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Gerasimova EV, Popkova TV, Shalygina MV, Kirillova IG, Gerasimova DA, Glukhova SI, Nasonov EL. [Subclinical atherosclerosis of the carotid arteries in patients with rheumatoid arthritis with low cardiovascular risk]. TERAPEVT ARKH 2023; 95:375-379. [PMID: 38158988 DOI: 10.26442/00403660.2023.05.202203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Accepted: 07/16/2023] [Indexed: 01/03/2024]
Abstract
AIM To evaluate the detection rate of subclinical carotid atherosclerosis in rheumatoid arthritis (RA) patients with low cardiovascular risk (CVR). MATERIALS AND METHODS The study included 182 RA patients with low CVR (mSCORE<1%) and no established cardiovascular diseases and a control group comprising 100 people. Atherosclerotic lesion of the carotid arteries was assessed using Doppler ultrasound of the carotid arteries and was determined by the detection of atherosclerotic plaque (ASP) - the local increase in the thickness of the intima-media complex (IMT) >1.5 mm. RESULTS Carotid ASP were observed more frequently in RA patients with low CVR than in the control group (17% versus 8%; p=0.02). The frequency of ASP in RA patients with low CVR did not depend on the disease's stage or activity and ongoing therapy. In RA, the detection of subclinical atherosclerosis was associated with traditional risk factors: carotid ASP were detected 4 times more often in men than in women (48% versus 12%, p<0.01); carotid IMT correlated with age (R=0.46), body mass index (R=0.17), LDL-C level (R=0.20), systolic blood pressure (R=0.17); p<0.05 in all cases. According to a multivariate model, in RA, the risk of developing ASP increased in the presence of dyslipidemia (odds ratio - OR 2.97; 95% confidence interval - CI 1.36-6.49; p=0.006) and arterial hypertension (OR 2.16; 95% CI 1.03-4.54; p=0.04). In RA patients with carotid ASP, sCD40L level was associated with carotid IMT (R=0.32; p=0.04) and cholesterol concentration (R=0.39; p=0.01). CONCLUSION Subclinical atherosclerotic lesions of the carotid arteries were observed in 24% of RA patients with low cardiovascular risk and were detected almost 2 times more often than in the control group. In RA patients with low CVR, the risk of developing carotid ASP increased by 2-3 times with concomitant hypertension and dyslipidemia. The carotid IMT was associated with traditional risk factors - age, gender, lipid levels and blood pressure indicators, in cases of detection of ASP - with an immunoinflammatory marker - sCD40L.
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Affiliation(s)
| | | | | | | | - D A Gerasimova
- Sechenov First Moscow State Medical University (Sechenov University)
| | | | - E L Nasonov
- Nasonova Research Institute of Rheumatology
- Sechenov First Moscow State Medical University (Sechenov University)
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Gerasimova EV, Popkova TV, Gerasimova DA, Markina YV, Kirichenko TV. Subclinical Carotid Atherosclerosis in Patients with Rheumatoid Arthritis at Low Cardiovascular Risk. Biomedicines 2023; 11:biomedicines11030974. [PMID: 36979953 PMCID: PMC10046543 DOI: 10.3390/biomedicines11030974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/16/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
OBJECTIVE To evaluate the rate of subclinical carotid atherosclerosis and clinical significance of immunoinflammatory markers in patients with rheumatoid arthritis (RA) at low cardiovascular risk. MATERIALS AND METHODS The study included 275 RA patients and a control group of 100 participants without autoimmune diseases. All study participants were at low cardiovascular risk, calculated by the QRISK3 scale (<20%), and free of cardiovascular disease. Ultrasound examination of carotid arteries was performed to measure cIMT and to detect atherosclerotic plaques (ASP) in carotid arteries. sIСАМ-1, sVСАМ, and sCD40L levels were determined by enzyme immunoassay. RESULTS Carotid ASP was observed more frequently in RA patients (27%) than in the control group (17%), p = 0.03. The frequency of ASP in RA patients did not depend on the disease's stage or activity. There was a significant correlation between cIMT and age, cardiovascular risk determined by QRISK3, level of total cholesterol, LDL, and blood pressure in RA patients, p < 0.05 in all cases. No correlation between cIMT and blood levels of sCD40L, sVCAM, and sICAM was found. In RA patients, a higher concentration of sVCAM was detected in the carotid ASP group compared to the non-atherosclerotic group. sCD40L was associated with cIMT and total cholesterol in the ASP group and with total cholesterol and blood pressure in non-atherosclerotic patients. CONCLUSIONS Subclinical atherosclerotic lesions of the carotid arteries were observed significantly more frequently in RA patients with low cardiovascular risk than in the control group. The results of the study demonstrate the association between cIMT, traditional cardiovascular risk factors, and immunoinflammatory markers in RA patients.
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Affiliation(s)
| | - Tatiana V Popkova
- V.A. Nasonova Research Institute of Rheumatology, 115522 Moscow, Russia
| | - Daria A Gerasimova
- Department of Organization and Economy of Pharmacy, Institute of Pharmacy, I.M. Sechenov First Moscow State Medical University (Sechenov University), 119991 Moscow, Russia
| | - Yuliya V Markina
- Petrovsky National Research Center of Surgery, 119991 Moscow, Russia
| | - Tatiana V Kirichenko
- Petrovsky National Research Center of Surgery, 119991 Moscow, Russia
- Chazov National Medical Research Center of Cardiology, 121552 Moscow, Russia
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3
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Kintrilis N, Gravani F, Rapti A, Papaioannou M, Flessa CM, Nezos A, Antypa E, Papadaki I, Karageorgas Τ, Moutsopoulos HM, Mavragani CP. Subclinical atherosclerosis profiles in rheumatoid arthritis and primary Sjögren's syndrome: the impact of BAFF genetic variations. Rheumatology (Oxford) 2023; 62:958-968. [PMID: 35689637 DOI: 10.1093/rheumatology/keac337] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 05/16/2022] [Accepted: 05/16/2022] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES RA and primary SS carry increased atherosclerotic risk, while B-cell activating factor holds a vital role in disease pathogenesis and atherosclerosis. We aimed to compare subclinical atherosclerosis profiles between the two clinical entities and define whether BAFF genetic variants alter atherosclerotic risk. METHODS DNA from 166 RA, 148 primary SS patients and 200 healthy controls of similar age and sex distribution was subjected to PCR-based assay for the detection of five single nucleotide polymorphisms of the BAFF gene (rs1224141, rs12583006, rs9514828, rs1041569 and rs9514827). Genotype and haplotype frequencies were determined by SNPStats software and statistical analysis was performed by SPSS and Graphpad Software. Subclinical atherosclerosis was defined by the presence of carotid/femoral plaque formation and arterial wall thickening. RESULTS Atherosclerotic plaque formation was more frequently detected in the RA vs primary SS group (80.7% vs 62.2%, P-value <0.001), along with higher rates of family CVD history, current steroid dose and serum inflammatory markers. The TT genotype of the rs1224141 variant was more prevalent in RA but not primary SS patients with plaque and arterial wall thickening vs their counterparts without. Regarding the rs1014569 variant, among RA patients the TT genotype increased the risk for plaque formation while in primary SS patients the AT genotype conferred increased risk. Haplotype GTTTT was protective in the RA cohort, while TATTT and TTCTT haplotypes increased susceptibility for arterial wall thickening in the primary SS cohort. CONCLUSIONS Increased inflammatory burden, higher steroid doses and distinct BAFF gene variations imply chronic inflammation and B-cell hyperactivity as key contributors for the augmented atherosclerotic risk among autoimmune patients.
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Affiliation(s)
- Nikolaos Kintrilis
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens
| | | | - Anna Rapti
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens.,Department of Rheumatology
| | - Myrto Papaioannou
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens
| | - Christina-Maria Flessa
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens
| | - Adrianos Nezos
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens
| | - Eleni Antypa
- Department of Radiology, G. Gennimatas General Hospital of Athens
| | | | - Τheofanis Karageorgas
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens
| | | | - Clio P Mavragani
- Department of Physiology, School of Medicine, National and Kapodistrian University of Athens.,Joint Academic Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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Popescu D, Rezus E, Badescu MC, Dima N, Seritean Isac PN, Dragoi IT, Rezus C. Cardiovascular Risk Assessment in Rheumatoid Arthritis: Accelerated Atherosclerosis, New Biomarkers, and the Effects of Biological Therapy. Life (Basel) 2023; 13:life13020319. [PMID: 36836675 PMCID: PMC9965162 DOI: 10.3390/life13020319] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/10/2023] [Accepted: 01/19/2023] [Indexed: 01/24/2023] Open
Abstract
Rheumatoid arthritis (RA), one of the most common of the chronic inflammatory autoimmune diseases (CIADs), is recognized as an independent cardiovascular risk factor. Traditional risk factors such as smoking, arterial hypertension, dyslipidemia, insulin resistance, and obesity are frequently found in RA. Given the increased risk of mortality and morbidity associated with cardiovascular disease (CVD) in RA patients, screening for risk factors is important. Moreover, there is a need to identify potential predictors of subclinical atherosclerosis. Recent studies have shown that markers such as serum homocysteine, asymmetric dimethylarginine, or carotid intima-media thickness (cIMT) are correlated with cardiovascular risk. Although RA presents a cardiovascular risk comparable to that of diabetes, it is not managed as well in terms of acute cardiovascular events. The introduction of biological therapy has opened new perspectives in the understanding of this pathology, confirming the involvement and importance of the inflammatory markers, cytokines, and the immune system. In addition to effects in inducing remission and slowing disease progression, most biologics have demonstrated efficacy in reducing the risk of major cardiovascular events. Some studies have also been conducted in patients without RA, with similar results. However, early detection of atherosclerosis and the use of targeted therapies are the cornerstone for reducing cardiovascular risk in RA patients.
