RESEARCH - Increased prevalence of carotid artery atherosclerosis in RA is artery-specific

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Increased Prevalence of Carotid Artery Atherosclerosis in Rheumatoid

Arthritis Is Artery-specific

HITOMI KOBAYASHI, JON T. GILES, JOSEPH F. POLAK, ROGER S. BLUMENTHAL,

MARY S. LEFFELL, MOYSES SZKLO, MICHELLE PETRI, ALLAN C. GELBER, WENDY

POST and JOAN M. BATHON

+ Author Affiliations

From the Divisions of Rheumatology, Cardiology, and Immunogenetics,

Department of Medicine, and Bloomberg School of Public Health, s

Hopkins Medical Institutions, Baltimore, land; and Tufts-New

England Medical Center, Boston, Massachusetts, USA.

H. Kobayashi, MD; J.T. Giles, MD, MPH, Division of Rheumatology, s

Hopkins Medical Institutions; J.F. Polak, MD, Tufts-New England

Medical Center; R.S. Blumenthal, MD, Division of Cardiology; M.S.

Leffell, MD, Division of Immunogenetics; M. Szklo, MD, MPH, Bloomberg

School of Public Health; M. Petri, MD; A.C. Gelber, MD, PhD, Division

of Rheumatology; W. Post, MD, Division of Cardiology; J.M. Bathon,

Division of Rheumatology, s Hopkins Medical Institutions.

Address correspondence to Dr. J.M. Bathon, Division of Rheumatology,

s Hopkins University School of Medicine, 5200 Eastern Ave., Suite

4100, Baltimore, MD 21224.

Abstract

Objective. Cardiovascular (CV) morbidity and mortality are increased

in rheumatoid arthritis (RA). Prior investigations of the association

of RA with measures of carotid atherosclerosis have yielded

conflicting results. We compared carotid intima-media thickness (IMT)

of both the common carotid (CCA) and proximal internal carotid

(bulb-ICA) arteries, and plaque prevalence, between RA and non-RA

participants.

Methods. Subjects with RA were participants in a cohort study of

subclinical CV disease in RA. Non-RA controls were selected from the

Multi-Ethnic Study of Atherosclerosis. Both groups underwent B-mode

ultrasonography of the right and left CCA and bulb-ICA. Linear

regression was used to model the association of RA status with CCA and

bulb-ICA-IMT, and logistic regression for the association of RA status

with plaque.

Results. We compared 195 RA patients to 198 non-RA controls. CV risk

factors were similarly distributed, except for a higher prevalence of

hypertension in the RA group. Mean adjusted bulb-ICA-IMT was higher in

RA patients than controls (1.16 vs 1.02 mm, respectively; p < 0.001),

while mean adjusted CCA-IMT did not differ significantly. After

adjusting for CV risk factors, the odds of plaque were significantly

increased in RA participants compared to controls (OR 2.41, 95% CI

1.26–4.61). The association of gender, age, smoking, and hypertension

with bulb-ICA-IMT and plaque did not significantly differ by RA

status. Interleukin 6 was strongly associated with bulb-ICA-IMT and

plaque in controls but not in RA patients. In the RA group, shared

epitope was associated with an increased prevalence of plaque.

Conclusion. Compared to controls, RA was associated with a higher

prevalence and higher severity of atherosclerosis in the bulb-ICA but

not the CCA. Our data suggest that future studies in RA that utilize

carotid artery measurements should include assessment of the bulb-ICA.

http://jrheum.org/content/37/4/730.abstract

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