Extent of subclinical macrovascular disease n patients with rheumatoid arthritis and the related vascular risk factors

ABSTRACT

To compare the extent of subclinical macrovascular disease [atherosclerosis] and the related potential vascular risk factors including thrombotic variables in patients with well controlled rheumatoid arthritis [RA], and in population controls. Fifty RA patients were compared with an age and sex matched fifty controls. Traditional vascular risk factors such as smoking, high blood pressure, blood sugar, lipids and steroid usage were assessed. Also thrombotic variables including plasma fibrinogen, von Willebrand factor antigen [vWE], tissue plasminogen activator antigen [t-PA] and fibrin D-dimer were assessed. Non invasive vascular tests including; carotid duplex scanning for measuring common carotid artery intima-media thickness [IMT], QT dispersion on ECG [QTD], and ankle-brachial blood pressure index [ABPI] were performed for patients and controls. The average IMT mean [SE] in RA patients was 0.79 [0.07] mm, compared with 0.63 [0.04] mm in the control group [P=0.001, MW]. QTD was higher in RA patients; mean [S.E] 58 [3.6] ms compared with 44 [2.9] ms for controls [P0.001, MW]. Low ABPI [< 1.0] was found in 14 out of 50 RA patients [28%] vs 3 out of 50 controls [6%] [P=0.001, X2 - test], all these results were statistically significant. There were no significant differences in the prevalence of traditional risk factors between RA patients and controls. RA patients who received long-term steroid showed significant positive correlation in the prevalence of macrovascular disease; IMT [P=0.02], QTD [P=0.032], and ABPI [0.03], Pearson's correlation test. Significant elevations of thrombotic variables were found in RA patients [fibrinogen [P=0.001], vWF [P=0.001], t-PA [P=0.006] and fibrin D-dimer [P=0.028], t-test] compared with controls. High thrombotic variables within the RA patients correlated positively with the prevalence of macrovascular disease. PA patients have an increased risk for subclinical macrovascular disease [atherosclerosis] as shown by the high prevalence of carotid disease [increased IMT], cardiac disease [prolonged QTD] and peripheral arterial disease [lower ABPI]. Among the related vascular risk factors, we found that long term steroid therapy and increased thrombotic variables are potential risk factors