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Affiliation(s)
- Diana Popescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Elena Rezus
- Department of Rheumatology and Physiotherapy, “Grigore. T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Rheumatology Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
- Correspondence: (E.R.); (M.C.B.)
| | - Minerva Codruta Badescu
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
- Correspondence: (E.R.); (M.C.B.)
| | - Nicoleta Dima
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Petronela Nicoleta Seritean Isac
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
| | - Ioan-Teodor Dragoi
- Department of Rheumatology and Physiotherapy, “Grigore. T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Rheumatology Clinic, Clinical Rehabilitation Hospital, 700661 Iasi, Romania
| | - Ciprian Rezus
- Department of Internal Medicine, “Grigore T. Popa” University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania
- Internal Medicine Clinic, “Sf. Spiridon” County Clinical Emergency Hospital, 700111 Iasi, Romania
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Nie Q, Luo Q, Yan W, Zhang T, Wang H, Wu J. Rheumatoid arthritis and coronary atherosclerosis: a two-sample Mendelian randomization study. Front Cardiovasc Med 2023; 10:1033644. [PMID: 37187788 PMCID: PMC10175685 DOI: 10.3389/fcvm.2023.1033644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 04/17/2023] [Indexed: 05/17/2023] Open
Abstract
Objectives The relationship between rheumatoid arthritis (RA) and coronary atherosclerosis is widely concerned, but observational studies have not clarified causality. We performed two-sample Mendelian randomization (MR) study to assess the causal association between RA and coronary atherosclerosis. Methods we mainly conducted MR analysis using the inverse variance weighted (IVW) approach. Weighted median, MR-Egger regression and maximum likelihood were conducted as sensitivity analyses for supplementary analysis. Multivariate MR also were performed to validate the results of two-sample MR. Furthermore, we performed the MR-Egger intercept, MR-PRESSO, Cochran's Q test, and "Leave-one-out" to assess the levels of pleiotropy and heterogeneity. Results IVW result showed a positive link between genetic predisposition to RA and increased relative risk of coronary atherosclerosis (OR: 1.0021, 95%CI 1.0011-1.0031, P < 0.05). The result was confirmed by the weighted median method (OR: 1.0028, 95%CI 1.0014-1.0042, P < 0.05), MR-Egger regression (OR: 1.0031, 95%CI 1.0012-1.0049, P < 0.05) and maximum likelihood (OR: 1.0021, 95%CI 1.0011-1.0030, P < 0.05). Multivariate MR also reached a consistent conclusion. In addition, MR-Egger intercept (P = 0.20) and MR-PRESSO (P = 0.06) did not provide evidence of horizontal pleiotropy. Meanwhile, the results of Cochran's Q test (P = 0.05) and "Leave-one-out" failed to detect significant heterogeneity. Conclusion The result of the two-sample MR analysis found genetic evidence to support the positive causal association between RA and coronary atherosclerosis, suggesting that active intervention for RA may reduce the incidence of coronary atherosclerosis.
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Affiliation(s)
- Qiong Nie
- Department of Geriatrics, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
| | - Qiang Luo
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
| | - Wei Yan
- Department of Geriatrics, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
| | - Tongtong Zhang
- Department of General Surgery, The Center of Gastrointestinal and Minimally Invasive Surgery, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
| | - Han Wang
- Department of Cardiology, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
- Correspondence: Han Wang Jing Wu
| | - Jing Wu
- Department of Geriatrics, The Affiliated Hospital of Southwest Jiaotong University, The Third People's Hospital of Chengdu, Chengdu, China
- Correspondence: Han Wang Jing Wu
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Giachi A, Cugno M, Gualtierotti R. Disease-modifying anti-rheumatic drugs improve the cardiovascular profile in patients with rheumatoid arthritis. Front Cardiovasc Med 2022; 9:1012661. [PMID: 36352850 PMCID: PMC9637771 DOI: 10.3389/fcvm.2022.1012661] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/28/2022] [Indexed: 11/28/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting about 0. 5–1% of the adult population and manifesting as persistent synovitis, systemic inflammation and production of autoantibodies. Patients affected by RA not only experience chronic disease progression, but are also burdened by a 1.5-fold increased cardiovascular (CV) risk, which is comparable to the risk experienced by patients with type 2 diabetes mellitus. RA patients also have a higher incidence and prevalence of coronary artery disease (CAD). Although RA patients frequently present traditional CV risk factors such as insulin resistance and active smoking, previous studies have clarified the pivotal role of chronic inflammation–driven by proinflammatory cytokines such as interleukin 6 (IL-6) and tumor necrosis factor alpha (TNF-alpha)–in accelerating the process of atherosclerosis and impairing the coagulation system. Over the last years, a number of studies have shown that disease-modifying anti-rheumatic drugs (DMARDs) reducing the inflammatory state in general improve the CV risk, however some drugs may carry some apparent negative effects. Thus, RA is a model of disease in which targeting inflammation may counteract the progression of atherosclerosis and reduce CV risk. Clinical and experimental evidence indicates that the management of RA patients should be tailored based on the positive and negative effects of DMARDs on CV risk together with the individual traditional CV risk profile. The identification of genetic, biochemical and clinical biomarkers, predictive of evolution and response to treatment, will be the next challenge for a precision approach to reduce the burden of the disease.
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Affiliation(s)
- Andrea Giachi
- UOC Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Massimo Cugno
- UOC Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
- *Correspondence: Massimo Cugno
| | - Roberta Gualtierotti
- UOC Medicina Generale Emostasi e Trombosi, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, Università Degli Studi Di Milano, Milan, Italy
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Anno S, Okano T, Mamoto K, Sugioka Y, Tada M, Inui K, Koike T, Nakamura H. Incidence of New Carotid Plaques in Rheumatoid Arthritis Patients: Six Years Prospective Results of the TOMORROW Study. Mod Rheumatol 2022; 33:481-489. [PMID: 35652495 DOI: 10.1093/mr/roac051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 03/18/2022] [Accepted: 06/01/2022] [Indexed: 11/14/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate new incidence of carotid plaques in rheumatoid arthritis (RA) patients over 6-year prospective follow-up and assess the risk factors. METHODS This is a 10-year prospective cohort study included 208 RA patients and 205 age- and gender-matched controls. Ultrasound assessment of the bilateral carotid arteries was performed in 2011 and 2017. RESULTS There were no differences in the incidence of new carotid atherosclerotic plaques over 6 years between the two groups (35.5% vs. 37.0%, respectively; p = 0.936). The mean Disease Activity Score 28- C-reactive protein over 6 years in RA patients was 2.73 ± 0.95. Multiple logistic regression analysis showed that RA was not a risk factor for new carotid atherosclerotic plaques (odds ratios, 0.708; 95% CI, 0.348-1.440; p = 0.340). An average glucocorticoid dose >1.8 mg/day over 6 years was a risk factor for new carotid atherosclerotic plaques (odds ratios, 8.54; 95% CI, 1.641-44.455; p =0.011). CONCLUSIONS Incidence of new carotid atherosclerotic plaques was similar between well-controlled disease activity RA patients and control subjects. A mean glucocorticoid dose >1.8 mg/day over 6 years was a risk factor for new carotid atherosclerotic plaques.
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Affiliation(s)
- Shohei Anno
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka Social Medical Center, Osaka, Japan
| | - Tadashi Okano
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Kenji Mamoto
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Yuko Sugioka
- Center for Senile Degenerative Disorders (CSDD), Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Masahiro Tada
- Department of Orthopaedic Surgery, Osaka City General Hospital, Osaka, Japan
| | - Kentaro Inui
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan.,Department of Orthopaedic Surgery, Osaka Saiseikai Nakatsu Hospital, Osaka, Japan
| | - Tatsuya Koike
- Center for Senile Degenerative Disorders (CSDD), Osaka City University Graduate School of Medicine, Osaka, Japan.,Search Institute for Bone and Arthritis Disease (SINBAD), Shirahama Foundation for Health and Welfare, Wakayama, Japan
| | - Hiroaki Nakamura
- Department of Orthopaedic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
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Choe JY, Park SH, Kim SK. Augmentation index, but not pulse wave velocity, is associated with disease activity in rheumatoid arthritis. EUR J INFLAMM 2022. [DOI: 10.1177/1721727x221090158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Rheumatoid arthritis (RA) is associated with premature atherosclerosis and increased risk of cardiovascular disease (CVD). The purpose of this study was to assess the relationship between disease activity and arterial stiffness indexes for CVD in RA patients. Two hundred twenty-two female RA patients were retrospectively recruited. Non-invasive arterial stiffness was assessed by brachial-ankle PWV (baPWV) and ankle-brachial index (ABI) using pulse wave analyses and the augmentation index (AIx). The AIx was classified into two groups of normal (grade 0) and abnormal (grade 1, 2, and 3). The baPWV was associated with only age and rheumatoid factor titer, but not disease activity index, DAS28-ESR. Univariate analysis indicated that AIx was related to body mass index, disease duration, and DAS28-ESR. In addition, the baPWV was associated with DAS28-ESR and disease duration after adjusting for confounding factors (β = 0.147, p = 0.032 and β = 0.183, p = 0.034, respectively). Multivariate logistic regression analysis showed that the tendency for abnormal AIx increased as DAS28-ESR increased, and the result was significant ( p for trend = 0.026). The results of this study indicated that the relationship between AIx and DAS28-ESR suggests that disease activity could affect arterial stiffness in RA.
