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Growth Differentiation Factor-15 as a Potent Predictor of Long-Term Mortality among Subjects with Osteoarthritis. J Clin Med 2020; 9:jcm9103107. [PMID: 32993054 PMCID: PMC7650798 DOI: 10.3390/jcm9103107] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/18/2020] [Accepted: 09/24/2020] [Indexed: 11/20/2022] Open
Abstract
Background: Subjects with osteoarthritis (OA) are at increased risk for cardiovascular (CV) and all-cause mortality. Whether biomarkers improve outcome prediction in these patients remains to be elucidated. We investigated the association between growth differentiation factor 15 (GDF-15), a novel stress-responsive cytokine, and long-term all-cause mortality among OA patients. Methods: Within the Ulm Osteoarthritis Study, GDF-15 has been measured in the serum of 636 subjects, who underwent hip or knee arthroplasty between 1995 and 1996 (median age 65 years). Results: During a median follow-up of 19.7 years, a total of 402 deaths occurred. GDF-15 was inversely associated with walking distance. Compared to the bottom quartile (Q), subjects within the top quartile of GDF-15 demonstrated a 2.69-fold increased risk of dying (hazard ratio (HR) (95% confidence interval (CI)) 2.69 (1.82–3.96) adjusted for age, sex, BMI, smoking status, localization of OA, diabetes, maximum walking distance, total cholesterol, and cystatin C. Further adjustment for NT-proBNP, troponin I, and hs-C-reactive protein did not change the results appreciably (HR (95%CI) 1.56 (1.07–2.28); 1.75 (1.21–2.55); 2.32 (1.55–3.47) for Q2, Q3, and Q4 respectively, p for trend < 0.001). Conclusions: In subjects with OA, GDF-15 represents a potent predictor of decreased survival over >20 years, independently of conventional CV risk factors, renal, cardiac, and inflammatory biomarkers as well as walking disability, previously associated with increased mortality and lower extremity OA.
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Mankad R, Lopez-Jimenez F. Cardiovascular risk in lupus: looking beyond the score. Eur J Prev Cardiol 2020; 28:344-345. [PMID: 33623992 DOI: 10.1093/eurjpc/zwaa009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Rekha Mankad
- Mayo Clinic Department of Cardiovascular Diseases Rochester, MN
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Løgstrup BB, Olesen KKW, Masic D, Gyldenkerne C, Thrane PG, Ellingsen T, Bøtker HE, Maeng M. Impact of rheumatoid arthritis on major cardiovascular events in patients with and without coronary artery disease. Ann Rheum Dis 2020; 79:1182-1188. [PMID: 32471895 DOI: 10.1136/annrheumdis-2020-217154] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/15/2020] [Accepted: 05/15/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a risk factor for cardiovascular disease. The clinical consequences of coincident RA and coronary artery disease (CAD) are unknown. OBJECTIVE We aimed to estimate the impact of RA on the risk of adverse cardiovascular events in patients with and without CAD. METHODS A population-based cohort of patients registered in the Western Denmark Heart Registry, who underwent coronary angiography (CAG) between 2003 and 2016, was stratified according to the presence of RA and CAD. Endpoints were myocardial infarction (MI), major adverse cardiovascular events (MACE; MI, ischaemic stroke and cardiac death) and all-cause mortality. RESULTS A total of 125 331 patients were included (RA: n=1732). Median follow-up was 5.2 years. Using patients with neither RA nor CAD as reference (cumulative MI incidence 2.7%), the 10-year risk of MI was increased for patients with RA alone (3.8%; adjusted incidence rate ratio (IRRadj) 1.63, 95% CI 1.04 to 2.54), for patients with CAD alone (9.9%; IRRadj 3.35, 95% CI 3.10 to 3.62), and highest for patients with both RA and CAD (12.2%; IRRadj 4.53, 95% CI 3.66 to 5.59). Similar associations were observed for MACE an all-cause mortality. CONCLUSIONS In patients undergoing CAG, RA is significantly associated with the 10-year risk of MI, MACE and all-cause mortality regardless of the presence of CAD. However, patients with RA and CAD carry the largest risk, while the additive risk of RA in patients without CAD is minor. Among patients with RA, risk stratification by presence or absence of documented CAD may allow for screening and personalised treatment strategies.
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Affiliation(s)
| | | | - Dzenan Masic
- Department of Rheumatology, Silkeborg Regional Hospital, Silkeborg, Denmark
| | | | | | - Torkell Ellingsen
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Hans Erik Bøtker
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Michael Maeng
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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Jamthikar AD, Gupta D, Puvvula A, Johri AM, Khanna NN, Saba L, Mavrogeni S, Laird JR, Pareek G, Miner M, Sfikakis PP, Protogerou A, Kitas GD, Kolluri R, Sharma AM, Viswanathan V, Rathore VS, Suri JS. Cardiovascular risk assessment in patients with rheumatoid arthritis using carotid ultrasound B-mode imaging. Rheumatol Int 2020; 40:1921-1939. [PMID: 32857281 PMCID: PMC7453675 DOI: 10.1007/s00296-020-04691-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 08/18/2020] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis (RA) is a systemic chronic inflammatory disease that affects synovial joints and has various extra-articular manifestations, including atherosclerotic cardiovascular disease (CVD). Patients with RA experience a higher risk of CVD, leading to increased morbidity and mortality. Inflammation is a common phenomenon in RA and CVD. The pathophysiological association between these diseases is still not clear, and, thus, the risk assessment and detection of CVD in such patients is of clinical importance. Recently, artificial intelligence (AI) has gained prominence in advancing healthcare and, therefore, may further help to investigate the RA-CVD association. There are three aims of this review: (1) to summarize the three pathophysiological pathways that link RA to CVD; (2) to identify several traditional and carotid ultrasound image-based CVD risk calculators useful for RA patients, and (3) to understand the role of artificial intelligence in CVD risk assessment in RA patients. Our search strategy involves extensively searches in PubMed and Web of Science databases using search terms associated with CVD risk assessment in RA patients. A total of 120 peer-reviewed articles were screened for this review. We conclude that (a) two of the three pathways directly affect the atherosclerotic process, leading to heart injury, (b) carotid ultrasound image-based calculators have shown superior performance compared with conventional calculators, and (c) AI-based technologies in CVD risk assessment in RA patients are aggressively being adapted for routine practice of RA patients.
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Affiliation(s)
- Ankush D Jamthikar
- Department of Electronics and Communications Engineering, Visvesvaraya National Institute of Technology, Nagpur, MH, India
| | - Deep Gupta
- Department of Electronics and Communications Engineering, Visvesvaraya National Institute of Technology, Nagpur, MH, India
| | | | - Amer M Johri
- Department of Medicine, Division of Cardiology, Queen's University, Kingston, ON, Canada
| | - Narendra N Khanna
- Department of Cardiology, Indraprastha APOLLO Hospitals, New Delhi, India
| | - Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (A.O.U.), Cagliari, Italy
| | - Sophie Mavrogeni
- Cardiology Clinic, Onassis Cardiac Surgery Center, Athens, Greece
| | - John R Laird
- Heart and Vascular Institute, Adventist Health St. Helena, St Helena, CA, USA
| | - Gyan Pareek
- Minimally Invasive Urology Institute, Brown University, Providence, RI, USA
| | - Martin Miner
- Men's Health Center, Miriam Hospital, Providence, RI, USA
| | - Petros P Sfikakis
- Rheumatology Unit, National Kapodistrian University of Athens, Athens, Greece
| | - Athanasios Protogerou
- Department of Cardiovascular Prevention, National and Kapodistrian University of Athens, Athens, Greece
| | - George D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
| | | | - Aditya M Sharma
- Division of Cardiovascular Medicine, University of Virginia, Charlottesville, VA, USA
| | - Vijay Viswanathan
- MV Hospital for Diabetes and Professor M Viswanathan Diabetes Research Centre, Chennai, India
| | - Vijay S Rathore
- Nephrology Department, Kaiser Permanente, Sacramento, CA, USA
| | - Jasjit S Suri
- Stroke Monitoring and Diagnostic Division, AtheroPoint™, Roseville, CA, 95661, USA.
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Mizus MC, Tiniakou E. Lipid-lowering Therapies in Myositis. Curr Rheumatol Rep 2020; 22:70. [PMID: 32845379 PMCID: PMC7986053 DOI: 10.1007/s11926-020-00942-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE OF REVIEW The use of lipid-lowering therapies in patients with idiopathic inflammatory myopathies (IIM) is complicated and there are no guidelines for diagnosing, monitoring, or treating atherosclerotic cardiovascular disease (ASCVD) in this group of patients. RECENT FINDINGS The use of lipid-lowering therapies, especially statins, is recommended in patients with increased risk for ASCVD, which includes patients with inflammatory diseases, based on recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines for ASCVD management. There is accumulating evidence that patients with IIM are at increased risk for ASCVD, similar to other inflammatory diseases. Lipid-lowering therapies have side effects that may be pronounced or confounding in myositis patients, potentially limiting their use. Statins are specifically contraindicated in patients with anti 3-hydroxy-3-methylglutaryl-CoA reductase (HMGCR) antibodies. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have been shown to be safe and potentially beneficial in patients with IIM. Here, we propose a framework for (1) ASCVD risk assessment and treatment based on ACC/AHA ASCVD primary prevention guidelines; (2) myositis disease monitoring while undergoing lipid-lowering therapy; and (3) management of statin intolerance, including, indications for the use of PCSK9 inhibitors.
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Affiliation(s)
- Marisa C Mizus
- Department of Medicine, Division of Rheumatology, Mason Lord, Center Tower, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
| | - Eleni Tiniakou
- Department of Medicine, Division of Rheumatology, Mason Lord, Center Tower, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD, 21224, USA.
