RESEARCH - RA is associated with increased pulse-wave velocity, which is reduced by anti-TNF therapy

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Circulation. 2006;114:1185-1192.)

© 2006 American Heart Association, Inc.

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Vascular Medicine

Rheumatoid Arthritis Is Associated With Increased Aortic Pulse-Wave

Velocity, Which Is Reduced by Anti–Tumor Necrosis Factor- Therapy

Kaisa M. Mäki-Petäjä, BSc; Frances C. Hall, MRCP, PhD; D.

Booth, MD, MRCP; Sharon M.L. Wallace, BA; Yasmin, PhD; Philip W.P.

Bearcroft, FRCR, FRCP; Srinivasan Harish, MBBS, FRCS, FRCR; Anita

Furlong, RN; Carmel M. McEniery, PhD; Brown, FRCP, DM; Ian B.

Wilkinson, FRCP, DM

From the Clinical Pharmacology Unit (K.M.M.-P., A.D.B., S.M.L.W., Y.,

C.M.M., I.B.W.) and Department of Clinical Medicine (F.C.H., A.F.),

University of Cambridge; Department of Radiology (P.W.P.B., S.H.),

Addenbrooke’s Hospital; and Trinity College (J.B.), University of

Cambridge, Cambridge, United Kingdom.

Received November 14, 2005; revision received May 23, 2006; accepted

June 8, 2006.

Background— Rheumatoid arthritis (RA) is associated with increased

cardiovascular risk, which is not explained by traditional

cardiovascular risk factors but may be due in part to increased aortic

stiffness, an independent predictor of cardiovascular mortality. In

the present study, our aim was to establish whether aortic stiffness

is increased in RA and to investigate the relationship between

inflammation and aortic stiffness. In addition, we tested the

hypothesis that aortic stiffness could be reduced with anti–tumor

necrosis factor- (TNF-) therapy.

Methods and Results— Aortic pulse-wave velocity (PWV), augmentation

index, and blood pressure were measured in 77 patients with RA and in

142 healthy individuals. Both acute and chronic inflammatory measures

and disease activity were determined. The effect of anti-TNF- therapy

on PWV and endothelial function was measured in 9 RA patients at 0, 4,

and 12 weeks. Median (interquartile range) aortic PWV was

significantly higher in subjects with RA than in control subjects

(8.35 [7.14 to 10.24] versus 7.52 [6.56 to 9.18] m/s, respectively;

P=0.005). In multiple regression analyses, aortic PWV correlated

independently with age, mean arterial pressure, and log-transformed

C-reactive protein (R2=0.701; P<0.0001). Aortic PWV was reduced

significantly by anti-TNF- therapy (8.82±2.04 versus 7.94±1.86 versus

7.68±1.56 m/s at weeks 0, 4, and 12, respectively; P<0.001);

concomitantly, endothelial function improved.

Conclusions— RA is associated with increased aortic stiffness, which

correlates with current but not historical measures of inflammation,

suggesting that increased aortic stiffness may be reversible. Indeed,

anti-TNF- therapy reduced aortic stiffness to a level comparable to

that of healthy individuals. Therefore, effective control of

inflammation may be of benefit in reducing cardiovascular risk in

patients with RA.

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Read the full article here:

http://circ.ahajournals.org/cgi/content/full/114/11/1185

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