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Affiliation(s)
- Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Seo-Hyeon Park
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
| | - Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea
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A Review of Safety Outcomes from Clinical Trials of Baricitinib in Rheumatology, Dermatology and COVID-19. Adv Ther 2022; 39:4910-4960. [PMID: 36063279 PMCID: PMC9443639 DOI: 10.1007/s12325-022-02281-4] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 07/21/2022] [Indexed: 01/30/2023]
Abstract
Baricitinib is an oral, selective inhibitor of Janus kinase (JAK)1/JAK2 that transiently and reversibly inhibits many proinflammatory cytokines. This mechanism is a key mediator in a number of chronic inflammatory diseases; accordingly, baricitinib has been studied and approved for the treatment of several rheumatological and dermatological disorders, as well as COVID-19. This narrative review summarises and discusses the safety profile of baricitinib across these diseases, with special focus on adverse events of special interest (AESI) for JAK inhibitors, using integrated safety data sets of clinical trial data, and puts findings into context with the underlying risk in the respective disease populations, using supporting literature. We show that rates of infection with baricitinib generally reflected the inherent risk of the disease populations being treated, with serious infections and herpes zoster being more frequent in rheumatic diseases than in dermatological disorders, and herpes simplex being reported particularly in atopic dermatitis. Similarly, rates of major adverse cardiovascular events (MACE), venous thromboembolism (VTE) and malignancies were generally within or below the ranges reported for the respective disease populations, thereby reflecting the underlying risk; these events were therefore more frequent in patients with rheumatic diseases than in those with dermatological disorders, the latter of whom generally had low absolute risk. AESI were usually more common in patients with risk factors specific for each event. When a population similar to that of ORAL Surveillance was considered, the incidence rate of MACE with baricitinib was numerically lower than that reported with tofacitinib and similar to that of tumour necrosis factor inhibitors. No safety concerns were observed in hospitalised patients with COVID-19 who received baricitinib for up to 14 days. Identifying the patterns and likelihoods of AEs that occur during treatment in large groups of patients with different diseases can help the physician and patient better contextualise the benefit-to-risk ratio for the individual patient.
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10
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Giles JT, Rist PM, Liao KP, Tawakol A, Fayad ZA, Mani V, Paynter NP, Ridker PM, Glynn RJ, Lu F, Broderick R, Murray M, Vanni KMM, Solomon DH, Bathon JM. Testing the Effects of Disease-Modifying Antirheumatic Drugs on Vascular Inflammation in Rheumatoid Arthritis: Rationale and Design of the TARGET Trial. ACR Open Rheumatol 2021; 3:371-380. [PMID: 33932148 PMCID: PMC8207684 DOI: 10.1002/acr2.11256] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 12/10/2020] [Indexed: 11/24/2022] Open
Abstract
Individuals with rheumatoid arthritis (RA) are at increased risk for atherosclerotic cardiovascular disease (ASCVD) events relative to the general population, potentially mediated by atherosclerotic plaques that are more inflamed and rupture prone. We sought to address whether RA immunomodulators reduce vascular inflammation, thereby reducing ASCVD risk, and whether such reduction depends on the type of immunomodulator. The TARGET (Treatments Against RA and Effect on 18-Fluorodeoxyglucose [18 F-FDG] Positron Emission Tomography [PET]/Computed Tomography [CT]) trial (NCT02374021) will enroll 150 patients with RA with active disease and an inadequate response to methotrexate. Participants will be randomized to add either a tumor necrosis factor (TNF) inhibitor (etanercept or adalimumab) or sulfasalazine and hydroxychloroquine to their background methotrexate. Participants will undergo full-body 18 F-FDG-labelled PET scanning at baseline and after 6 months. Efficacy and safety evaluations will occur every 6 weeks, with therapy modified in a treat-to-target approach. The primary outcome is the comparison of change in arterial inflammation in the wall of the aorta and carotid arteries between the randomized treatment groups, specifically, the change in the mean of the maximum target-to-background ratio of arterial 18 F-FDG uptake in the most diseased segment of either the aorta and carotid arteries. A secondary analysis will compare the effects of achieving low disease activity or remission with those of moderate to high disease activity on vascular inflammation. The TARGET trial will test, for the first time, whether RA treatments reduce arterial inflammation and whether such reduction differs according to treatment strategy with either TNF inhibitors or a combination of nonbiologic disease-modifying antirheumatic drugs.
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Affiliation(s)
- Jon T. Giles
- Columbia UniversityVagelos College of Physicians & SurgeonsNew YorkNew York
| | - Pamela M. Rist
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Katherine P. Liao
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Ahmed Tawakol
- Massachusetts General Hospital and Harvard Medical SchoolBoston
| | - Zahi A. Fayad
- Translational and Molecular Imaging InstituteIcahn School of Medicine at Mount SinaiNew York
| | - Venkatesh Mani
- Translational and Molecular Imaging InstituteIcahn School of Medicine at Mount SinaiNew York
| | - Nina P. Paynter
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Paul M. Ridker
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Robert J. Glynn
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Fengxin Lu
- Brigham and Women's HospitalBostonMassachusetts
| | - Rachel Broderick
- Columbia UniversityVagelos College of Physicians & SurgeonsNew YorkNew York
| | | | | | - Daniel H. Solomon
- Brigham and Women's Hospital and Harvard Medical SchoolBostonMassachusetts
| | - Joan M. Bathon
- Columbia UniversityVagelos College of Physicians & SurgeonsNew YorkNew York
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Karpouzas GA, Bui VL, Ronda N, Hollan I, Ormseth SR. Biologics and atherosclerotic cardiovascular risk in rheumatoid arthritis: a review of evidence and mechanistic insights. Expert Rev Clin Immunol 2021; 17:355-374. [PMID: 33673792 DOI: 10.1080/1744666x.2021.1899809] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Cardiovascular disease is a leading comorbidity in rheumatoid arthritis. Timely introduction of biologic therapies in a treat-to-target approach has optimized disease-related outcomes and attenuated accrual of comorbidities, including cardiovascular risk.Areas covered: A literature search in MEDLINE (via PubMed) was performed between January 2009 and November 2020. This manuscript explores recent developments in atherosclerotic cardiovascular risk in RA compared with non-RA individuals; it synopsizes differences in vascular function and inflammation, prevalence, burden, vulnerability, and progression of atherosclerotic plaque and their underlying cellular and molecular mechanisms. Finally, it reviews the recent literature on cardioprotective benefits of biologics and draws mechanistic links with inhibition of new plaque formation, stabilization of high-risk lesions and improvement in endothelial function, arterial stiffness, lipid metabolism, and traditional cardiac risk factors.Expert opinion: Increasing evidence points to a solid cardioprotective influence of earlier, longer, and ongoing use of biologic treatments in RA. Nevertheless, the precise mechanistic effects of plaque progression and remodeling, vascular stiffness, endothelial dysfunction, lipid metabolism, and traditional cardiac risk factors are less rigorously characterized.
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Affiliation(s)
- George A Karpouzas
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Viet L Bui
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
| | - Nicoletta Ronda
- Department of Food and Drug, University of Parma, Parma, Italy
| | - Ivana Hollan
- The Norwegian University of Science and Technology, Gjøvik, Norway.,Beitostølen Sport and Health Centre, Beitostølen, Norway
| | - Sarah R Ormseth
- Division of Rheumatology, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, CA, USA
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Giles JT, Reinholdt J, Andrade F, Konig MF. Associations of Antibodies Targeting Periodontal Pathogens With Subclinical Coronary, Carotid, and Peripheral Arterial Atherosclerosis in Rheumatoid Arthritis. Arthritis Rheumatol 2021; 73:568-575. [PMID: 33205531 DOI: 10.1002/art.41572] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 10/27/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Both periodontal disease and cardiovascular disease (CVD) are overrepresented in rheumatoid arthritis (RA). This study was undertaken to investigate the contribution of periodontal pathogens to CVD in RA. METHODS RA patients underwent assessments of coronary artery calcification (CAC), carotid intima-media thickness and plaque, and ankle-brachial index via computed tomography, ultrasound, and Doppler ultrasound, respectively. Sera were assayed for antibodies targeting Porphyromonas gingivalis (Pg), Aggregatibacter actinomycetemcomitans serotype B (Aa), and Aa-derived leukotoxin A (LtxA). Associations of antibodies against these periodontal pathogens with measures of atherosclerosis were explored using generalized linear models. RESULTS Among 197 RA patients, anti-Pg was detected in 72 patients (37%), anti-Aa in 41 patients (21%), and anti-LtxA in 84 patients (43%). Adjusting for relevant confounders and reported tooth loss, the mean CAC score was 90% higher in those with anti-Aa and/or anti-LtxA compared with those without either antibody (19 units versus 10 units; P = 0.033). The adjusted odds of CAC ≥100 units were 2.23-fold higher in those with anti-Aa and/or anti-LtxA compared with those without either antibody (P = 0.040). Anti-Aa and/or anti-LtxA seropositivity was significantly associated with all other assessed measures of atherosclerosis except carotid plaque. Anti-Pg was not associated with any measure of atherosclerosis. Higher swollen joint count was associated with CAC exclusively in the group with anti-Aa and/or anti-LtxA. CONCLUSION Immunoreactivity against Aa and/or its major virulence factor LtxA was associated with atherosclerosis in multiple vascular beds of RA patients and amplified the effect of swollen joints on coronary atherosclerosis, suggesting a role for treatment/prevention of periodontal disease in the prevention of CVD in RA.