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GlycA Levels during the Earliest Stages of Rheumatoid Arthritis: Potential Use as a Biomarker of Subclinical Cardiovascular Disease. J Clin Med 2020; 9:jcm9082472. [PMID: 32752190 PMCID: PMC7463667 DOI: 10.3390/jcm9082472] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/22/2020] [Accepted: 07/29/2020] [Indexed: 02/06/2023] Open
Abstract
This study aimed at evaluating the clinical relevance of glycoprotein profiles during the earliest phases of rheumatoid arthritis (RA) as biomarkers of cardiovascular (CV) risk and treatment response. Then, GlycA and GlycB serum levels were measured using 1H-nuclear magnetic resonance in 82 early RA patients, 14 clinically-suspect arthralgia (CSA), and 28 controls. Serum glycosyltransferase activity was assessed by a colorimetric assay. Subclinical CV disease was assessed by Doppler-ultrasound. We found that GlycA and GlycB serum levels were increased in RA (both p < 0.001), but not in CSA, independently of cardiometabolic risk factors. Increased serum glycosyltransferase activity paralleled GlycA (r = 0.405, p < 0.001) and GlycB levels (r = 0.327, p = 0.005) in RA. GlycA, but not GlycB, was associated with atherosclerosis occurrence (p = 0.012) and severity (p = 0.001). Adding GlycA to the mSCORE improved the identification of patients with atherosclerosis over mSCORE alone, increasing sensitivity (29.7 vs. 68.0%) and accuracy (55.8 vs. 76.6%) and allowing reclassification into more appropriate risk categories. GlycA-reclassification identified patients with impaired lipoprotein metabolism. Finally, baseline GlycA levels predicted poor clinical response upon anti-rheumatic treatment at 6 and 12 months in univariate and multivariate analysis. In sum, increased GlycA levels during the earliest stage of RA can be considered a powerful biomarker for CV risk stratification and treatment response.
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Björsenius I, Rantapää-Dahlqvist S, Berglin E, Södergren A. Extent of atherosclerosis after 11-year prospective follow-up in patients with early rheumatoid arthritis was affected by disease severity at diagnosis. Scand J Rheumatol 2020; 49:443-451. [PMID: 32691642 DOI: 10.1080/03009742.2020.1767200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Objective: Cardiovascular disease (CVD) is increased among patients with rheumatoid arthritis (RA). The underlying cause is not clear. In this prospective study, patients with early RA were investigated for associations between subclinical atherosclerosis and CVD risk factors as well as inflammation. Method: At diagnosis, RA patients were recruited into a prospective study. A subgroup was included (n = 55) for ultrasound measurements of intima-media thickness (IMT) at inclusion (T0), and after 5 years (T5) and 11 years (T11). Thirty-one age and gender-matched controls were also included for comparison. Results: IMT increased significantly between T0 and T11 among patients and controls (p < 0.0001). No statistically significant differences in IMT between patients and controls were detected at T11, T5, or T0 (p > 0.05 for all). In simple regression models, IMT at T11 was significantly associated with age (p < 0.0001), as well as systolic blood pressure at T0 (p < 0.01) and T11 (p < 0.01) among RA patients. Furthermore, the composite Systematic COronary Risk Evaluation (SCORE) measurements (p < 0.0001) and Reynolds risk score (p < 0.01) and the radiographic Larsen score (p < 0.05) at T0 were all significantly associated with IMT at T11. Results from conditional logistic regression analysis showed an increased progression rate between T0 and T11 in the RA group compared with controls (p < 0.05). Conclusion: We found increased atherosclerotic development among patients with RA compared with controls 11 years after diagnosis. The atherosclerotic burden was associated with disease severity at baseline.
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Affiliation(s)
- I Björsenius
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University , Umeå, Sweden
| | - S Rantapää-Dahlqvist
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University , Umeå, Sweden
| | - E Berglin
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University , Umeå, Sweden
| | - A Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University , Umeå, Sweden.,Wallenberg Centre for Molecular Medicine (WCMM), Umeå University , Umeå, Sweden
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Atherosclerotic cardiovascular disease prevention in rheumatoid arthritis. Nat Rev Rheumatol 2020; 16:361-379. [PMID: 32494054 DOI: 10.1038/s41584-020-0428-y] [Citation(s) in RCA: 103] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2020] [Indexed: 12/18/2022]
Abstract
Patients with rheumatoid arthritis (RA) are at high risk of developing cardiovascular disease (CVD). Inflammation has a pivotal role in the pathogenesis of CVD. RA is an inflammatory joint disease and, compared with the general population, patients with RA have approximately double the risk of atherosclerotic CVD, stroke, heart failure and atrial fibrillation. Although this high risk of CVD has been known for decades, patients with RA receive poorer primary and secondary CVD preventive care than other high-risk patients, and an unmet need exists for improved CVD preventive measures for patients with RA. This Review summarizes the evidence for atherosclerotic CVD in patients with RA and provides a contemporary analysis of what is known and what needs to be further clarified about recommendations for CVD prevention in patients with RA compared with the general population. The management of traditional CVD risk factors, including blood pressure, lipids, diabetes mellitus and lifestyle-related risk factors, as well as the effects of inflammation and the use of antirheumatic medication on CVD risk and risk management in patients with RA are discussed. The main aim is to provide a roadmap of atherosclerotic CVD risk management and prevention for patients with RA.
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Cardiovascular Health in Patients With Rheumatoid Arthritis. J Nurse Pract 2020. [DOI: 10.1016/j.nurpra.2020.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Drosos GC, Konstantonis G, Sfikakis PP, Tektonidou MG. Underperformance of clinical risk scores in identifying vascular ultrasound-based high cardiovascular risk in systemic lupus erythematosus. Eur J Prev Cardiol 2020:2047487320906650. [PMID: 32122200 DOI: 10.1177/2047487320906650] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/28/2024]
Abstract
AIMS The aim of this study was to assess the performance of eight clinical risk prediction scores to identify individuals with systemic lupus erythematosus (SLE) at high cardiovascular disease (CVD) risk, as defined by the presence of atherosclerotic plaques. METHODS CVD risk was estimated in 210 eligible SLE patients without prior CVD or diabetes mellitus (female: 93.3%, mean age: 44.8 ± 12 years) using five generic (Systematic Coronary Risk Evaluation (SCORE), Framingham Risk Score (FRS), Pooled Cohort Risk Equations (ASCVD), Globorisk, Prospective Cardiovascular Münster Study risk calculator (PROCAM)) and three 'SLE-adapted' (modified-SCORE, modified-FRS, QRESEARCH risk estimator, version 3 (QRISK3)) CVD risk scores, as well as ultrasound examination of the carotid and femoral arteries. Calibration, discrimination and classification measures to identify high CVD risk based on the presence of atherosclerotic plaques were assessed for all risk models. CVD risk reclassification was applied for all scores by incorporating ultrasound results. RESULTS Moderate calibration (p-value range from 0.38 to 0.63) and discrimination (area under the curve 0.73-0.84), and low-to-moderate sensitivity (8.3-71.4%) and classification ability (Matthews correlation coefficient (MCC) 0.25-0.47) were observed for all risk models to identify patients with plaques at any arterial site as high-risk. MCC was improved for modified-FRS versus FRS (0.43 vs 0.36), but not for modified-SCORE versus SCORE (0.25 vs 0.25). Based on plaque presence, CVD risk was upgraded to high-risk in 10%, 16.1%, 20.5%, 21.5%, 24%, 28.2% and 28.6% of cases classified as non-high-risk by QRISK3, modified-FRS, Globorisk, FRS/PROCAM, ASCVD, modified-SCORE and SCORE, respectively. CONCLUSIONS Most of the five generic and three 'SLE-adapted' clinical risk scores underestimated high CVD risk defined by atherosclerotic plaque presence in patients with SLE.
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Affiliation(s)
- George C Drosos
- Cardiovascular Risk Research Laboratory, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - George Konstantonis
- Cardiovascular Risk Research Laboratory, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - Petros P Sfikakis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - Maria G Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
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Drosos GC, Konstantonis G, Sfikakis PP, Tektonidou MG. Underperformance of clinical risk scores in identifying vascular ultrasound-based high cardiovascular risk in systemic lupus erythematosus. Eur J Prev Cardiol 2020; 28:346-352. [PMID: 33891687 DOI: 10.1093/eurjpc/zwaa256] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Accepted: 01/25/2020] [Indexed: 12/26/2022]
Abstract
AIMS The aim of this study was to assess the performance of eight clinical risk prediction scores to identify individuals with systemic lupus erythematosus (SLE) at high cardiovascular disease (CVD) risk, as defined by the presence of atherosclerotic plaques. METHODS CVD risk was estimated in 210 eligible SLE patients without prior CVD or diabetes mellitus (female: 93.3%, mean age: 44.8 ± 12 years) using five generic (Systematic Coronary Risk Evaluation (SCORE), Framingham Risk Score (FRS), Pooled Cohort Risk Equations (ASCVD), Globorisk, Prospective Cardiovascular Münster Study risk calculator (PROCAM)) and three 'SLE-adapted' (modified-SCORE, modified-FRS, QRESEARCH risk estimator, version 3 (QRISK3)) CVD risk scores, as well as ultrasound examination of the carotid and femoral arteries. Calibration, discrimination and classification measures to identify high CVD risk based on the presence of atherosclerotic plaques were assessed for all risk models. CVD risk reclassification was applied for all scores by incorporating ultrasound results. RESULTS Moderate calibration (p-value range from 0.38 to 0.63) and discrimination (area under the curve 0.73-0.84), and low-to-moderate sensitivity (8.3-71.4%) and classification ability (Matthews correlation coefficient (MCC) 0.25-0.47) were observed for all risk models to identify patients with plaques at any arterial site as high-risk. MCC was improved for modified-FRS versus FRS (0.43 vs 0.36), but not for modified-SCORE versus SCORE (0.25 vs 0.25). Based on plaque presence, CVD risk was upgraded to high-risk in 10%, 16.1%, 20.5%, 21.5%, 24%, 28.2% and 28.6% of cases classified as non-high-risk by QRISK3, modified-FRS, Globorisk, FRS/PROCAM, ASCVD, modified-SCORE and SCORE, respectively. CONCLUSIONS Most of the five generic and three 'SLE-adapted' clinical risk scores underestimated high CVD risk defined by atherosclerotic plaque presence in patients with SLE.
