RESEARCH - RA patients at high risk for preclinical carotid atherosclerosis

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RA patients at high risk for preclinical carotid atherosclerosis

Feb 21, 2006 Gandey

New York, NY - Patients with rheumatoid arthritis (RA) have an accelerated

risk of developing atherosclerosis, researchers say. Reporting in the

February 21, 2006 issue of the ls of Internal Medicine, the authors

emphasize that the threefold increased risk is independent of traditional

risk factors, including age [1]. They call for aggressive control of RA

disease activity to curb chronic inflammation, which they say may be the

source of premature atherosclerosis.

In this cross-sectional study, researchers led by Dr Roman (Weill

Medical College of Cornell University, New York) consecutively recruited 98

patients with RA. They were matched with controls on age, sex, and

ethnicity. Subjects ranged in age from 20 to 83 years, with a mean age at

diagnosis of 35.

The researchers assessed cardiovascular risk and conducted carotid

ultrasonography in all participants. They recorded disease severity,

treatment, and inflammatory markers. They found that despite a more

favorable risk-factor profile, patients with RA had experienced a spike in

carotid atherosclerotic plaque (44% vs 15%, p<0.001).

The researchers also found that the relationship between rheumatoid

arthritis and carotid atherosclerotic plaque remained after accounting for

age, serum cholesterol levels, smoking history, and hypertensive status. The

adjusted predicted prevalence was 38.5% for RA patients (95% CI 25.4%-53.5%)

and 7.4% for the control group (95% CI 3.4%-15.2%). Age and current

cigarette use were also significantly associated with carotid

atherosclerotic plaque (p<0.001 and p<0.014).

The challenge of addressing cardiovascular risk factors in RA

" In addition to prospective management of traditional risk factors, " Roman

and her team write, " we emphasize the need for aggressive control of

rheumatoid arthritis disease activity, because chronic inflammation is

probably a driving force for premature atherosclerosis. " They add that

carotid ultrasonography is a simple and inexpensive way of identifying

preclinical atherosclerosis in this highly vulnerable population.

The authors of another study, published in the February 2006 issue of the

Journal of Rheumatology, came to a similar conclusion [2]. They found that a

third of their cohort of RA patients in India had subclinical

atherosclerosis. " An increased carotid intima-media thickness in patients

with RA in our study provides valuable confirmation to earlier reports in

Korean, Japanese, British, and Spanish patients using similar methodology, "

comment the researchers, led by Dr Sundeep Grover (Sanjay Gandhi

Postgraduate Institute of Medical Sciences, Lucknow, India).

" These are important findings, " write Drs Dessein and Barry Joffe

(University of the Witwatersrand, Johannesburg, South Africa) in an

accompanying editorial [3]. But they are quick to add that these results

cannot be generalized, since more than 80% of RA patients have at least one

modifiable traditional risk factor. " Specifically, this study design

precludes the determination of the relative contribution of traditional vs

nontraditional risk factors to cardiovascular disease in the RA population

at large. " To address this issue, they say, cohorts of unselected patients

are needed.

The editorialists note that while cardiovascular disease is challenging to

address in the general population, it is even more so in RA. " Traditional

risk factors, a range of nontraditional risk factors that are RA

characteristics, as well as risk-factor interactions, are all likely to be

involved. "

They suggest that until optimal preventive strategies can be defined on the

basis of results from longitudinal studies, comprehensive assessment and

treatment of traditional and nontraditional cardiovascular risk factors

should form part of the routine care of the RA patient.

Sources

1. Roman MJ, Moeller E, A, et al. Preclinical carotid

atherosclerosis in patients with rheumatoid arthritis. Ann Intern Med 2006;

144:249-256.

2. Grover S, Sinha RP, Singh U, et al. Subclinical

atherosclerosis in rheumatoid arthritis in India. J Rheumatol 2006;

33:244-247.

3. Dessein PH, Joffe BI. When is a patient with rheumatoid

arthritis at risk for cardiovascular disease? J Rheumatol 2006; 33:201-203.

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