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Affiliation(s)
- Jon T Giles
- Columbia University Vagelos College of Physicians and Surgeons, New York, New York
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13
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Mal K, Kumar R, Mansoor F, Kaur N, Kumar A, Memon S, Rizwan A. Risk of Major Adverse Cardiovascular Events in Patients With Rheumatoid Arthritis. Cureus 2020; 12:e12246. [PMID: 33505813 PMCID: PMC7823064 DOI: 10.7759/cureus.12246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Rheumatoid arthritis is a chronic, inflammatory, and multisystem disease, which, along with the joints, can involve the cardiovascular system. The treatment of rheumatoid arthritis or rheumatoid arthritis itself can lead to atherosclerosis, which is considered one of the major causes by which it can affect the cardiovascular system. In this study, we will assess the risk of cardiovascular events in patients with rheumatoid arthritis as compared to the general population. Method This case-control study was conducted from January 2018 to November 2018. Two-hundred twenty-two (222) patients with diagnosed rheumatoid arthritis were included as cases in the study. Two-hundred eleven (211) patients were included in the study as the control group (patients without rheumatoid arthritis). All the data were recorded in a self-structured questionnaire. Result Participants with rheumatoid arthritis also showed an increased risk of myocardial infarction (MI) by an odds ratio of 2.50 (95% CI; 0.77-8.14). There was also an increased risk of cardiovascular death in participants with rheumatoid arthritis by an odds ratio of 1.99 (0.58-6.71). Conclusion The study suggests that rheumatoid arthritis along with joint inflammation can also affect the cardiovascular system. Hence, a multidisciplinary team of rheumatologists and cardiologists should manage patients suffering from rheumatoid arthritis, which will improve morbidity and mortality in such patients.
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Affiliation(s)
- Kheraj Mal
- Cardiology, National Institute of Cardiovascular Diseases, Sukkur, PAK
| | - Ratan Kumar
- Cardiology, Khairpur Medical College, Nawabshah, PAK
| | - Farah Mansoor
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Navneet Kaur
- Internal Medicine, Adesh Institute of Medical Sciences and Research, Buchu Kalan, IND
| | - Anil Kumar
- Cardiology, National Institute of Cardiovascular Diseases, Sukkur, PAK
| | - Sidra Memon
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Amber Rizwan
- Family Medicine, Jinnah Post Graduate Medical Center, Karachi, PAK
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14
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Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Semin Arthritis Rheum 2020; 51:219-229. [PMID: 33385862 DOI: 10.1016/j.semarthrit.2020.11.005] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 10/19/2020] [Accepted: 11/05/2020] [Indexed: 02/07/2023]
Abstract
C-reactive protein (CRP) is routinely assessed as a marker of systemic inflammation in rheumatoid arthritis (RA). However, it is also an immune regulator that plays an important role in inflammatory pathways associated with RA and promotes atherogenic effects. Comorbidities linked to systemic inflammation are common in RA, and CRP has been associated with the risk for cardiovascular disease, diabetes, metabolic syndrome, pulmonary diseases, and depression. The relationship between systemic inflammation, CRP, and comorbidities in RA is complex, and it is challenging to determine how changing CRP levels may affect the risk or progression of these comorbidities. We review the biological role of CRP in RA and its implications for disease activity and treatment response. We also discuss the impact of treatment on CRP levels and whether reducing systemic inflammation and inhibiting CRP-mediated inflammatory pathways may have an impact on conditions commonly comorbid with RA.
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Affiliation(s)
- Janet E Pope
- Janet E. Pope: Schulich School of Medicine, University of Western Ontario, St. Joseph's Health Care, London, ON, Canada
| | - Ernest H Choy
- Ernest H. Choy: Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, United Kingdom.
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Fragoulis GE, Panayotidis I, Nikiphorou E. Cardiovascular Risk in Rheumatoid Arthritis and Mechanistic Links: From Pathophysiology to Treatment. Curr Vasc Pharmacol 2020; 18:431-446. [PMID: 31258091 DOI: 10.2174/1570161117666190619143842] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 05/22/2019] [Accepted: 05/22/2019] [Indexed: 12/19/2022]
Abstract
Rheumatoid arthritis (RA) is an autoimmune inflammatory arthritis. Inflammation, however, can spread beyond the joints to involve other organs. During the past few years, it has been well recognized that RA associates with increased risk for cardiovascular (CV) disease (CVD) compared with the general population. This seems to be due not only to the increased occurrence in RA of classical CVD risk factors and comorbidities like smoking, obesity, hypertension, diabetes, metabolic syndrome, and others but also to the inflammatory burden that RA itself carries. This is not unexpected given the strong links between inflammation and atherosclerosis and CVD. It has been shown that inflammatory cytokines which are present in abundance in RA play a significant role in every step of plaque formation and rupture. Most of the therapeutic regimes used in RA treatment seem to offer significant benefits to that end. However, more studies are needed to clarify the effect of these drugs on various parameters, including the lipid profile. Of note, although pharmacological intervention significantly helps reduce the inflammatory burden and therefore the CVD risk, control of the so-called classical risk factors is equally important. Herein, we review the current evidence for the underlying pathogenic mechanisms linking inflammation with CVD in the context of RA and reflect on the possible impact of treatments used in RA.
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Affiliation(s)
- George E Fragoulis
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, United Kingdom
| | - Ismini Panayotidis
- Faculty of Medical Sciences, Medical School, University College London, London, United Kingdom
| | - Elena Nikiphorou
- Department of Inflammation Biology, King's College London, London, UK and Department of Rheumatology, King's College Hospital, London, United Kingdom
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Traditional cardiovascular risk factors and residual disease activity are associated with atherosclerosis progression in rheumatoid arthritis patients. Hypertens Res 2020; 43:922-928. [PMID: 32341443 DOI: 10.1038/s41440-020-0441-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/13/2020] [Accepted: 03/12/2020] [Indexed: 12/12/2022]
Abstract
Patients with rheumatoid arthritis (RA) have an increased incidence of cardiovascular events. Ultrasound examination of the carotid arteries can show the presence of plaques and detect the atherosclerotic subclinical process through the evaluation of intima-media thickness (cIMT) and carotid segmental distensibility (cCD). The aim of the present study was to identify which factors could independently influence the evolution of atherosclerosis (plaques, cIMT, and cCD) after 1 year of follow-up in a sample of patients with RA. A total of 137 patients with RA without previous cardiovascular (CV) events were enrolled at baseline, and 105 (M/F: 21/84, age 59.34 ± 11.65 years) were reassessed after one year using ultrasound of carotid arteries to detect atheromatous plaques and to measure cIMT and cCD. After one year, all the indices of subclinical atherosclerosis worsened with respect to baseline (Δ-cIMT = 0.030 ± 0.10 mm, p = 0.005; Δ-cCD = -1.64 ± 4.83, 10-3/KPa, p = 0.005; Δ-plaques = 8.6%, p = 0.035). Traditional CV risk factors (age, mean arterial pressure, and diabetes) and corticosteroid therapy were independently associated with the worsening of subclinical atherosclerosis. Interestingly, when considering RA patients divided according to the degree of disease activity score 28 with C-reactive protein (DAS28 [CRP] ≥2.6), the worsening of subclinical atherosclerosis indices was detectable exclusively in the group of patients with active disease. Our longitudinal study supports the hypothesis of a key role of both traditional CV risk factors and the inflammatory activity of arthritic disease in the progression of subclinical atherosclerosis in RA patients. In addition, corticosteroids might have a deleterious effect.
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17
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Karpouzas GA, Ormseth SR, Hernandez E, Budoff MJ. Impact of Cumulative Inflammation, Cardiac Risk Factors, and Medication Exposure on Coronary Atherosclerosis Progression in Rheumatoid Arthritis. Arthritis Rheumatol 2020; 72:400-408. [PMID: 31532064 DOI: 10.1002/art.41122] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 09/12/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE To explore incidence and progression of coronary atherosclerosis and identify determinants in patients with rheumatoid arthritis (RA). We specifically evaluated the impact of inflammation, cardiac risk factors, duration of medication exposure, and their interactions on coronary plaque progression. METHODS One hundred one participants with baseline coronary computed tomography angiography findings underwent follow-up assessment a mean ± SD of 83 ± 3.6 months after baseline. Plaque burden was reported as the segment involvement score (describing the number of coronary segments with plaque) and the segment stenosis score (characterizing the cumulative plaque stenosis over all evaluable segments). Plaque composition was classified as noncalcified, mixed, or calcified. Coronary artery calcium (CAC) was quantified using the Agatston method. RESULTS Total plaque increased in 48% of patients, and progression was predicted by older age, higher cumulative inflammation, and total prednisone dose (P < 0.05). CAC progressors were older, more obese, hypertensive, and had higher cumulative inflammation compared to nonprogressors (P < 0.05). Longer exposure to biologics was associated with lower likelihood of noncalcified plaque progression, lesion remodeling, and constrained CAC change in patients without baseline calcification, independent of inflammation, prednisone dose, or statin exposure (all P < 0.05). Longer statin treatment further restricted noncalcified plaque progression and attenuated the effect of inflammation on increased plaque and CAC (P < 0.05). Stringent systolic blood pressure (BP) control further weakened the effect of inflammation on total plaque progression. CONCLUSION Inflammation was a consistent and independent predictor of coronary atherosclerosis progression in RA. It should therefore be specifically targeted toward mitigating cardiovascular risk. Biologic disease-modifying antirheumatic drugs, statins, and BP control may further constrain plaque progression directly or indirectly.
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18
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Kravvariti E, Konstantonis G, Sfikakis PP, Tektonidou MG. Progression of subclinical atherosclerosis in systemic lupus erythematosus versus rheumatoid arthritis: the impact of low disease activity. Rheumatology (Oxford) 2019; 57:2158-2166. [PMID: 30102390 DOI: 10.1093/rheumatology/key233] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Indexed: 02/03/2023] Open
Abstract
Objectives The progression of subclinical atherosclerosis in SLE and RA has not been comparatively assessed. We sought to investigate the impact of low disease activity and other disease-related factors on atherosclerosis progression in SLE vs RA. Methods We performed a 3-year follow-up carotid and femoral artery ultrasound in 101 patients with SLE, 85 with RA and 85 controls after a baseline examination in 115 SLE and 1:1 age- and gender-matched RA patients and controls. We used logistic regression to compare atherosclerosis progression (new plaque development) between SLE and RA vs controls, and assess determinants of progression in SLE patients with different lupus low disease activity state (LLDAS) durations, adjusting for disease-related factors, antihypertensives, antiplatelets, statins and the Systemic Coronary Risk Evaluation 10-year cardiovascular risk. Results The odds ratio (OR) of plaque progression vs controls was significantly higher in SLE (OR = 2.81, P = 0.043), but not in RA (OR = 2.22, P = 0.109). Results were similar in patients with low disease activity (88% of SLE, 74% of RA). Multivariate determinants of progression in SLE included antiphospholipid antibodies (OR = 2.00, P = 0.043) and Systemic Coronary Risk Evaluation (OR = 2.87, P = 0.019) for all patients, and additionally cumulative corticosteroid dose during follow-up (OR = 1.38, P = 0.013) and disease duration (OR = 1.20, P = 0.022) for patients in LLDAS over entire follow-up. Results were similar for patients with shorter LLDAS durations (>75% or >50% of follow-up). Conclusion Plaque progression is accelerated in SLE regardless of disease activity, and is associated with antiphospholipid antibodies and the Systemic Coronary Risk Evaluation. In LLDAS, cumulative corticosteroid dose and disease duration are additional determinants of progression.