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Affiliation(s)
- George C Drosos
- Cardiovascular Risk Research Laboratory, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - George Konstantonis
- Cardiovascular Risk Research Laboratory, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - Petros P Sfikakis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
| | - Maria G Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Medical School, National and Kapodistrian University of Athens, Laiko General Hospital, Greece
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Garton M, McInnes IB, Sattar N. Comment on: Lipid screening and statins alongside disease-modifying anti-rheumatic drugs for patients with rheumatoid arthritis. Rheumatology (Oxford) 2020; 59:453-454. [PMID: 31873738 DOI: 10.1093/rheumatology/kez613] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Accepted: 09/13/2019] [Indexed: 11/12/2022] Open
Affiliation(s)
- Mark Garton
- Department of Rheumatology, Wrexham Maelor Hospital, Wrexham
| | | | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
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Ångström L, Hörnberg K, Sundström B, Jonsson SW, Södergren A. Aerobic capacity is associated with disease activity and cardiovascular risk factors in early rheumatoid arthritis. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2020; 25:e1833. [PMID: 31913553 PMCID: PMC7378948 DOI: 10.1002/pri.1833] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 11/12/2019] [Accepted: 12/13/2019] [Indexed: 12/21/2022]
Abstract
Objectives The aim of this study was to investigate aerobic capacity and its associations with disease activity and risk factors for cardiovascular disease (CVD) in early rheumatoid arthritis (RA). Methods This cross‐sectional study included 67 patients with early RA. Aerobic capacity was estimated with the Åstrand submaximal test adjusted according to the Nord‐Tröndelag Health Study formula. The following were also assessed: subclinical atherosclerosis by carotid intima‐media thickness and pulse wave analysis; body composition by dual X‐ray absorptiometry; estimated CVD mortality risk by the Systematic Coronary Risk Evaluation; disease activity by the Disease Activity Score 28, C‐reactive protein and erythrocyte sedimentation rate; blood lipids by total cholesterol, low‐density lipoproteins, high‐density lipoproteins, and triglycerides; and functional ability by the Stanford health assessment questionnaire. Univariate and multiple linear regression analyses were performed to explore the associations between variables. Results The mean (SD) aerobic capacity was 31.6 (8.7) ml O2−1 kg min−1. Disease activity and risk factors for CVD were more favourable for patients with aerobic capacity above the median value. Aerobic capacity was associated with ESR and several CVD risk factors, independent of age and sex. In a multiple regression model that was adjusted for age and sex, aerobic capacity was significantly associated with per cent body fat (β = −0.502, 95% CI [−0.671, −0.333]) and triglycerides (β = −2.365, 95% CI [−4.252, −0.479]). Conclusions Disease activity and risk factors for CVD were in favour for patients with a higher aerobic capacity. Aerobic capacity was associated with disease activity and several risk factors for CVD, independent of age and sex. In RA, these findings may provide insights into the benefits of using aerobic capacity as a marker to prevent CVD.
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Affiliation(s)
- Lars Ångström
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Kristina Hörnberg
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Björn Sundström
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | | | - Anna Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden.,Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
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Garshick MS. Editorial commentary: Psoriasis, inflammation and cardiometabolic disease. Will we ever get to the heart of the matter? Trends Cardiovasc Med 2019; 30:479-480. [PMID: 31810858 DOI: 10.1016/j.tcm.2019.11.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Accepted: 11/19/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Michael S Garshick
- Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University School of Medicine, 435 East 30th Street, 7th Floor, New York, NY 10016, United States; Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, United States.
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Hammam N, Ezeugwu VE, Rumsey DG, Manns PJ, Pritchard-Wiart L. Physical activity, sedentary behavior, and long-term cardiovascular risk in individuals with rheumatoid arthritis. PHYSICIAN SPORTSMED 2019; 47:463-470. [PMID: 31122104 DOI: 10.1080/00913847.2019.1623995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Individuals with rheumatoid arthritis (RA) have increased risk of cardiovascular disease (CVD). Lifestyle factors such as prolonged sedentary behavior (SB) and reduced physical activity (PA) may heighten the risk of CVD. The objective of the study was to investigate the role of SB and PA as predictors for long-term CVD risk in RA patients.Methods: A subsample of 273 people diagnosed with RA was extracted from the 2003-2006 National Health and Nutrition Examination Survey and included in this cross-sectional study. Valid accelerometry data were categorized into sedentary behavior, very light, light, and moderate-to-vigorous physical activity. Functional limitations were assessed using a physical function questionnaire. The Framingham risk score (FRS) was used to calculate 10-year CVD risk. Regression models were used to examine the relationships between SB, PA, and 10-year CVD risk while controlling for potential confounders.Results: Participants spent an average of 9 h/day sedentary, 4 h in very light PA, 1 h in light PA, and 0.4 h in moderate-to-vigorous PA. Greater sedentary time was associated with higher 10-year CVD risk (p= 0.019). Increased daily PA, at all intensities, was inversely associated with 10-year CVD risk (p< 0.01). In the fully adjusted regression model, associations between 10-year CVD risk and SB (β = 0.31, R2 = 0.27, p< 0.01), very light PA (β = -0.19, R2 = 0.26, p< 0.01), light PA (β = -0.16, R2 = 0.25, p< 0.01), and moderate-to-vigorous PA (β = -0.15, R2 = 0.25, p< 0.01) remained significant.Conclusions: Strategies for decreasing SB and increasing PA should be explored with individuals with RA in order to decrease long-term CVD risk.
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Affiliation(s)
- Nevin Hammam
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.,Department of Rheumatology and Rehabilitation, Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Victor E Ezeugwu
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Dax G Rumsey
- Department of Pediatrics, Stollery Children's Hospital, University of Alberta, Edmonton, AB, Canada
| | - Patricia J Manns
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lesley Pritchard-Wiart
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
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Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol 2019; 74:e177-e232. [PMID: 30894318 PMCID: PMC7685565 DOI: 10.1016/j.jacc.2019.03.010] [Citation(s) in RCA: 947] [Impact Index Per Article: 189.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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67
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Arnett DK, Blumenthal RS, Albert MA, Buroker AB, Goldberger ZD, Hahn EJ, Himmelfarb CD, Khera A, Lloyd-Jones D, McEvoy JW, Michos ED, Miedema MD, Muñoz D, Smith SC, Virani SS, Williams KA, Yeboah J, Ziaeian B. 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation 2019; 140:e596-e646. [PMID: 30879355 PMCID: PMC7734661 DOI: 10.1161/cir.0000000000000678] [Citation(s) in RCA: 1367] [Impact Index Per Article: 273.4] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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68
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Agca R, Heslinga SC, Rollefstad S, Heslinga S, Södergren A, Semb AG, Kitas GD, Sattar N, Nurmohamed MT. Response to: "Influence of changes in cholesterol levels and disease activity on the 10-year cardiovascular risk estimated with different algorithms in rheumatoid arthritis patients" by Fornaro et al. Ann Rheum Dis 2019; 79:e105. [PMID: 31413003 DOI: 10.1136/annrheumdis-2019-215748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/29/2019] [Indexed: 11/04/2022]
Affiliation(s)
- Rabia Agca
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands .,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Sjoerd C Heslinga
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - S Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinical, Diakonhjemmet Hospital, Oslo, Norway
| | - S Heslinga
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
| | - Anna Södergren
- Department of Public Health and Clinical Medicine/Rhematology, University of Umeå and Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
| | - A G Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinical, Diakonhjemmet Hospital, Oslo, Norway
| | - George D Kitas
- Head of Research and Development, Academic Affairs Dudley Group NHS Foundation Trust, Arthritis Research UK Centre for Epidemiology, University of Manchester, Russells Hall Hospital, Clinical Research Unit, Dudley, UK
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Science, University of Glasgow, Glasgow, UK
| | - Michael T Nurmohamed
- Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location Reade, Amsterdam, The Netherlands.,Department of Rheumatology, Amsterdam Rheumatology and immunology Center, location VU University Medical Center, Amsterdam, The Netherlands
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69
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Colaco K, Ocampo V, Ayala AP, Harvey P, Gladman DD, Piguet V, Eder L. Predictive Utility of Cardiovascular Risk Prediction Algorithms in Inflammatory Rheumatic Diseases: A Systematic Review. J Rheumatol 2019; 47:928-938. [DOI: 10.3899/jrheum.190261] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2019] [Indexed: 01/04/2023]
Abstract
Objective.We performed a systematic review of the literature to describe current knowledge of cardiovascular (CV) risk prediction algorithms in rheumatic diseases.Methods.A systematic search of MEDLINE, EMBASE, and Cochrane Central databases was performed. The search was restricted to original publications in English, had to include clinical CV events as study outcomes, assess the predictive properties of at least 1 CV risk prediction algorithm, and include patients with rheumatoid arthritis (RA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), psoriatic arthritis (PsA), or psoriasis. By design, only cohort studies that followed participants for CV events were selected.Results.Eleven of 146 identified manuscripts were included. Studies evaluated the predictive performance of the Framingham Risk Score, QRISK2, Systematic Coronary Risk Evaluation (SCORE), Reynolds Risk Score, American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE), Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), and the Italian Progetto CUORE score. Approaches to improve predictive performance of general risk algorithms in patients with RA included the use of multipliers, biomarkers, disease-specific variables, or a combination of these to modify or develop an algorithm. In both SLE and PsA patients, multipliers were applied to general risk algorithms. In studies of RA and SLE patients, efforts to include nontraditional risk factors, disease-related variables, multipliers, and biomarkers largely failed to substantially improve risk estimates.Conclusion.Our study confirmed that general risk algorithms mostly underestimate and at times overestimate CV risk in rheumatic patients. We did not find studies that evaluated models for psoriasis or AS, which further demonstrates a need for research in these populations.
