RESUMO
AIM: To examine the significance of conventional cardiovascular factors of risk and immunoinflammatory markers in development of vascular atherosclerosis in rheumatoid arthritis (RA). MATERIAL AND METHODS: Conventional cardiovascular risk factors were evaluated in 103 RA patients (85 females and 18 males, mean age 46.3 years, duration of the disease 75 months). Forty six controls (32 females and 14 males) had no rheumatic diseases. Vascular atherosclerosis was diagnosed at ultrasonic scanning of the carotid arteries. Highly sensitive C-reactive protein (hsCRP) concentration in the blood serum was measured with highly sensitive enzyme immunoassay. RESULTS: No differences by the rate of conventional cardiovascular risk factors between the groups were identified except arterial hypertension. Cardiovascular complications (ischemic heart disease, myocardial infarction, transient ischemic attacks) occurred more frequently in RA patients. Intima/media complex (IMC) thickness differences between the groups were not registered. Atherosclerotic plaques were detected more often in RA patients. In RA patients there was a correlation between IMC thickness in the carotid arteries and age (p = 0.00001), systolic blood pressure (p = 0.001) and diastolic blood pressure (p = 0.01), concentration of blood cholesterol (C) (p = 0.03) and total coronary risk (TCR) (p = 0.003). Correlation between carotid artery IMC thickness, duration and activity of the disease, RA systemic manifestations was not detected (p > 0.05). A mean concentration of hsCRP in RA was higher than in the controls: 2.8 (4.4-25.6) mg/l and 1.3 (0.6-2.7) mg/ml, respectively (p = 0.001). A positive correlation existed between concentration of hsCRP and DAS4 (p = 0.0004) and negative--with C concentration (p = 0.01), LDL C, HDL C (p = 0.02). Increased concentration of hsCRP, IMC thickness in the carotid arteries, existence of atherosclerotic plaques and clinical picture of vascular atherosclerosis related insignificantly. CONCLUSION: RA patients often suffer from cardiovascular pathology. Immunological markers of inflammation, primarily, hsCRP, in addition to conventional cardiovascular risk factors are essential in development of vascular atherosclerosis.