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Affiliation(s)
- Evrydiki Kravvariti
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - George Konstantonis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Petros P Sfikakis
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Maria G Tektonidou
- Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
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19
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Södergren A, Karp K, Bengtsson C, Möller B, Rantapää-Dahlqvist S, Wållberg-Jonsson S. Biomarkers associated with cardiovascular disease in patients with early rheumatoid arthritis. PLoS One 2019; 14:e0220531. [PMID: 31381601 PMCID: PMC6681963 DOI: 10.1371/journal.pone.0220531] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Accepted: 07/17/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives Patients with rheumatoid arthritis (RA) have an increased mortality and morbidity due to cardiovascular disease (CVD). In this prospective 5-year follow up of patients with RA, we analysed several biomarkers, known to be associated with atherosclerosis and/or inflammation in the general population. The aim of this study was to find out whether the RA-disease per se affect these biomarkers and if those could be associated with the progression of atherosclerosis, as measured by intima media thickness (IMT) among patients with early RA. Methods Patients from northern Sweden diagnosed with early RA, are consecutively recruited into an ongoing prospective study on CVD comorbidity. A subgroup of patients, aged ≤60 years (n = 71) was included for ultrasound measurements of IMT at inclusion (T0) and after 5 years (T5) together with age-sex-matched controls (n = 40). The patients were clinically assessed. Blood was analysed for lipids, ESR and CRP and several biomarkers known to be associated with atherosclerosis in the general population. Results At T0, the patients with RA had significantly lower levels of MIF and significantly higher levels of interleukin (IL)-18 and MIC-1 compared with controls. At T5, the patients with RA had significantly higher levels of pentraxin3, MIC-1, TNF-R2, ICAM-1, VCAM-1 and endostatin compared with controls. At T0 the levels of MPO correlated with DAS28, sCD40L with CRP and IL-18 with systolic blood pressure and Reynolds risk score. Using PLSR on a CVD-panel analysed with multiplex immunoassay, the patients with RA could be correctly classified into those who had a worsening in their IMT over the five years or not. Here, MMP3 was identified as influential. Conclusions This study indicates that the RA disease itself could affect several of the biomarkers in this study, and possibly also the processes involved in the development of atherosclerosis.
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Affiliation(s)
- Anna Södergren
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
- Wallenberg Centre for Molecular Medicine (WCMM), Umeå University, Umeå, Sweden
- * E-mail:
| | - Kjell Karp
- Department of Surgical and Perioperative Sciences, University of Umeå, Umeå, Sweden
| | - Christine Bengtsson
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
- Department of Rheumatology, Kristianstad Hospital, Kristianstad, Sweden
| | - Bozena Möller
- Department of Rheumatology, Sunderby Hospital, Luleå, Sweden
| | | | - Solveig Wållberg-Jonsson
- Department of Public Health and Clinical Medicine/Rheumatology, University of Umeå, Umeå, Sweden
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20
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van der Geest R, van der Sluis RJ, Groen AK, Van Eck M, Hoekstra M. Cholestasis-associated glucocorticoid overexposure does not increase atherogenesis. J Endocrinol 2019; 242:1-12. [PMID: 31035252 DOI: 10.1530/joe-19-0079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 12/15/2022]
Abstract
Chronic glucocorticoid overexposure predisposes to the development of atherosclerotic cardiovascular disease in humans. Cholestatic liver disease is associated with increased plasma glucocorticoid levels. Here, we determined - in a preclinical setting - whether the chronic presence of cholestatic liver disease also induces a concomitant negative impact on atherosclerosis susceptibility. Hereto, regular chow diet-fed atherosclerosis-susceptible hypercholesterolemic apolipoprotein E (APOE)-knockout mice were treated with the bile duct toxicant alpha-naphthylisothiocyanate (ANIT) for 8 weeks. ANIT exposure induced the development of fibrotic cholestatic liver disease as evident from collagen deposits and compensatory bile duct hyperproliferation within the liver and the rise in plasma levels of bilirubin (+60%; P < 0.01) and bile acids (10-fold higher; P < 0.01). Adrenal weights (+22%; P < 0.01) and plasma corticosterone levels (+72%; P < 0.01) were increased in ANIT-treated mice. In contrast, atherosclerosis susceptibility was not increased in response to ANIT feeding, despite the concomitant increase in plasma free cholesterol (+30%; P < 0.01) and cholesteryl ester (+42%; P < 0.001) levels. The ANIT-induced hypercorticosteronemia coincided with marked immunosuppression as judged from the 50% reduction (P < 0.001) in circulating lymphocyte numbers. However, hepatic glucocorticoid signaling was not enhanced after ANIT treatment. It thus appears that the immunosuppressive effect of glucocorticoids is uncoupled from their metabolic effect under cholestatic disease conditions. In conclusion, we have shown that cholestatic liver disease-associated endogenous glucocorticoid overexposure does not increase atherosclerosis susceptibility in APOE-knockout mice. Our studies provide novel preclinical evidence for the observations that the hypercholesterolemia seen in cholestatic human subjects does not translate into a higher risk for atherosclerotic cardiovascular disease.
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Affiliation(s)
- Rick van der Geest
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Gorlaeus Laboratories, Leiden, The Netherlands
| | - Ronald J van der Sluis
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Gorlaeus Laboratories, Leiden, The Netherlands
| | - Albert K Groen
- Departments of Pediatrics and Laboratory Medicine, University Medical Center Groningen, Groningen, The Netherlands
| | - Miranda Van Eck
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Gorlaeus Laboratories, Leiden, The Netherlands
| | - Menno Hoekstra
- Division of BioTherapeutics, Leiden Academic Centre for Drug Research, Gorlaeus Laboratories, Leiden, The Netherlands
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Imaging for screening cardiovascular involvement in patients with systemic rheumatologic diseases: more questions than answers. Eur Heart J Cardiovasc Imaging 2019; 20:967-978. [DOI: 10.1093/ehjci/jez171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 05/30/2019] [Accepted: 06/04/2019] [Indexed: 11/14/2022] Open
Abstract
Abstract
Cardiovascular involvement due to systemic rheumatologic diseases (SRDs) remains largely underdiagnosed despite causing excess mortality and limiting the favourable effect of therapeutic developments on survival. Traditional risk scoring systems are poorly calibrated for SRD patients. There is an unmet need to develop a cardiovascular (CV) risk stratification tool and screening algorithm for CV involvement dedicated to asymptomatic patients with SRDs. Even though accelerated atherosclerosis is the most prominent cause of major CV events, a more comprehensive approach is crucial to detect different pathological processes associated with SRDs that are leading to CV complications. In that regard, incorporation of imaging parameters obtained from echocardiography and carotid ultrasound (CUS) might help to improve risk models, to detect and monitor subclinical CV involvement. These two imaging modalities should be an integral part of screening SRD patients with suspicion of CV involvement on top of electrocardiogram (ECG). Cardiac magnetic resonance and multi-slice computerized tomography angiography and nuclear imaging modalities seem very important to complement echocardiography and CUS for further evaluation. However, to answer the question ‘Should asymptomatic patients with SRDs undergo screening with echocardiography and CUS on top of ECG?’ necessitates large studies performing cardiac screening with a standard approach by using these imaging methods to obtain longitudinal data with hard CV outcomes.
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22
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Rheumatoid arthritis (RA) and cardiovascular disease. Autoimmun Rev 2019; 18:679-690. [PMID: 31059840 DOI: 10.1016/j.autrev.2019.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/27/2019] [Indexed: 12/13/2022]
Abstract
Patients with rheumatoid arthritis (RA) suffer cardiovascular events 1.5-2 fold than the general population, and cardiovascular (CV) events are leading cause of death in patients with RA. It is known that patients with RA have endothelial dysfunction, related with impaired function of endothelial progenitor cells (EPCs). The mechanistic pathways leading to endothelial function are complicated, but understanding these mechanisms may open new frontiers of management and therapies to patients suffering from atherosclerosis. Inflammation is a key factor in atherosclerosis, including endothelial function, plaque stabilization and post infarct remodeling; thus, inhibition of TNF-α may affect the inflammatory burden and plaque vulnerability leading to less cardiovascular events and myocardial infarctions. An aggressive management of inflammation may lead to a significant improvement in the clinical cardiovascular outcome of patients with RA. The clinical evidence that showed a reduced risk of CV events following treatment with anti-inflammatory agents may suggest a new approach to treat atherosclerosis, i.e., inhibition of inflammation using biological medications that were primarily aimed to treat the high scale inflammation of RA and other autoimmune-inflammatory diseases, but may be useful also to prevent progression of atherosclerosis.