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Hollan I, Ronda N, Dessein P, Agewall S, Karpouzas G, Tamargo J, Niessner A, Savarese G, Rosano G, Kaski JC, Wassmann S, Meroni PL. Lipid management in rheumatoid arthritis: a position paper of the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2019; 6:104-114. [DOI: 10.1093/ehjcvp/pvz033] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/29/2019] [Accepted: 08/08/2019] [Indexed: 12/24/2022]
Abstract
Abstract
Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity, partly due to alterations in lipoprotein quantity, quality and cell cholesterol trafficking. Although cardiovascular disease significantly contributes to mortality excess in RA, cardiovascular prevention has been largely insufficient. Because of limited evidence, optimal strategies for lipid management (LM) in RA have not been determined yet, and recommendations are largely based on expert opinions. In this position paper, we describe abnormalities in lipid metabolism and introduce a new algorithm for estimation of cardiovascular risk (CVR) and LM in RA. The algorithm stratifies patients according to RA-related factors impacting CVR (such as RA activity and severity and medication). We propose strategies for monitoring of lipid parameters and treatment of dyslipidaemia in RA (including lifestyle, statins and other lipid-modifying therapies, and disease modifying antirheumatic drugs). These opinion-based recommendations are meant to facilitate LM in RA until more evidence is available.
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Affiliation(s)
- Ivana Hollan
- Lillehammer Hospital for Rheumatic Diseases, M. Grundtvigs veg 6, 2609 Lillehammer, Norway
- Department of Medicine, Division of Cardiovascular Medicine, 75 Francis Street, Boston, MA, 02115, USA
| | | | - Patrick Dessein
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, 7 York Road, Parktown, Johannesburg 2193, South Africa
- Department of Rheumatology, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Jubilee Road, Parktown, Johannesburg 2196, South Africa
- Rheumatology Unit, Free University Hospital, Faculty of Medicine and Pharmacy, Free University, Laarbeeklaan 103, Jette, Brussels 1090, Belgium
| | - Stefan Agewall
- Department of Cardiology, Oslo University Hospital Ullevål, Kirkeveien 166, 0450 Oslo, Norway
| | - George Karpouzas
- Department of Medicine, Division of Rheumatology, Los Angeles Biomedical Research Institute, Harbor-UCLA Medical Center, 1124 W Carson Street, Building E4-R17A,Torrance, CA 90502, USA
| | - Juan Tamargo
- Department of Pharmacology and Toxicology, School of Medicine, Universidad Complutense, CIBERCV, Plaza de Ramón y Cajal s/n, 28040, Madrid, Spain
| | - Alexander Niessner
- Division of Cardiology, Department of Internal Medicine II, Medical University of Vienna, Waehringer Guertel 18-20, 1090 Vienna, Austria
| | - Gianluigi Savarese
- Norrbacka, S1:02, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Giuseppe Rosano
- Department of Medical Sciences, IRCCS San Raffaele Roma, Via della Pisana 249, 00163 Roma, Italy
| | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St. George's, University of London, Cranmer Terrace, London SW17 ORE, UK
| | - Sven Wassmann
- Cardiology Pasing, Institutstr. 14, 81241 Munich, Germany
- Department of Cardiology, University of the Saarland, Kirrbergerstr. 100, 66421 Homburg/Saar, Germany
| | - Pier Luigi Meroni
- Immunorheumatology Research Laboratory, Istituto Auxologico Italiano, Via Ariosto, 14, 20145 Milan, Italy
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71
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Mackey RH, Kuller LH, Moreland LW. Inflammatory joint diseases and atherosclerosis: time to look beyond the 'lipid paradox'. Curr Opin Lipidol 2019; 30:342-349. [PMID: 31145122 DOI: 10.1097/mol.0000000000000620] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
PURPOSE OF REVIEW Uncertainty persists about the contribution of lipids to the increased risk of cardiovascular disease (CVD) among rheumatoid arthritis and other inflammatory joint disease (IJD) patients. In reviewing recent research, we consider potential insights gained by quantifying lipoprotein particles directly, rather than by their lipid content. RECENT FINDINGS Although inflammation often decreases LDL cholesterol (LDL-C), and anti-inflammatory medications often increase LDL-C, both inflammation and anti-inflammatory medications can increase atherogenic Apolipoprotein B (ApoB)-containing lipoprotein particles, attenuated by statins. CVD risk factors, that is, smoking, obesity, ApoB, may increase years prior to IJD diagnosis. Increased risks of nonatherosclerotic myocardial and pulmonary disease, heart failure and mortality may be directly related to disease activity, inflammation, and possibly to HDL particles and function. SUMMARY For IJD patients, higher cumulative lifetime exposure to CVD risk factors accelerates atherosclerosis and subsequent CVD risk that is underestimated by current risk factor levels. CVD risk reduction in IJD requires aggressive and earlier reduction in CVD risk factors (ApoB lipoproteins, smoking, hypertension, diabetes, lack of physical activity), in addition to control of disease activity and inflammation. Lipid-lowering medications can attenuate anti-inflammatory medication-induced increases in ApoB and LDL-C, but can also reduce CVD risk due to cumulative lifetime exposure.
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Affiliation(s)
- Rachel H Mackey
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
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72
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Gavriilaki E, Gkaliagkousi E, Sakellari I, Anyfanti P, Douma S, Anagnostopoulos A. Early Prediction of Cardiovascular Risk after Hematopoietic Cell Transplantation: Are We There Yet? Biol Blood Marrow Transplant 2019; 25:e310-e316. [PMID: 31310812 DOI: 10.1016/j.bbmt.2019.07.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 07/03/2019] [Accepted: 07/10/2019] [Indexed: 12/14/2022]
Abstract
Cardiovascular (CV) events have emerged as a major cause of morbidity and mortality among hematopoietic cell transplantation (HCT) survivors. Accumulating evidence supports the presence of increased CV risk in HCT recipients. Most studies have focused mainly on traditional CV risk factors, such as the metabolic syndrome and hypertension. However, detection of these factors suggests the development of irreversible overt clinical atherosclerosis. Therefore, earlier prediction of CV risk is needed to prevent CV morbidity and mortality in these patients. In the field of CV research, endothelial dysfunction is considered an early event in the pathophysiology of CV risk factors, and a number of markers have been proposed for its assessment. In addition, markers of subclinical target organ damage have been introduced to implement CV risk prediction and early preventive or intensive therapeutic interventions. Furthermore, a number of CV models have been suggested aiming for optimal stratification of patients. Preliminary studies have indicated excess CV risk using these early markers in HCT recipients. However, their role in the pathophysiology and clinical practice in HCT survivors remains largely understudied. Taking into account the need for increased awareness from treating physicians in this evolving setting, we conducted a state-of-the-art review aiming to summarize current knowledge on endothelial dysfunction, subclinical target organ damage, and CV risk prediction in HCT survivors.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece.
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioanna Sakellari
- Hematology Department-BMT Unit, G. Papanicolaou Hospital, Thessaloniki, Greece
| | - Panagiota Anyfanti
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Hansen PR, Feineis M, Abdulla J. Rheumatoid arthritis patients have higher prevalence and burden of asymptomatic coronary artery disease assessed by coronary computed tomography: A systematic literature review and meta-analysis. Eur J Intern Med 2019; 62:72-79. [PMID: 30826172 DOI: 10.1016/j.ejim.2019.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 01/28/2019] [Accepted: 02/23/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) is associated with increased risk of coronary artery disease (CAD) and studies with coronary computed tomography have suggested increased rates of asymptomatic CAD determined by the coronary calcium score (CCS) in these patients. To synthesize the evidence on this topic, we conducted a systematic review and meta-analysis of the literature. METHODS A systematic review was performed of data comparing the prevalence and burden of asymptomatic CAD in RA and controls using CCS with or without coronary computed tomographic angiography (CCTA). For the meta-analysis, pooled data provided the estimated risk ratio (RR) of CAD and weighted mean differences of CCS in patients with RA compared to controls. RESULTS The search revealed 1841 results of which 1083 were screened and 26 full text papers were evaluated. Eight studies were included with data on 788 patients with RA and 1641 controls. Patients with RA had significantly increased risk of CAD (RR = 1.26 [95% CI 1.04-1.52]; p = .021) and increased weighted mean differences for CCS (48.25 [95% CI 26.97-69.53]; p < .001) compared to controls. Limited evidence suggested that patients with RA had a higher prevalence of moderate-severe (CCS > 100) CAD and more multivessel CAD, and RA duration and disease activity were associated with higher CCS, RA disease activity was linked with presence of high risk (non-calcified or mixed) coronary plaques, and treatment with methotrexate was tied to absence of CAD, respectively. CONCLUSIONS In patients with RA, asymptomatic CAD is more prevalent, with higher mean CCS, more multivessel disease, and more high-risk plaques compared to controls.
