RESEARCH - Role of insulin resistance in increased frequency of atherosclerosis in RA

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J Rheumatol. 2006 Dec;33(12):2447-52.

Role of insulin resistance in increased frequency of atherosclerosis

detected by carotid ultrasonography in rheumatoid arthritis.

Pamuk ON, Unlu E, Cakir N.

OBJECTIVE: We evaluated the presence of subclinical atherosclerosis and

factors influencing atherosclerosis, including insulin resistance (IR), in

patients with rheumatoid arthritis (RA). METHODS: Sixty-three patients with

RA and 34 controls were studied. Patients' cardiovascular risk factors were

recorded; biochemical variables were determined. Intima-media thickness

(IMT) of carotid arteries was determined by B-mode ultrasonography, and

presence of atheromatous plaques was determined. IR was calculated according

to the HOMA-IR homeostasis model. RESULTS: There were no differences in

atherosclerotic risk factors between patients with RA and controls. In the

RA group, the median carotid IMT was 0.61 mm (range 0.56-0.74), greater than

the 0.54 mm (range 0.50-0.64) in controls (p = 0.01). There was a tendency

to a higher frequency of carotid plaques in the RA group compared to

controls [12 RA patients (19%) vs 2 controls (5.9%); p = 0.10]. Multivariate

regression analysis revealed the factors that had an independent effect on

increased carotid IMT: age (p < 0.001), male sex (p = 0.01), and total

cholesterol level (p = 0.02). In RA patients with plaques, age (64.5 vs 48

yrs; p = 0.005), carotid IMT (0.75 vs 0.60 mm; p = 0.001), frequency of

hypertension (58.3% vs 23.5%; p = 0.03), and IR (83.3% vs 29.4%; p = 0.001)

were higher. Multivariate logistic regression analysis showed that factors

independently associated with the presence of plaques were IR (OR 15.85, 95%

CI 2.23-112.89, p = 0.006) and age (OR 1.11, 95% CI 1.02-1.21, p = 0.02). In

RA patients, HOMA-IR correlated with age (r = 0.26, p = 0.04), Health

Assessment Questionnaire score (r = 0.28, p = 0.04), and concentrations of

triglyceride (r = 0.39, p = 0.003) and cholesterol (r = 0.33, p = 0.02).

CONCLUSION: IR in the setting of active rheumatoid disease may contribute to

mechanisms of accelerated atherogenesis observed in patients with RA.

PMID: 17143979

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

7143979

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