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Teague HL, Varghese NJ, Tsoi LC, Dey AK, Garshick MS, Silverman JI, Baumer Y, Harrington CL, Stempinski E, Elnabawi YA, Dagur PK, Cui K, Tunc I, Seifuddin F, Joshi AA, Stansky E, Purmalek MM, Rodante JA, Keel A, Aridi TZ, Carmona-Rivera C, Sanda GE, Chen MY, Pirooznia M, McCoy JP, Gelfand JM, Zhao K, Gudjonsson JE, Playford MP, Kaplan MJ, Berger JS, Mehta NN. Neutrophil Subsets, Platelets, and Vascular Disease in Psoriasis. ACTA ACUST UNITED AC 2019; 4:1-14. [PMID: 30847414 PMCID: PMC6390681 DOI: 10.1016/j.jacbts.2018.10.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Revised: 10/29/2018] [Accepted: 10/31/2018] [Indexed: 11/29/2022]
Abstract
LDGs are a subset of neutrophils that were elevated in psoriasis and associated with the severity of disease. In psoriasis, LDGs associated with noncalcified coronary plaque burden beyond cardiovascular risk factors and in vitro, induced endothelial cell damage. Compared to normal-density granulocyte neutrophils, platelet-associated biological pathways were upregulated in LDGs, suggesting enhanced platelet adherence to the LDG surface. LDGs co-localized with platelets in circulation, and the LDG-platelet interaction associated more strongly with non-calcified coronary burden by coronary CTA compared to LDGs alone.
Psoriasis is an inflammatory skin disease associated with increased cardiovascular risk and serves as a reliable model to study inflammatory atherogenesis. Because neutrophils are implicated in atherosclerosis development, this study reports that the interaction among low-density granulocytes, a subset of neutrophils, and platelets is associated with a noncalcified coronary plaque burden assessed by coronary computed tomography angiography. Because early atherosclerotic noncalcified burden can lead to fatal myocardial infarction, the low-density granulocyte−platelet interaction may play a crucial target for clinical intervention.
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Key Words
- CCTA, coronary computed tomography angiography
- CVD, cardiovascular disease
- FDR, false discovery rate
- HAoEC, human aortic endothelial cell
- LDG, low-density granulocyte
- MI, myocardial infarction
- NCB, noncalcified coronary plaque burden
- NDG, normal-density granulocyte
- NET, neutrophil extracellular trap
- PASI, psoriasis area severity index
- SLE, systemic lupus erythematosus
- TB, total coronary plaque burden
- cardiovascular disease
- low-density granulocytes
- neutrophils
- platelets
- psoriasis
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Affiliation(s)
- Heather L Teague
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Nevin J Varghese
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Lam C Tsoi
- Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Amit K Dey
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Michael S Garshick
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York
| | - Joanna I Silverman
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Yvonne Baumer
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Charlotte L Harrington
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Erin Stempinski
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Youssef A Elnabawi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Pradeep K Dagur
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Kairong Cui
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Ilker Tunc
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Fayaz Seifuddin
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Aditya A Joshi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Elena Stansky
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Monica M Purmalek
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Justin A Rodante
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Andrew Keel
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Tarek Z Aridi
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Carmelo Carmona-Rivera
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Gregory E Sanda
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Marcus Y Chen
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mehdi Pirooznia
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - J Philip McCoy
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Joel M Gelfand
- Department of Dermatology, Perelman School of Medicine, Philadelphia, Pennsylvania.,Department of Biostatics, Epidemiology, and Informatics, Perelman School of Medicine, Philadelphia, Pennsylvania
| | - Keji Zhao
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Martin P Playford
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
| | - Mariana J Kaplan
- Systemic Autoimmunity Branch, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Bethesda, Maryland
| | - Jeffrey S Berger
- Department of Medicine, Division of Cardiology, New York University School of Medicine, New York, New York
| | - Nehal N Mehta
- National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland
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Role of inflammation in the pathogenesis of atherosclerosis and therapeutic interventions. Atherosclerosis 2018; 276:98-108. [DOI: 10.1016/j.atherosclerosis.2018.07.014] [Citation(s) in RCA: 197] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 07/03/2018] [Accepted: 07/11/2018] [Indexed: 12/15/2022]
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Targońska-Stępniak B, Piotrowski M, Zwolak R, Drelich-Zbroja A, Majdan M. Prospective assessment of cardiovascular risk parameters in patients with rheumatoid arthritis. Cardiovasc Ultrasound 2018; 16:18. [PMID: 30068353 PMCID: PMC6090938 DOI: 10.1186/s12947-018-0136-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 07/24/2018] [Indexed: 01/08/2023] Open
Abstract
Background The study presents a prospective follow-up assessment of cardiovascular (CV) risk parameters in patients with rheumatoid arthritis (RA) in comparison with control subjects. Methods The study group consisted of 41 RA patients. The following parameters were assessed at subsequent visits [initial (T0), follow-up after 6 years (T6)]: traditional CV risk factors, carotid intima media thickness (cIMT), QTc duration, serum concentration of amino-terminal pro-brain natriuretic peptide (NT-proBNP). A comparative cIMT assessment was performed on 23 healthy controls of comparable age. Results The mean (SD) cIMT value in RA patients was significantly higher at T6 than at T0 [0.87 (0.21) vs 0.76 (0.15) mm, p < 0.001], the increase in patients with atherosclerotic plaques was noted. Patients with plaques were significantly older, had higher inflammatory parameters. The mean cIMT was significantly higher in RA patients than in controls at both T6, T0 visits. Certain traditional CV risk factors exacerbated during follow up. Unfavorable metabolic parameters and significantly higher cIMT were found in male patients than in female patients at T6. During follow-up, no significant differences in NT-proBNP, QTc were found. There were no significant relationships between cIMT, NT-proBNP, QTc and parameters of disease activity at T6. Conclusions During the 6-year course of established RA, significant exacerbation of atherosclerosis was found, revealed by higher cIMT. A careful monitoring should be applied to patients with atherosclerotic plaques and of male gender due to higher burden of CV risk. In long-standing disease, traditional CV risk factors seem to play a key role, beyond the inflammatory activity.
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Affiliation(s)
- Bożena Targońska-Stępniak
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland.
| | - Mariusz Piotrowski
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland
| | - Robert Zwolak
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland
| | - Anna Drelich-Zbroja
- Department of Interventional Radiology and Neuroradiology, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland
| | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, ul. Jaczewskiego 8, 20-950, Lublin, Poland
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Bergström U, Jovinge S, Persson J, Jacobsson LTH, Turesson C. Effects of Treatment with Adalimumab on Blood Lipid Levels and Atherosclerosis in Patients with Rheumatoid Arthritis. Curr Ther Res Clin Exp 2018; 89:1-6. [PMID: 30128057 PMCID: PMC6097545 DOI: 10.1016/j.curtheres.2018.07.001] [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: 05/19/2018] [Revised: 07/15/2018] [Accepted: 07/17/2018] [Indexed: 01/04/2023] Open
Abstract
Background Treatment with tumor necrosis factor inhibitors for rheumatoid arthritis has been associated with a decreased risk of cardiovascular disease in observational studies. There are conflicting data on the influence of tumor necrosis factor inhibitors on lipid levels. Objectives To evaluate the effect of treatment with adalimumab on blood lipid levels, lipoproteins, and atherosclerosis of the carotid artery. Methods Fourteen patients with active rheumatoid arthritis (11 women and 3 men; mean age 63.7 years; median disease duration 9.0 years; and 78% rheumatoid factor positive) were treated with adalimumab 40 mg subcutaneously every 2 weeks and followed for 3 months. The patients had not been treated with adalimumab previously and had not received other tumor necrosis factor inhibitors within the past 3 months or moderate/high dose corticosteroids within the past 2 weeks. The intima-media thickness of the common carotid artery was assessed using B mode ultrasonography. Triglycerides, total cholesterol, LDL cholesterol, and HDL cholesterol levels were analyzed in fresh fasting blood samples, whereas apolipoprotein B and apolipoprotein A1 (apoA1) levels were determined in thawed plasma samples using standard turbidimetric immunoassays. Results Total cholesterol (mean = 5.36 vs 5.96 mmol/L; P = 0.005), LDL cholesterol (mean = 3.33 vs 3.77 mmol/L; P = .005), HDL cholesterol (mean = 1.43 vs 1.55 mmol/L; P = 0.048), apolipoprotein B (mean = 1.04 vs 1.13 g/L; P = .012), and apoA1 (mean = 1.42 vs 1.58 g/L; P = 0.005) all increased, but there were no major changes in the LDL to HDL cholesterol ratio (median = 2.56 vs 2.35; P = 0.27) or the apolipoprotein B to apoA1 ratio (mean = 0.76 vs 0.74; P = 0.46). There was no change in triglyceride levels (P = 0.55). Disease activity decreased significantly from baseline to the 3-month evaluation (disease activity score based on 28 joints mean = 5.6 vs 4.1; P = 0.007). An increase in apoA1 correlated with decreases in the patient global assessment of disease severity (r = 0.79; P = 0.001) and C-reactive protein level (r = 0.74; P = 0.003). Changes in the apoliprotein B to apoA1 ratio correlated with changes in erythrocyte sedimentation rate (r = 0.54; P = 0.046). There was no major change in the common carotid artery intima-media thickness (mean = 0.78 vs 0.80 mm; P = 0.48). Conclusions Although these results suggest that control of inflammation could have a beneficial effect on the lipid profile through an increase in HDL cholesterol levels, the observed protective effect on cardiovascular disease events by tumor necrosis factor blockers is likely to be explained by other mechanisms than changes in lipid levels or short-term effects on atherosclerosis of the carotid artery.