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Affiliation(s)
- Peter Riis Hansen
- Department of Cardiology, Herlev and Gentofte Hospital, Hellerup, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Martin Feineis
- Department of Medicine, Section of Cardiology, Glostrup University Hospital, Glostrup, Denmark
| | - Jawdat Abdulla
- Department of Medicine, Section of Cardiology, Glostrup University Hospital, Glostrup, Denmark
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74
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Giles JT. On Needles and Haystacks: The Perils of Cardiovascular Risk Screening in Rheumatoid Arthritis. J Rheumatol 2019; 46:121-123. [PMID: 30709999 DOI: 10.3899/jrheum.180933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Jon T Giles
- Division of Rheumatology, Columbia University, College of Physicians and Surgeons, 630 West 168th St., Physicians and Surgeons Building, Suite 3-450, New York, New York 10032, USA.
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Rheumatoid Arthritis: Atherosclerosis Imaging and Cardiovascular Risk Assessment Using Machine and Deep Learning-Based Tissue Characterization. Curr Atheroscler Rep 2019; 21:7. [PMID: 30684090 DOI: 10.1007/s11883-019-0766-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF THE REVIEW Rheumatoid arthritis (RA) is a chronic, autoimmune disease which may result in a higher risk of cardiovascular (CV) events and stroke. Tissue characterization and risk stratification of patients with rheumatoid arthritis are a challenging problem. Risk stratification of RA patients using traditional risk factor-based calculators either underestimates or overestimates the CV risk. Advancements in medical imaging have facilitated early and accurate CV risk stratification compared to conventional cardiovascular risk calculators. RECENT FINDING In recent years, a link between carotid atherosclerosis and rheumatoid arthritis has been widely discussed by multiple studies. Imaging the carotid artery using 2-D ultrasound is a noninvasive, economic, and efficient imaging approach that provides an atherosclerotic plaque tissue-specific image. Such images can help to morphologically characterize the plaque type and accurately measure vital phenotypes such as media wall thickness and wall variability. Intelligence-based paradigms such as machine learning- and deep learning-based techniques not only automate the risk characterization process but also provide an accurate CV risk stratification for better management of RA patients. This review provides a brief understanding of the pathogenesis of RA and its association with carotid atherosclerosis imaged using the B-mode ultrasound technique. Lacunas in traditional risk scores and the role of machine learning-based tissue characterization algorithms are discussed and could facilitate cardiovascular risk assessment in RA patients. The key takeaway points from this review are the following: (i) inflammation is a common link between RA and atherosclerotic plaque buildup, (ii) carotid ultrasound is a better choice to characterize the atherosclerotic plaque tissues in RA patients, and (iii) intelligence-based paradigms are useful for accurate tissue characterization and risk stratification of RA patients.
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Quevedo-Abeledo JC, Rúa-Figueroa Í, Sánchez-Pérez H, Tejera-Segura B, de Vera-González A, González-Delgado A, Llorca J, González-Gay MÁ, Ferraz-Amaro I. Disease Damage Influences Cardiovascular Risk Reclassification Based on Carotid Ultrasound in Patients with Systemic Lupus Erythematosus. J Rheumatol 2019; 46:483-491. [PMID: 30647175 DOI: 10.3899/jrheum.180881] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Composite scores of cardiovascular (CV) risk factors underestimate the CV risk in patients with systemic lupus erythematosus (SLE). Carotid artery ultrasound (US) was found useful in identifying high CV-risk patients with inflammatory arthritis. We assessed the effect of carotid US assessments on the CV risk stratification of patients with SLE. METHODS This cross-sectional study included 276 patients with SLE. These indices were measured: lipid profile, Systematic COronary Risk Evaluation (SCORE) risk calculation, and disease activity (SLE Disease Activity Index), severity (Katz), and damage [Systemic Lupus International Collaborating Clinics (SLICC)/American College of Rheumatology Damage Index]. Carotid plaques were assessed by US. A multivariable regression analysis, adjusted for classic CV-related factors, was performed to evaluate how risk reclassification was influenced by disease characteristics in patients with SLE. RESULTS Thirty-six percent of patients had carotid plaques. However, only 6% of them fulfilled the definitions for high or very high risk according to the SCORE risk charts. Following carotid US assessment, 32% of the patients were reclassified as very high risk. Disease duration (OR 1.04, 95% CI 1.00-1.07, p = 0.025) and a SLICC > 0 (OR 2.48 95% CI 1.15-5.34, p = 0.020) were independently associated with a higher risk of reclassification. A predictive model for reclassification included age (cutoff 52 yrs, sensitivity 60%, specificity 86%), disease duration (cutoff 24 yrs, sensitivity 40%, specificity 82%), presence of hypertension, SLICC > 0, waist circumference (cutoff 102 cm, sensitivity 48%, specificity 84%), and C3 (cutoff 127 mg/dl, sensitivity 52%, specificity 92%) and triglyceride (cutoff 140 mg/dl, sensitivity 68%, specificity 79%) serum levels. CONCLUSION Reclassification into a very high-risk category is frequent after carotid US assessments in patients with SLE. This is independently influenced by disease damage.
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Affiliation(s)
- Juan C Quevedo-Abeledo
- From the Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife; Division of Rheumatology, Hospital Insular, Las Palmas de Gran Canaria; Central Laboratory Division, Hospital Universitario de Canarias, Tenerife; Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Investigacíon Sanitaria (IDIVAL); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín; I. Rúa-Figueroa, MD, PhD, Division of Rheumatology, Hospital Doctor Negrín; H. Sánchez-Pérez, MD, Division of Rheumatology, Hospital Universitario de Canarias; B. Tejera-Segura, MD, Division of Rheumatology, Hospital Insular; A. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. González-Delgado, MD, Central Laboratory Division, Hospital Universitario de Canarias; J. Llorca, MD, PhD, Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP, IDIVAL; M.A. González-Gay, MD, PhD, Division of Rheumatology, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Íñigo Rúa-Figueroa
- From the Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife; Division of Rheumatology, Hospital Insular, Las Palmas de Gran Canaria; Central Laboratory Division, Hospital Universitario de Canarias, Tenerife; Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Investigacíon Sanitaria (IDIVAL); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín; I. Rúa-Figueroa, MD, PhD, Division of Rheumatology, Hospital Doctor Negrín; H. Sánchez-Pérez, MD, Division of Rheumatology, Hospital Universitario de Canarias; B. Tejera-Segura, MD, Division of Rheumatology, Hospital Insular; A. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. González-Delgado, MD, Central Laboratory Division, Hospital Universitario de Canarias; J. Llorca, MD, PhD, Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP, IDIVAL; M.A. González-Gay, MD, PhD, Division of Rheumatology, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Hiurma Sánchez-Pérez
- From the Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife; Division of Rheumatology, Hospital Insular, Las Palmas de Gran Canaria; Central Laboratory Division, Hospital Universitario de Canarias, Tenerife; Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Investigacíon Sanitaria (IDIVAL); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín; I. Rúa-Figueroa, MD, PhD, Division of Rheumatology, Hospital Doctor Negrín; H. Sánchez-Pérez, MD, Division of Rheumatology, Hospital Universitario de Canarias; B. Tejera-Segura, MD, Division of Rheumatology, Hospital Insular; A. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. González-Delgado, MD, Central Laboratory Division, Hospital Universitario de Canarias; J. Llorca, MD, PhD, Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP, IDIVAL; M.A. González-Gay, MD, PhD, Division of Rheumatology, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Beatriz Tejera-Segura
- From the Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife; Division of Rheumatology, Hospital Insular, Las Palmas de Gran Canaria; Central Laboratory Division, Hospital Universitario de Canarias, Tenerife; Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Investigacíon Sanitaria (IDIVAL); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín; I. Rúa-Figueroa, MD, PhD, Division of Rheumatology, Hospital Doctor Negrín; H. Sánchez-Pérez, MD, Division of Rheumatology, Hospital Universitario de Canarias; B. Tejera-Segura, MD, Division of Rheumatology, Hospital Insular; A. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. González-Delgado, MD, Central Laboratory Division, Hospital Universitario de Canarias; J. Llorca, MD, PhD, Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP, IDIVAL; M.A. González-Gay, MD, PhD, Division of Rheumatology, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Antonia de Vera-González
- From the Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife; Division of Rheumatology, Hospital Insular, Las Palmas de Gran Canaria; Central Laboratory Division, Hospital Universitario de Canarias, Tenerife; Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Investigacíon Sanitaria (IDIVAL); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín; I. Rúa-Figueroa, MD, PhD, Division of Rheumatology, Hospital Doctor Negrín; H. Sánchez-Pérez, MD, Division of Rheumatology, Hospital Universitario de Canarias; B. Tejera-Segura, MD, Division of Rheumatology, Hospital Insular; A. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. González-Delgado, MD, Central Laboratory Division, Hospital Universitario de Canarias; J. Llorca, MD, PhD, Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP, IDIVAL; M.A. González-Gay, MD, PhD, Division of Rheumatology, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Alejandra González-Delgado
- From the Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife; Division of Rheumatology, Hospital Insular, Las Palmas de Gran Canaria; Central Laboratory Division, Hospital Universitario de Canarias, Tenerife; Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Investigacíon Sanitaria (IDIVAL); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín; I. Rúa-Figueroa, MD, PhD, Division of Rheumatology, Hospital Doctor Negrín; H. Sánchez-Pérez, MD, Division of Rheumatology, Hospital Universitario de Canarias; B. Tejera-Segura, MD, Division of Rheumatology, Hospital Insular; A. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. González-Delgado, MD, Central Laboratory Division, Hospital Universitario de Canarias; J. Llorca, MD, PhD, Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP, IDIVAL; M.A. González-Gay, MD, PhD, Division of Rheumatology, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Javier Llorca
- From the Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife; Division of Rheumatology, Hospital Insular, Las Palmas de Gran Canaria; Central Laboratory Division, Hospital Universitario de Canarias, Tenerife; Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Investigacíon Sanitaria (IDIVAL); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín; I. Rúa-Figueroa, MD, PhD, Division of Rheumatology, Hospital Doctor Negrín; H. Sánchez-Pérez, MD, Division of Rheumatology, Hospital Universitario de Canarias; B. Tejera-Segura, MD, Division of Rheumatology, Hospital Insular; A. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. González-Delgado, MD, Central Laboratory Division, Hospital Universitario de Canarias; J. Llorca, MD, PhD, Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP, IDIVAL; M.A. González-Gay, MD, PhD, Division of Rheumatology, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Miguel Á González-Gay
- From the Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife; Division of Rheumatology, Hospital Insular, Las Palmas de Gran Canaria; Central Laboratory Division, Hospital Universitario de Canarias, Tenerife; Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Investigacíon Sanitaria (IDIVAL); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín; I. Rúa-Figueroa, MD, PhD, Division of Rheumatology, Hospital Doctor Negrín; H. Sánchez-Pérez, MD, Division of Rheumatology, Hospital Universitario de Canarias; B. Tejera-Segura, MD, Division of Rheumatology, Hospital Insular; A. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. González-Delgado, MD, Central Laboratory Division, Hospital Universitario de Canarias; J. Llorca, MD, PhD, Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP, IDIVAL; M.A. González-Gay, MD, PhD, Division of Rheumatology, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias
| | - Iván Ferraz-Amaro
- From the Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria; Division of Rheumatology, Hospital Universitario de Canarias, Tenerife; Division of Rheumatology, Hospital Insular, Las Palmas de Gran Canaria; Central Laboratory Division, Hospital Universitario de Canarias, Tenerife; Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria; CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Investigacíon Sanitaria (IDIVAL); Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IDIVAL; Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL; School of Medicine, University of Cantabria, Santander, Spain; Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa. .,J.C. Quevedo-Abeledo, MD, Division of Rheumatology, Hospital Doctor Negrín; I. Rúa-Figueroa, MD, PhD, Division of Rheumatology, Hospital Doctor Negrín; H. Sánchez-Pérez, MD, Division of Rheumatology, Hospital Universitario de Canarias; B. Tejera-Segura, MD, Division of Rheumatology, Hospital Insular; A. de Vera-González, MD, Central Laboratory Division, Hospital Universitario de Canarias; A. González-Delgado, MD, Central Laboratory Division, Hospital Universitario de Canarias; J. Llorca, MD, PhD, Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBERESP, IDIVAL; M.A. González-Gay, MD, PhD, Division of Rheumatology, Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, IDIVAL, and School of Medicine, University of Cantabria, and Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand; I. Ferraz-Amaro, MD, PhD, Division of Rheumatology, Hospital Universitario de Canarias.
