005 Mar;32(3):435-42.

Traditional and nontraditional cardiovascular risk factors are associated

with atherosclerosis in rheumatoid arthritis.

Dessein PH, Joffe BI, Veller MG, s BA, Tobias M, Reddi K, Stanwix AE.

Department of Rheumatology, Johannesburg Hospital, Johannesburg, South

Africa.

OBJECTIVE: To determine the association between cardiovascular (CV) risk

factors and atherosclerosis in patients with rheumatoid arthritis (RA).

METHODS: The common carotid artery intima-media thickness (IMT) and plaque

were evaluated by high resolution B-mode ultrasound in 74 consecutive

patients with RA. Patients with an IMT >/= 0.60 mm and plaque were

considered to have atherosclerosis and advanced atherosclerosis,

respectively. Traditional risk factors as well as an extensive range of

other clinical and laboratory variables were recorded. Methods used to

analyze the data included logistic regression, classification and regression

tree (CART), and factor analyses. RESULTS: Fifty-three (72%) patients had

atherosclerosis, 23 (31%) had plaque, and 21 (28%) were free of

atherosclerosis. In multivariable analysis, age and hypertension were

independently associated with atherosclerosis and plaque (p </= 0.04).

Radiographic scores and polymorphonuclear cell counts were also strongly

associated with plaque (p </= 0.008). Uric acid concentrations were

associated with atherosclerosis, and hypothyroidism was associated with

plaque, both with borderline significance (p = 0.078 and 0.052,

respectively). In CART analysis, age, polymorphonuclear cell counts, and

joint space narrowing in the hands were considered to be the most important

determinants of plaque, and 62% of patients could be classified correctly

after cross-validation. Factor analysis (varimax rotation) revealed that age

and uric acid levels were related to low glomerular filtration rates,

polymorphonuclear cell counts to disease activity, and radiographic scores

to disease duration, and hypertension was associated with high cholesterol

levels. The 10-year risk for a coronary event estimated using the Framingham

risk equation (calculated from traditional risk factors) was only 7% in

patients with plaque.

CONCLUSION: Atherosclerosis in RA is associated with the traditional CV risk

factors age and hypertension, as well as nontraditional risk factors

comprising current inflammation as reflected by polymorphonuclear cell

counts, cumulative inflammation as disclosed by radiographic scores, and, to

a lesser extent, with uric acid levels and hypothyroidism. Multiple risk

factor assessment equations that are based on traditional risk factors only

are likely to be insufficient to capture CV risk extent in RA.

PMID: 15742434

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