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Affiliation(s)
- Ulf Bergström
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
| | - Stefan Jovinge
- Fred and Lena Meijer Heart and Vascular Institute, Spectrum Health, Grand Rapids, Michigan.,Van Andel Institute, Grand Rapids, Michigan
| | - Jerker Persson
- Department of Medicine, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Lennart T H Jacobsson
- Department of Rheumatology and Inflammation Research, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Carl Turesson
- Department of Clinical Sciences, Malmö, Lund University, Malmö, Sweden.,Department of Rheumatology, Skåne University Hospital, Malmö, Sweden
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Mackey RH, Kuller LH, Moreland LW. Update on Cardiovascular Disease Risk in Patients with Rheumatic Diseases. Rheum Dis Clin North Am 2018; 44:475-487. [PMID: 30001787 DOI: 10.1016/j.rdc.2018.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Cardiovascular disease (CVD) risk is 1.5-fold higher in rheumatoid arthritis (RA), partly due to subclinical atherosclerosis that develops before the diagnosis of RA. Dyslipidemia in RA is better quantified by lipoproteins and apolipoproteins than by cholesterol levels. Current risk factors likely underestimate CVD risk by underestimating prior risk factor levels. Some of the 2-fold higher risk of heart failure and total mortality in RA may be due to myocardial disease caused by inflammation. Per recent recommendations, to reduce CVD risk in RA, control disease activity, reduce inflammation, and aggressively treat CVD risk factors.
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Affiliation(s)
- Rachel H Mackey
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, 542 Bellefield Professional Building, 130 North Bellefield Avenue, Pittsburgh, PA 15213, USA.
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Room 550, Bellefield Professional Building, 130 North Bellefield Avenue, Pittsburgh, PA 15213, USA
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3500 Terrace Street, Thomas E. Starzl Biomedical Science Tower South 711, Pittsburgh, PA 15261, USA
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28
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Giollo A, Bissell LA, Buch MH. Cardiovascular outcomes of patients with rheumatoid arthritis prescribed disease modifying anti-rheumatic drugs: a review. Expert Opin Drug Saf 2018; 17:697-708. [PMID: 29871535 DOI: 10.1080/14740338.2018.1483331] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is associated with a heightened risk of cardiovascular disease (CVD), with both traditional CV risk factors and inflammation contributing to this risk. AREAS COVERED This review highlights the burden of CVD in RA and associated traditional CV risk factors, including the complexity of dyslipidemia in RA and the so-called 'lipid paradox.' Furthermore, the recognized RA-disease-specific factors associated with higher risk of CVD and the role of systemic inflammation in the pathogenesis of CVD in RA will be addressed. With the advent of biologic and targeted synthetic therapies in the treatment of RA, the effect of conventional and newer generation disease modifying anti-rheumatic therapies (DMARDs) on CV risk and associated risk factors will also be discussed. EXPERT OPINION Identifying the RA phenotype at greatest risk of CVD, understanding the interplay of increased traditional risk factors, common inflammatory processes and RA-specific factors, and personalized use of DMARDs according to disease phenotype and comorbidity to reduce this risk are key areas for future research.
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Affiliation(s)
- Alessandro Giollo
- a Leeds Institute of Rheumatic and Musculoskeletal Medicine , University of Leeds, Chapel Allerton Hospital , Leeds , UK.,b NIHR Leeds Biomedical Research Centre , Leeds Teaching Hospitals NHS Trust , Leeds , LS7 4SA , UK.,c Department of Medicine, Rheumatology Unit , University of Verona , Verona , Italy
| | - Lesley-Anne Bissell
- a Leeds Institute of Rheumatic and Musculoskeletal Medicine , University of Leeds, Chapel Allerton Hospital , Leeds , UK.,b NIHR Leeds Biomedical Research Centre , Leeds Teaching Hospitals NHS Trust , Leeds , LS7 4SA , UK
| | - Maya H Buch
- a Leeds Institute of Rheumatic and Musculoskeletal Medicine , University of Leeds, Chapel Allerton Hospital , Leeds , UK.,b NIHR Leeds Biomedical Research Centre , Leeds Teaching Hospitals NHS Trust , Leeds , LS7 4SA , UK
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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: 255] [Impact Index Per Article: 42.5] [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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30
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Burggraaf B, van Breukelen – van der Stoep DF, de Vries MA, Klop B, van Zeben J, van de Geijn GJM, van der Meulen N, Birnie E, Prinzen L, Castro Cabezas M. Progression of subclinical atherosclerosis in subjects with rheumatoid arthritis and the metabolic syndrome. Atherosclerosis 2018; 271:84-91. [DOI: 10.1016/j.atherosclerosis.2018.02.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 02/02/2018] [Accepted: 02/13/2018] [Indexed: 10/18/2022]
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31
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Mackey RH, Kuller LH, Moreland LW. Cardiovascular Disease Risk in Patients with Rheumatic Diseases. Clin Geriatr Med 2018; 33:105-117. [PMID: 27886692 DOI: 10.1016/j.cger.2016.08.008] [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] [Indexed: 12/22/2022]
Abstract
Evidence suggests the greater than 1.5 increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA) is related to an accelerated burden of subclinical atherosclerosis that develops before the diagnosis of RA. Dyslipidemia in RA is better quantified by lipoproteins and apolipoproteins than cholesterol levels. Current risk factors likely underestimate CVD risk partly by underestimating prior risk factor levels. To reduce CVD risk in RA, control disease activity and aggressively treat CVD risk factors. Some of the two-fold higher risk of heart failure and total mortality in RA may be due to myocardial disease caused by inflammation.
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Affiliation(s)
- Rachel H Mackey
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, University of Pittsburgh, 542 Bellefield Professional Building, 130 North Bellefield Avenue, Pittsburgh, PA 15213, USA.
| | - Lewis H Kuller
- Department of Epidemiology, University of Pittsburgh Graduate School of Public Health, Room 550, Bellefield Professional Building, 130 North Bellefield Avenue, Pittsburgh, PA 15213, USA
| | - Larry W Moreland
- Division of Rheumatology and Clinical Immunology, University of Pittsburgh School of Medicine, 3500 Terrace Street, Thomas E. Starzl Biomedical Science Tower South 711, Pittsburgh, PA 15261, USA
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32
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Imaging atherosclerosis in rheumatoid arthritis: evidence for increased prevalence, altered phenotype and a link between systemic and localised plaque inflammation. Sci Rep 2017; 7:827. [PMID: 28400572 PMCID: PMC5429790 DOI: 10.1038/s41598-017-00989-w] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Accepted: 03/17/2017] [Indexed: 01/20/2023] Open
Abstract
In rheumatoid arthritis (RA), chronic inflammation is thought to drive increased cardiovascular risk through accelerated atherosclerosis. It may also lead to a more high-risk plaque phenotype. We sought to investigate carotid plaque phenotype in RA patients using Dynamic Contrast-Enhanced MRI (DCE-MRI) and Fludeoxyglucose Positron Emission Tomography(FDG-PET). In this pilot study, RA patients and age/sex-matched controls were evaluated for cardiovascular risk factors and carotid plaque on ultrasound. Subjects with plaque >2 mm thick underwent DCE-MRI, and a subgroup of patients had FDG-PET. Comparison of MRI findings between groups and correlation between clinical, serological markers and imaging findings was undertaken. 130 patients and 62 controls were recruited. Plaque was more prevalent in the RA group (53.1% vs 37.0%, p = 0.038) and was independently associated with IL6 levels (HR[95%CI]: 2.03 [1.26, 3.26] per quartile). DCE-MRI data were available in 15 patients and 5 controls. Higher prevalence of plaque calcification was noted in RA, despite similar plaque size (73.3% vs 20%, p = 0.04). FDG-PET detected plaque inflammation in 12/13 patients scanned and degree of inflammation correlated with hs-CRP (r = 0.58, p = 0.04). This study confirms increased prevalence of atherosclerosis in RA and provides data to support the hypothesis that patients have a high-risk plaque phenotype.
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33
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Eder L, Chandran V, Cook R, Gladman DD. The Risk of Developing Diabetes Mellitus in Patients with Psoriatic Arthritis: A Cohort Study. J Rheumatol 2017; 44:286-291. [PMID: 28148695 DOI: 10.3899/jrheum.160861] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2016] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To estimate the prevalence of diabetes mellitus (DM) in patients with psoriatic arthritis (PsA) in comparison with the general population and to assess whether the level of disease activity over time predicts the development of DM in these patients. METHODS A cohort analysis was conducted in patients followed in a large PsA clinic from 1978 to 2014. The prevalence of DM in the patients was compared with the general population of Ontario, Canada, and the age-standardized prevalence ratio (SPR) was calculated. For the assessment of risk factors for DM, time-weighted arithmetic mean (AM) levels of PsA-related disease activity measures were assessed as predictors for the development of DM. Multivariable Cox proportional hazards models were used to compute HR for incident DM after controlling for potential confounders. RESULTS A total of 1305 patients were included in the analysis. The SPR of DM in PsA compared with the general population in Ontario was 1.43 (p = 0.002). Of the 1065 patients who were included in the time-to-event analysis, 73 patients were observed to develop DM. Based on multivariable analyses, AM tender joint count (HR 1.53, 95% CI 1.08-2.18, p = 0.02) and AM erythrocyte sedimentation rate (HR 1.21, 95% CI 1.03-1.41, p = 0.02) predicted the development of DM. CONCLUSION The prevalence of DM is higher in patients with PsA compared with the general population. Patients with elevated levels of disease activity are at higher risk of developing DM.