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Ljung L, Ueda P, Liao KP, Greenberg JD, Etzel CJ, Solomon DH, Askling J. Performance of the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis in a geographically distant National Register-based cohort: an external validation. RMD Open 2018; 4:e000771. [PMID: 30622736 PMCID: PMC6307600 DOI: 10.1136/rmdopen-2018-000771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/22/2018] [Accepted: 11/13/2018] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Cardiovascular (CV) risk stratification for patients with rheumatoid arthritis (RA) should facilitate evidence-based management. Prior work has derived an internally validated a CV risk score, the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA), using US data. The aim of this study was to perform an external validation among unselected patients with RA from Europe. METHODS Three large, partially overlapping, cohorts of patients with RA from the Swedish Rheumatology Quality register were identified for external validation, two with information on smoking and two with close to 10 years of median follow-up. The 10 -year rate of first CV events was assessed using the Kaplan-Meier method. The performance of ERS-RA was assessed using C-index and comparisons of observed versus predicted risks. RESULTS The C-index for ERS-RA varied across the three RA cohorts, from 0.75 to 0.78. Predicted risks corresponded well to observed risks among individuals with ≤10 % observed 10- year CV risk, but underestimated risk in individuals with a higher observed risk. In the absence of data on smoking, ERS-RA underestimated the CV risk by 3.3%, whereas in the cohorts including data on smoking, the calibration was within 1% (0.06% and 0.7%). In the clinically relevant risk intervals (<5%, 5.0%-<7.5%, 7.5%-<10%), ERS-RA performed well. CONCLUSIONS In an unselected Swedish population with RA, ERS-RA performed well, although the 10-year CV risk was underestimated in high-risk groups and in the absence of data on smoking. ERS-RA could be considered as a risk stratification tool for targeted preventive interventions in clinical rheumatology practice.
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Affiliation(s)
- Lotta Ljung
- Department of Medicine Solna, Clinical Epidemiology Section, Karolinska Institutet, Stockholm, Sweden
- Department of Public Health and Clinical Medicine/Rheumatology, Umeå University, Umeå, Sweden
| | - Peter Ueda
- Department of Medicine Solna, Clinical Epidemiology Section, Karolinska Institutet, Stockholm, Sweden
| | - Katherine P Liao
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Jeffrey D Greenberg
- Division of Rheumatology, New York University School of Medicine (JDG), NYU Hospital for Joint Diseases, New York City, New York, USA
| | | | - Daniel H Solomon
- Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Johan Askling
- Department of Medicine Solna, Clinical Epidemiology Section, Karolinska Institutet, Stockholm, Sweden
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Anyfanti P, Gkaliagkousi E, Gavriilaki E, Triantafyllou A, Dolgyras P, Galanopoulou V, Aslanidis S, Douma S. Association of galectin-3 with markers of myocardial function, atherosclerosis, and vascular fibrosis in patients with rheumatoid arthritis. Clin Cardiol 2018; 42:62-68. [PMID: 30353563 DOI: 10.1002/clc.23105] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 10/14/2018] [Accepted: 10/17/2018] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Galectin-3 has emerged as a promising novel biomarker of cardiovascular fibrosis in patients with cardiovascular diseases. HYPOTHESIS We investigated whether galectin-3 correlates with markers of vascular fibrosis, subclinical atherosclerosis, and cardiac function in patients with rheumatoid arthritis (RA), a disease accompanied by high cardiovascular risk. METHODS RA and non-RA individuals underwent applanation tonometry, carotid ultrasound, and impedance cardiography, to obtain markers of arterial stiffness, subclinical atherosclerosis, and myocardial function, respectively. Cardiovascular risk was estimated from the Framingham Heart Study. Serum levels of galectin-3 were determined by enzyme-linked immunosorbent assay. RESULTS Galectin-3 was elevated in RA patients (n = 85) compared to controls (n = 39), but this difference was no longer significant after adjustment for the presence of cardiovascular comorbidities. In the univariate analysis, galectin-3 significantly correlated with markers of vascular stiffness (including pulse wave velocity, central blood pressure, central and peripheral pulse pressure, and total arterial compliance); atherosclerosis (carotid intima-media thickness); myocardial blood flow (cardiac output, stroke volume) and contractibility (acceleration and velocity index); systemic vascular resistance, and estimated cardiovascular risk. Multivariate analysis models revealed an independent association between galectin-3 and both cardiac output (β = -0.274, P = 0.039), as well as systemic vascular resistance (β = 0.266, P = 0.039). CONCLUSIONS In a relatively well-controlled cohort of RA patients with low-grade systemic inflammation and long-standing disease, serum galectin-3 might be useful as a marker of cardiac function and cardiovascular fibrosis.
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Affiliation(s)
- Panagiota Anyfanti
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eleni Gavriilaki
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Panagiotis Dolgyras
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Galanopoulou
- Rheumatology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Aslanidis
- Rheumatology Department, 2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lloyd-Jones DM, Braun LT, Ndumele CE, Smith SC, Sperling LS, Virani SS, Blumenthal RS. Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. Circulation 2018; 139:e1162-e1177. [PMID: 30586766 DOI: 10.1161/cir.0000000000000638] [Citation(s) in RCA: 188] [Impact Index Per Article: 31.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Risk assessment is a critical step in the current approach to primary prevention of atherosclerotic cardiovascular disease. Knowledge of the 10-year risk for atherosclerotic cardiovascular disease identifies patients in higher-risk groups who are likely to have greater net benefit and lower number needed to treat for both statins and antihypertensive therapy. Current US prevention guidelines for blood pressure and cholesterol management recommend use of the pooled cohort equations to start a process of shared decision-making between clinicians and patients in primary prevention. The pooled cohort equations have been widely validated and are broadly useful for the general US clinical population. But, they may systematically underestimate risk in patients from certain racial/ethnic groups, those with lower socioeconomic status or with chronic inflammatory diseases, and overestimate risk in patients with higher socioeconomic status or who have been closely engaged with preventive healthcare services. If uncertainty remains for patients at borderline or intermediate risk, or if the patient is undecided after a patient-clinician discussion with consideration of risk enhancing factors (eg, family history), additional testing with measurement of coronary artery calcium can be useful to reclassify risk estimates and improve selection of patients for use or avoidance of statin therapy. This special report summarizes the rationale and evidence base for quantitative risk assessment, reviews strengths and limitations of existing risk scores, discusses approaches for refining individual risk estimates for patients, and provides practical advice regarding implementation of risk assessment and decision-making strategies in clinical practice.
