Independent association of increased trunk fat with increased arterial stiffening in postmenopausal patients with rheumatoid arthritis.

OBJECTIVE: We recently reported increased arterial thickening and stiffening in patients with rheumatoid arthritis (RA) to which inflammation and increased bone resorption contributed. The current study examined the possible involvement of trunk fat in increased arterial stiffening in postmenopausal patients with RA. METHODS: RA patients (n = 30) and healthy controls (n = 30), all postmenopausal women, were examined for body adiposity and brachial-ankle pulse wave velocity (baPWV) by dual-energy x-ray absorptiometry and waveform analyzer, respectively. Subjects having other diseases and predisposed to atherosclerosis were excluded. Trunk:peripheral fat ratio was calculated as the fat mass of the trunk divided by the sum of the fat mass of arms and legs. Bone mineral density (BMD) at ultradistal radius was measured by peripheral quantitative computed tomography. Inflammation markers and bone resorption markers were also measured. RESULTS: Age, body mass index, and systolic blood pressure (BP) of RA patients were 60.8 +/- 9.8 years, 22.5 +/- 3.3, and 129.6 +/- 20.8 mm Hg, respectively, which did not differ from data from healthy controls. Duration of RA was 10.4 years with mean daily dose of prednisolone 3.02 +/- 3.85 mg. RA patients exhibited a significantly greater trunk:peripheral fat ratio (1.041 +/- 0.253 vs 0.839 +/- 0.223; p < 0.001) and baPWV value (1544.7 +/- 304.9 vs 1373.8 +/- 256.1; p < 0.005) than healthy controls. In RA patients, age (r = 0.588, p < 0.001), systolic BP (r = 0.553, p < 0.005), trabecular BMD at ultradistal radius (r = -0.346, p = 0.061), and trunk:peripheral fat ratio (r = 0.366, p = 0.046) were correlated with baPWV. Trunk:peripheral fat ratio did not differ significantly between RA patients with and those without prednisolone treatment. In multiple regression analysis that included age, systolic BP, and trunk:peripheral fat ratio as independent variables, the trunk:peripheral fat ratio emerged as an independent factor significantly associated with baPWV in RA patients. When trabecular BMD at ultradistal radius was inserted in place of trunk:peripheral fat ratio, it emerged as a factor that was significantly associated with baPWV. CONCLUSION: We showed that increased trunk fat was significantly and independently associated with increased arterial stiffening in postmenopausal patients with RA.

Paraarticular trabecular bone loss at the ultradistal radius and increased arterial stiffening in postmenopausal patients with rheumatoid arthritis.

OBJECTIVE: We recently reported enhanced arterial thickening in patients with rheumatoid arthritis (RA) and the importance of increased bone resorption in this process. Our aim was to examine whether arterial stiffening, another aspect of atherosclerosis, is also increased in patients with RA, and to determine if it is an important risk factor. METHODS: The subjects were 47 patients with RA and 49 healthy controls, all postmenopausal women. Subjects having risk factors for atherosclerosis were excluded. Femoral-ankle (fa) pulse wave velocity (PWV) and brachial-ankle (ba) PWV were measured in all patients using a waveform analyzer. Bone mineral density (BMD) at the ultradistal radius was assessed by peripheral quantitative computed tomography. Inflammation markers (C-reactive protein, erythrocyte sedimentation rate, rheumatoid factor, platelet count) and bone resorption markers (urinary excretion of deoxypyridinoline and N-terminal telopeptide) were also measured. RESULTS: The median values of faPWV and baPWV in RA patients were 1124 cm/s [interquartile range (IQR) 1040-1175] and 1539 cm/s (IQR 1297-1738), respectively, which were significantly greater than the respective values of 982 cm/s (IQR 819-1054; p < 0.001) and 1322 cm/s (IQR 1112-1398; p = 0.004) in controls. In multiple regression analysis, the presence of RA emerged as an independent factor associated with the greater faPWV and baPWV when adjusted for age, blood pressure, and smoking. In RA patients alone, BMD in the trabecular bone component, but not for the total bone (cortical plus trabecular), at the ultradistal radius correlated significantly with both faPWV and baPWV. Multiple regression analysis showed that trabecular BMD at the distal radius was a significant factor independently associated with greater faPWV and baPWV when adjusted for age, blood pressure, and smoking. None of the measured inflammation markers or bone resorption markers correlated with either faPWV or baPWV in patients with RA. CONCLUSION: Patients with RA show increased arterial stiffening, in addition to the arterial thickening we have previously reported, supporting the notion of enhanced atherosclerosis in RA patients. Paraarticular bone loss in the trabecular bone component at the ultradistal radius is a factor significantly associated with increased arterial stiffening in RA patients.

Increased arterial stiffening and thickening in the paretic lower limb in patients with hemiparesis.

Atherosclerosis has two key components, thickening and stiffening of arterial wall. These parameters are quantified ultrasonographically by IMT (intima-media thickness) and PWV (pulse wave velocity). In the present study, we determined the FA IMT (IMT of the bilateral femoral artery) and PWV of femoral-ankle (PWV fa) and brachial-ankle (PWV ba) segments in order to examine whether the degree of atherosclerosis is different between paretic and non-paretic lower limbs in 24 patients with hemiparesis. The values of PWV fa, PWV ba and FA IMT were all significantly greater on the paretic than the non-paretic side. Furthermore, significant decreases in masses of muscle, bone and fat, determined by dual-energy X-ray absorptiometry, were observed in paretic lower limbs compared with the non-paretic side. PWV fa correlated significantly and negatively with muscle mass ( r =-0.488, P =0.0004) and tended to correlate negatively with BMC (bone mineral content; r =-0.264, P =0.069) when statistical analyses were performed with the paretic and non-paretic sides together. Multiple regression analysis elucidated that the muscle mass was associated significantly with PWV fa and PWV ba, independent of age, duration after cerebrovascular accident, gender, bone and fat mass and FA IMT. The muscle mass was still associated with increased PWV fa and PWV ba when multivariate analysis was conducted independently in the paretic and non-paretic sides. In summary, our results indicated that arterial thickening and stiffening were greater on the paretic than the non-paretic side and suggested that a decrease of muscle mass might be associated with increased arterial stiffening in the paretic lower limb.