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Use of Risk Assessment Tools to Guide Decision-Making in the Primary Prevention of Atherosclerotic Cardiovascular Disease: A Special Report From the American Heart Association and American College of Cardiology. J Am Coll Cardiol 2018; 73:3153-3167. [PMID: 30423392 DOI: 10.1016/j.jacc.2018.11.005] [Citation(s) in RCA: 145] [Impact Index Per Article: 24.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Risk assessment is a critical step in the current approach to primary prevention of atherosclerotic cardiovascular disease. Knowledge of the 10-year risk for atherosclerotic cardiovascular disease identifies patients in higher-risk groups who are likely to have greater net benefit and lower number needed to treat for both statins and antihypertensive therapy. Current U.S. prevention guidelines for blood pressure and cholesterol management recommend use of the pooled cohort equations to start a process of shared decision-making between clinicians and patients in primary prevention. The pooled cohort equations have been widely validated and are broadly useful for the general U.S. clinical population. But, they may systematically underestimate risk in patients from certain racial/ethnic groups, those with lower socioeconomic status or with chronic inflammatory diseases, and overestimate risk in patients with higher socioeconomic status or who have been closely engaged with preventive healthcare services. If uncertainty remains for patients at borderline or intermediate risk, or if the patient is undecided after a patient-clinician discussion with consideration of risk enhancing factors (e.g., family history), additional testing with measurement of coronary artery calcium can be useful to reclassify risk estimates and improve selection of patients for use or avoidance of statin therapy. This special report summarizes the rationale and evidence base for quantitative risk assessment, reviews strengths and limitations of existing risk scores, discusses approaches for refining individual risk estimates for patients, and provides practical advice regarding implementation of risk assessment and decision-making strategies in clinical practice.
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Wahlin B, Innala L, Magnusson S, Möller B, Smedby T, Rantapää-Dahlqvist S, Wållberg-Jonsson S. Performance of the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis Is Not Superior to the ACC/AHA Risk Calculator. J Rheumatol 2018; 46:130-137. [PMID: 30275258 DOI: 10.3899/jrheum.171008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/03/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Cardiovascular (CV) risk estimation calculators for the general population do not perform well in patients with rheumatoid arthritis (RA). An RA-specific risk calculator has been developed, but did not perform better than a risk calculator for the general population when validated in a heterogeneous multinational cohort. METHODS In a cohort of patients with new-onset RA from northern Sweden (n = 665), the risk of CV disease was estimated by the Expanded Cardiovascular Risk Prediction Score for Rheumatoid Arthritis (ERS-RA) and the American College of Cardiology/American Heart Association algorithm (ACC/AHA). The ACC/AHA estimation was analyzed, both as crude data and when adjusted according to the recommendations by the European League Against Rheumatism (ACC/AHA × 1.5). ERS-RA was calculated using 2 variants: 1 from patient and physician reports of hypertension (HTN) and hyperlipidemia [ERS-RA (reported)] and 1 from assessments of blood pressure (BP) and blood lipids [ERS-RA (measured)]. The estimations were compared with observed CV events. RESULTS All variants of risk calculators underestimated the CV risk. Discrimination was good for all risk calculators studied. Performance of all risk calculators was poorer in patients with a high grade of inflammation, whereas ACC/AHA × 1.5 performed best in the high-inflammatory patients. In those patients with an estimated risk of 5-15%, no risk calculator performed well. CONCLUSION ERS-RA underestimated the risk of a CV event in our cohort of patients, especially when risk estimations were based on patient or physician reports of HTN and hyperlipidemia instead of assessment of BP and blood lipids. The performance of ERS-RA was no better than that of ACC/AHA × 1.5, and neither performed well in high-inflammatory patients.
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Affiliation(s)
- Bengt Wahlin
- From the Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå; Department of Rheumatology, Sundsvall Hospital, Sundsvall; Department of Rheumatology, Sunderby Hospital, Luleå; Department of Rheumatology, Östersund Hospital, Östersund, Sweden. .,B. Wahlin, MD, PhD student, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; L. Innala, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; S. Magnusson, MD, Department of Rheumatology, Sundsvall Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; T. Smedby, MD, Department of Rheumatology, Östersund Hospital; S. Rantapää-Dahlqvist, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; S. Wållberg-Jonsson, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University.
| | - Lena Innala
- From the Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå; Department of Rheumatology, Sundsvall Hospital, Sundsvall; Department of Rheumatology, Sunderby Hospital, Luleå; Department of Rheumatology, Östersund Hospital, Östersund, Sweden.,B. Wahlin, MD, PhD student, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; L. Innala, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; S. Magnusson, MD, Department of Rheumatology, Sundsvall Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; T. Smedby, MD, Department of Rheumatology, Östersund Hospital; S. Rantapää-Dahlqvist, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; S. Wållberg-Jonsson, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
| | - Staffan Magnusson
- From the Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå; Department of Rheumatology, Sundsvall Hospital, Sundsvall; Department of Rheumatology, Sunderby Hospital, Luleå; Department of Rheumatology, Östersund Hospital, Östersund, Sweden.,B. Wahlin, MD, PhD student, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; L. Innala, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; S. Magnusson, MD, Department of Rheumatology, Sundsvall Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; T. Smedby, MD, Department of Rheumatology, Östersund Hospital; S. Rantapää-Dahlqvist, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; S. Wållberg-Jonsson, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
| | - Bozena Möller
- From the Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå; Department of Rheumatology, Sundsvall Hospital, Sundsvall; Department of Rheumatology, Sunderby Hospital, Luleå; Department of Rheumatology, Östersund Hospital, Östersund, Sweden.,B. Wahlin, MD, PhD student, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; L. Innala, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; S. Magnusson, MD, Department of Rheumatology, Sundsvall Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; T. Smedby, MD, Department of Rheumatology, Östersund Hospital; S. Rantapää-Dahlqvist, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; S. Wållberg-Jonsson, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
| | - Torgny Smedby
- From the Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå; Department of Rheumatology, Sundsvall Hospital, Sundsvall; Department of Rheumatology, Sunderby Hospital, Luleå; Department of Rheumatology, Östersund Hospital, Östersund, Sweden.,B. Wahlin, MD, PhD student, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; L. Innala, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; S. Magnusson, MD, Department of Rheumatology, Sundsvall Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; T. Smedby, MD, Department of Rheumatology, Östersund Hospital; S. Rantapää-Dahlqvist, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; S. Wållberg-Jonsson, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
| | - Solbritt Rantapää-Dahlqvist
- From the Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå; Department of Rheumatology, Sundsvall Hospital, Sundsvall; Department of Rheumatology, Sunderby Hospital, Luleå; Department of Rheumatology, Östersund Hospital, Östersund, Sweden.,B. Wahlin, MD, PhD student, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; L. Innala, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; S. Magnusson, MD, Department of Rheumatology, Sundsvall Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; T. Smedby, MD, Department of Rheumatology, Östersund Hospital; S. Rantapää-Dahlqvist, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; S. Wållberg-Jonsson, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
| | - Solveig Wållberg-Jonsson
- From the Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå; Department of Rheumatology, Sundsvall Hospital, Sundsvall; Department of Rheumatology, Sunderby Hospital, Luleå; Department of Rheumatology, Östersund Hospital, Östersund, Sweden.,B. Wahlin, MD, PhD student, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; L. Innala, MD, PhD, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University; S. Magnusson, MD, Department of Rheumatology, Sundsvall Hospital; B. Möller, MD, Department of Rheumatology, Sunderby Hospital; T. Smedby, MD, Department of Rheumatology, Östersund Hospital; S. Rantapää-Dahlqvist, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå; S. Wållberg-Jonsson, MD, PhD, Professor, Department of Public Health and Clinical Medicine/Rheumatology, Umeå University
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Anyfanti P, Triantafyllou A, Gkaliagkousi E, Koletsos N, Athanasopoulos G, Zabulis X, Galanopoulou V, Aslanidis S, Douma S. Retinal vessel morphology in rheumatoid arthritis: Association with systemic inflammation, subclinical atherosclerosis, and cardiovascular risk. Microcirculation 2018; 24. [PMID: 28926162 DOI: 10.1111/micc.12417] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 09/08/2017] [Indexed: 01/31/2023]
Abstract
OBJECTIVE Quantification of retinal vessel morphology has emerged as a marker of cardiovascular health. We examined retinal microvascular diameters in RA, particularly in regard to systemic inflammation, subclinical atherosclerosis, and cardiovascular risk. METHODS Retinal images from RA patients and controls were processed using computerized software, to obtain CRAE and CRVE and AVR. Subclinical atherosclerosis was assessed with cIMT, and 10-year risk of general cardiovascular disease was calculated. RESULTS Both CRAE (78.8 ± 8.9 vs 90.2 ± 9.9 μm, P < .001) and AVR (0.69 ± 0.09 vs 0.81 ± 0.09, P < .001) were decreased in RA patients (n = 87) compared to controls (n = 46), whereas CRVE did not differ. Among RA patients, CRAE and AVR were inversely associated with both cIMT and CRP, whereas CRVE positively correlated with CRP (P < .05 for all). CRAE additionally correlated with cardiovascular risk score (r = -.396, P = .001). In the multivariate analysis, cardiovascular risk was associated with CRAE; age with CRVE, while CRP independently predicted AVR. CONCLUSIONS Our study shows altered retinal microvascular morphology in RA patients. Inflammation appears as the biological link for the observed association between retinal microvascular abnormalities and subclinical atherosclerosis. Retinal arteriolar narrowing might play its own role in cardiovascular risk prediction in RA.
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Affiliation(s)
- Panagiota Anyfanti
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Koletsos
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Georgios Athanasopoulos
- Ophthalmology Department, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xenophon Zabulis
- Institute of Computer Science, Foundation for Research and Technology - Hellas (FORTH), Heraklion, Greece
| | - Vasiliki Galanopoulou
- Rheumatology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Aslanidis
- Rheumatology Department-2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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The best cardiovascular risk calculator to predict carotid plaques in rheumatoid arthritis patients. Clin Rheumatol 2018; 37:2373-2380. [DOI: 10.1007/s10067-018-4181-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 05/11/2018] [Accepted: 06/13/2018] [Indexed: 10/28/2022]
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84
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Anyfanti P, Gkaliagkousi E, Triantafyllou A, Zabulis X, Dolgyras P, Galanopoulou V, Aslanidis S, Douma S. Dermal capillary rarefaction as a marker of microvascular damage in patients with rheumatoid arthritis: Association with inflammation and disorders of the macrocirculation. Microcirculation 2018; 25:e12451. [PMID: 29734516 DOI: 10.1111/micc.12451] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/10/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Capillary rarefaction is observed in various cardiovascular diseases, yet it remains understudied in RA, a chronic inflammatory disease accompanied by excess cardiovascular risk. We quantified capillary density in RA patients and explored potential associations with macrocirculatory disorders, inflammation, and cardiovascular risk. METHODS Dermal capillary density was assessed with nailfold capillaroscopy in RA and non-RA individuals, using specifically designed semiautomated software. Macrocirculation assessments included large artery stiffening, evaluated with PWV, and myocardial blood flow, calculated as cardiac index from impedance cardiography. Cardiovascular risk score was estimated from the Framingham Heart Study. RESULTS The number of capillaries per visual field was lower in patients (n = 99) compared to controls (n = 35) (132.6 ± 30.3 vs 152.9 ± 25.2, P = .001). In the RA group, capillary density negatively correlated with CRP and PWV, and positively with HDL and cardiac index. In the multivariate analysis, CRP independently predicted capillary rarefaction (P = .044). Capillary density significantly correlated with cardiovascular risk, even after adjustment for inflammation (P = .030). CONCLUSION Capillary rarefaction appears pronounced in RA and correlates with lower cardiac output, increased arterial stiffness, and cardiovascular risk. However, the associations with macrocirculatory disorders may be obscured by inflammation, which appears as the major contributor to capillary rarefaction in RA.
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Affiliation(s)
- Panagiota Anyfanti
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eugenia Gkaliagkousi
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Areti Triantafyllou
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Xenophon Zabulis
- Institute of Computer Science, Foundation for Research and Technology - Hellas (FORTH), Heraklion, Greece
| | - Panagiotis Dolgyras
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Vasiliki Galanopoulou
- Rheumatology Department, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Spyros Aslanidis
- Rheumatology Department-2nd Propedeutic Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stella Douma
- 3rd Department of Internal Medicine, Papageorgiou Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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85
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England BR, Thiele GM, Anderson DR, Mikuls TR. Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications. BMJ 2018; 361:k1036. [PMID: 29685876 PMCID: PMC6889899 DOI: 10.1136/bmj.k1036] [Citation(s) in RCA: 257] [Impact Index Per Article: 42.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis is a systemic autoimmune disease characterized by excess morbidity and mortality from cardiovascular disease. Mechanisms linking rheumatoid arthritis and cardiovascular disease include shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, alterations in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction. Despite a growing understanding of these mechanisms and their complex interplay with conventional cardiovascular risk factors, optimal approaches of risk stratification, prevention, and treatment in the context of rheumatoid arthritis remain unknown. A multifaceted approach to reduce the burden posed by cardiovascular disease requires optimal management of traditional risk factors in addition to those intrinsic to rheumatoid arthritis such as increased disease activity. Treatments for rheumatoid arthritis seem to exert differential effects on cardiovascular risk as well as the mechanisms linking these conditions. More research is needed to establish whether preferential rheumatoid arthritis therapies exist in terms of prevention of cardiovascular disease. Ultimately, understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.
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Affiliation(s)
- Bryant R England
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Geoffrey M Thiele
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel R Anderson
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ted R Mikuls
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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86
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Jagpal A, Navarro-Millán I. Cardiovascular co-morbidity in patients with rheumatoid arthritis: a narrative review of risk factors, cardiovascular risk assessment and treatment. BMC Rheumatol 2018; 2:10. [PMID: 30886961 PMCID: PMC6390616 DOI: 10.1186/s41927-018-0014-y] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 02/28/2018] [Indexed: 12/19/2022] Open
Abstract
Cardiovascular disease (CVD) is markedly increased in patients with rheumatoid arthritis partly due to accelerated atherosclerosis from chronic inflammation. Traditional cardiovascular risk factors such as hypertension, hyperlipidemia, smoking, diabetes mellitus and physical inactivity are also highly prevalent among patients with rheumatoid arthritis (RA) and contribute to the CVD risk. The impact of traditional risk factors on the CVD risk appears to be different in the RA and non-RA population. However, hyperlipidemia, diabetes mellitus, body mass index and family history of CVD influence the CVD risk in RA patients the same way they do for the non-RA population. Despite that, screening and treatment of these risk factors is suboptimal among patients with RA. Recent guidelines from the European League Against Rheumatism (EULAR) recommend aggressive management of traditional risk factors in addition to RA disease activity control to decrease the CVD risk. Several CVD risk calculators are available for clinical use to stratify a patients' risk of developing a CVD event. Most of these calculators do not account for RA as a risk factor; thus, a multiplication factor of 1.5 is recommended to predict the risk more accurately. In order to reduce CVD in the RA population, national guidelines for the prevention of CVD should be applied to manage traditional risk factors in addition to aggressive control of RA disease activity. While current data suggests a protective effect of non-biologic disease modifying anti-rheumatic drugs (DMARDs) and biologics on cardiovascular events among patients with RA, more data is needed to define this effect more accurately.
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Affiliation(s)
- Aprajita Jagpal
- Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, 836 Faculty Office Tower, 510 20th Street South, Birmingham, AL 35294 USA
| | - Iris Navarro-Millán
- Joan and Sanford I Weill Medical College of Cornell University, Division of General Internal Medicine, 525 East 68th Street, F-2019, PO Box #331, New York, NY 10065 USA
- Division of Rheumatology, Hospital for Special Surgery, New York, NY USA
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87
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Association of nocturnal blood pressure patterns with inflammation and central and peripheral estimates of vascular health in rheumatoid arthritis. J Hum Hypertens 2018. [DOI: 10.1038/s41371-018-0047-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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88
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Kurmann RD, Mankad R. Atherosclerotic vascular disease in the autoimmune rheumatologic woman. Clin Cardiol 2018; 41:258-263. [PMID: 29480591 DOI: 10.1002/clc.22916] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 01/30/2018] [Accepted: 02/01/2018] [Indexed: 01/03/2023] Open
Abstract
Autoimmune rheumatologic conditions have increased cardiovascular morbidity and mortality compared to the general population. Many of these diseases occur more commonly in women, such as rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), systemic sclerosis, and Sjogren's. Most of the literature that has identified the link between autoimmune diseases and atherosclerotic cardiovascular disease (ASCVD) has been regarding patients with RA and SLE. The reason for the increased ASCVD is related to both traditional risk factors for atherosclerosis and nontraditional risk factors such as the burden of inflammation. Presently, our ability to adequately determinecardiovascular risk in the autoimmune patient is subpar, as scoring systems fail to take into account the role of inflammation. No present guidelines exist that take into account the increased burden of cardiovascular disease in this complex patient cohort.
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Affiliation(s)
| | - Rekha Mankad
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota
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Goodman SM, Bass AR. Perioperative medical management for patients with RA, SPA, and SLE undergoing total hip and total knee replacement: a narrative review. BMC Rheumatol 2018; 2:2. [PMID: 30886953 PMCID: PMC6390575 DOI: 10.1186/s41927-018-0008-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022] Open
Abstract
Total hip (THA) and total knee arthroplasty (TKA) are widely used, successful procedures for symptomatic end stage arthritis of the hips or knees, but patients with rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), and spondyloarthritis (SPA) including ankylosing spondylitis (AS) and psoriatic arthritis (PSA) are at higher risk for adverse events after surgery. Utilization rates of THA and TKA remain high for patients with RA, and rates of arthroplasty have increased for patients with SLE and SPA. However, complications such as infection are increased for patients with SLE, RA, and SPA, most of whom are receiving potent immunosuppressant medications and glucocorticoids at the time of surgery. Patients with SLE and AS are also at increased risk for perioperative cardiac and venous thromboembolism (VTE), while RA patients do not have an increase in perioperative cardiac or VTE risk, despite an overall increase in VTE and cardiac disease. This narrative review will discuss the areas of heightened risk for patients with RA, SLE, and SPA, and the perioperative management strategies currently used to minimize the risks.
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Affiliation(s)
- Susan M. Goodman
- Department of Medicine, Weill Cornell Medical School, Division of Rheumatology Hospital for Special Surgery, 535 E 70th St, New York City, NY 10021 USA
| | - Anne R. Bass
- Department of Medicine, Weill Cornell Medical School, Division of Rheumatology Hospital for Special Surgery, 535 E 70th St, New York City, NY 10021 USA
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Gualtierotti R, Ughi N, Marfia G, Ingegnoli F. Practical Management of Cardiovascular Comorbidities in Rheumatoid Arthritis. Rheumatol Ther 2017; 4:293-308. [PMID: 28752316 PMCID: PMC5696280 DOI: 10.1007/s40744-017-0068-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Indexed: 12/16/2022] Open
Abstract
Cardiovascular (CV) comorbidities are a frequent extra-articular manifestation of rheumatoid arthritis (RA). Cardiovascular disease (CVD) with accelerated atherosclerosis is a major cause of morbidity and mortality in patients with RA. Subclinical CVD may be present since the early phase of RA. Not only traditional but also non-traditional CV risk factors are involved in the pathogenesis of RA-related CVD. Due to the lack of specifically designed randomized clinical trials, it is still unclear which tools to use to perform CV risk assessment, how to interpret the results and which interventions are appropriate in RA patients both to prevent and to manage CVD. Based on the available evidence, we propose a practical approach.
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Affiliation(s)
- Roberta Gualtierotti
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Nicola Ughi
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Giovanni Marfia
- Neurosurgery Unit, Laboratory of Experimental Neurosurgery and Cell Therapy, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, University of Milan, Milan, Italy
| | - Francesca Ingegnoli
- Division of Rheumatology, ASST Pini, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
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