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Affiliation(s)
- Lihi Eder
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada. .,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; R. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, PhD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network.
| | - Vinod Chandran
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; R. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, PhD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network
| | - Richard Cook
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; R. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, PhD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network
| | - Dafna D Gladman
- From the Women's College Research Institute, Women's College Hospital; Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto; Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network, Toronto; Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada.,L. Eder, MD, PhD, Women's College Research Institute, Women's College Hospital, and Department of Medicine, University of Toronto; V. Chandran, MD, DM, PhD, Department of Medicine, and Department of Laboratory Medicine and Pathobiology, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network; R. Cook, PhD, Department of Statistics and Actuarial Science, University of Waterloo; D.D. Gladman, MD, PhD, FRCPC, Department of Medicine, University of Toronto, and Centre for Prognosis Studies in the Rheumatic Diseases, Krembil Research Institute, University Health Network
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34
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Liu JH, Ng MY, Cheung T, Chung HY, Chen Y, Zhen Z, Zou Y, Mak KF, Khong PL, Lau CS, Tse HF, Yiu KH. Ten-year progression of coronary artery, carotid artery, and aortic calcification in patients with rheumatoid arthritis. Clin Rheumatol 2017; 36:807-816. [PMID: 28127640 DOI: 10.1007/s10067-016-3536-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/11/2016] [Accepted: 12/30/2016] [Indexed: 11/29/2022]
Abstract
Rheumatoid arthritis (RA) is associated with increased vascular calcification, although the rate of progress of calcification is uncertain. The aim of the study was to evaluate the progression of and the predictors for calcification in different vascular beds over 10 years. The 10-year actual coronary calcium score (CS) and 10-year predicted coronary CS, based on the pattern of the general population, were compared. Calcification of the coronary and carotid artery and the aorta was assessed by multi-detector computed tomography. Significant CS progression was determined by the difference between the square root of baseline and square root of follow-up calcium score (i.e., SQRT method). The 10-year predicted coronary CS was based on the mathematical formula derived by the Heinz Nixdorf Recall Study. A total of 49 patients (54 ± 11 years, 90% female) had a follow-up scan after 10.0 ± 0.2 years. The CS in all vascular beds was significantly increased; 55% of the patients had a significant progression of CS in the coronary, 29% in the carotid, and 80% in the aorta. Age and systolic blood pressure (SBP) were independently associated with calcification progression in all vascular beds. Importantly, the absolute increase in 10-year actual coronary CS was significantly higher than that predicted. In patients with RA, calcification in all vascular beds significantly increased over 10 years and was independently associated with age and SBP. Importantly, the absolute increase in 10-year actual coronary CS progression was significantly higher than that predicted.
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Affiliation(s)
- Ju-Hua Liu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China.,Department of medicine, Affiliated Hospital of North Sichuan Medical College, Nanchong City, Sichuan Province, China
| | - Ming-Yen Ng
- Division of Radiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Tommy Cheung
- Division of Rheumatology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Ho-Yin Chung
- Division of Rheumatology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Yan Chen
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China
| | - Zhe Zhen
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China
| | - Yuan Zou
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China
| | - Ka-Fung Mak
- Division of Radiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Pek-Lan Khong
- Division of Radiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Chak-Sing Lau
- Division of Rheumatology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Hong Kong, China
| | - Hung-Fat Tse
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China.,Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Kai-Hang Yiu
- Division of Cardiology, Department of Medicine, The University of Hong Kong, Queen Mary Hospital, Rm 1929b, Block K, Hong Kong, China. .,Research Centre of Heart, Brain, Hormone and Healthy Aging, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China. .,Division of Cardiology, Department of Medicine, The University of Hong Kong Shenzhen Hospital, Hong Kong, China.
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Liao KP. Cardiovascular disease in patients with rheumatoid arthritis. Trends Cardiovasc Med 2016; 27:136-140. [PMID: 27612551 DOI: 10.1016/j.tcm.2016.07.006] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/18/2016] [Accepted: 07/29/2016] [Indexed: 01/13/2023]
Abstract
The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is 1.5-2-fold higher than age- and sex-matched individuals from the general population. This excess risk is attributed to the systemic chronic inflammation which is a hallmark of RA. Challenges to optimizing CV risk management in RA include the need for improved methods to predict CV risk, and defining the target risk factor(s) to reduce CV risk. Lessons learned from RA studies can also inform CV risk prevention in the general population, where inflammation also has an important role in the pathogenesis of atherosclerosis.
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Affiliation(s)
- Katherine P Liao
- Division of Rheumatology, Immunology, and Allergy, Brigham and Women׳s Hospital, 75 Francis St, PBB-B3, Boston, MA 02115.
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The Link Between Inflammatory Disorders and Coronary Heart Disease: a Look at Recent Studies and Novel Drugs in Development. Curr Atheroscler Rep 2016; 18:3. [PMID: 26739273 DOI: 10.1007/s11883-015-0557-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Inflammation is a critical component in the development of coronary heart disease (CHD), specifically in the process of atherogenesis. Human translational and preclinical studies have demonstrated that inflammation contributes to the development, sustainment, and progression of atherosclerosis, and epidemiological studies demonstrate that human diseases associated with increased systemic inflammation increase the risk of CHD-related events. Therefore, over the last decade, multiple clinical studies were designed to target the inflammatory cascade in order to reduce the risk of CHD and to identify which populations may benefit from these preventative treatment strategies. This review briefly summarizes inflammation as a risk factor in atherosclerosis, human disease states associated with accelerated atherosclerosis, and current treatment strategies for CHD targeting the inflammatory cascade.
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Wu GC, Leng RX, Lu Q, Fan YG, Wang DG, Ye DQ. Subclinical Atherosclerosis in Patients With Inflammatory Bowel Diseases: A Systematic Review and Meta-Analysis. Angiology 2016; 68:447-461. [PMID: 27252243 DOI: 10.1177/0003319716652031] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We evaluated the differences in major markers of cardiovascular (CV) risk between inflammatory bowel diseases (IBDs) and controls by a systematic review and a meta-analysis. We searched PubMed, EMBASE, and Cochrane databases for literature comparing CV risk markers in IBDs and controls. The overall mean carotid intima-media thickness (CIMT), flow-mediated dilation (FMD%), and carotid-femoral pulse wave velocity (cfPWV) difference between patients with IBDs and control groups were calculated. Twenty-eight studies were included in the meta-analysis, including 16 studies with data on CIMT, 7 studies reporting FMD%, and 9 studies on cfPWV. Compared to controls, patients with IBDs showed significantly higher CIMT (standardized mean difference [ SMD]: 0.534 mm; 95% confidence interval [CI], 0.230 to 0.838; P = .001), significantly lower FMD% ( SMD, -0.721%; 95% CI, -1.020 to -0.421; P < .0001), and significantly increased cfPWV ( SMD, 0.849; 95% CI, 0.589 to 1.110; P < .0001). When analyzing subgroups with ulcerative colitis and Crohn disease (CD), all results were still significant except CIMT in CD. Our findings support the current evidence for an elevated CV burden in patients with IBD and support the clinical utility of markers of subclinical atherosclerosis in the management of these patients.
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Affiliation(s)
- Guo-Cui Wu
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Rui-Xue Leng
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Qi Lu
- 2 Department of Clinical Medicine, The College of Clinical Medicine, Anhui Medical University, Hefei, Anhui, China
| | - Yin-Guang Fan
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - De-Guang Wang
- 3 Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Dong-Qing Ye
- 1 Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
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Treat-to-target therapy does not prevent excessive progression of carotid intima media thickness during the first year of therapy in early rheumatoid arthritis. ACTA ACUST UNITED AC 2016; 1:e36-e43. [PMID: 28905017 PMCID: PMC5421530 DOI: 10.5114/amsad.2016.60225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 05/13/2016] [Indexed: 12/15/2022]
Abstract
Introduction The aim of the study was to investigate the presence of subclinical atherosclerosis and predictors of change in carotid intima-media measures in early rheumatoid arthritis patients (eRA) as compared to chronic RA patients and patients without arthritis. Material and methods Fifty-five consecutive eRA patients were assessed at the time of diagnosis and after 1 year of therapy. Fifty-five sex- and age-matched chronic RA patients and 29 patients without inflammatory disease were used as controls. Carotid artery intima-media thickness (CIMT) and carotid plaques were measured at baseline and after follow-up. In eRA patients ultrasound assessment of hand joints was performed before and after treatment. Carotid artery intima-media thickness was assessed again after 2 years in 44 eRA patients. Results Carotid artery intima-media thickness progression after 1 year of therapy was higher in eRA patients compared to both control groups (p = 0.017) and correlated with symptoms duration (p = 0.017) and DMARD monotherapy (p = 0.015). Ultrasound progression of hand joint erosions was associated with longer symptoms duration (p = 0.006). After 2 years of observation CIMT progression was similar in all examined groups. Conclusions We observed rapid CIMT progression during the first year of RA therapy. Longer symptoms duration and less aggressive therapy were associated with CIMT increase.
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Rheumatoid Arthritis Pharmacotherapies: Do They Have Anti-Atherosclerotic Activity? Curr Rheumatol Rep 2016; 18:27. [DOI: 10.1007/s11926-016-0578-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Sintek MA, Sparrow CT, Mikuls TR, Lindley KJ, Bach RG, Kurz HI, Novak E, Singh J. Repeat revascularisation outcomes after percutaneous coronary intervention in patients with rheumatoid arthritis. Heart 2015; 102:363-9. [DOI: 10.1136/heartjnl-2015-308634] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 11/18/2015] [Indexed: 11/03/2022] Open
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Is Lipoprotein-Associated Phospholipase A2 a Link between Inflammation and Subclinical Atherosclerosis in Rheumatoid Arthritis? BIOMED RESEARCH INTERNATIONAL 2015; 2015:673018. [PMID: 26504820 PMCID: PMC4609366 DOI: 10.1155/2015/673018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 04/23/2015] [Indexed: 12/23/2022]
Abstract
Objective. Lipoprotein-associated phospholipase A2 (Lp-PLA2), a marker of vascular inflammation, is associated with cardiovascular disease. This prospective study of an inception cohort aimed to investigate whether the level of Lp-PLA2 is associated with subclinical atherosclerosis in patients with rheumatoid arthritis (RA). Methods. Patients from northern Sweden diagnosed with early RA were consecutively recruited into an ongoing prospective study. From these, all patients ≤60 years (n = 71) were included for measurements of subclinical atherosclerosis at inclusion (T0) and five years later (T5). Forty age- and sex-matched controls were included. The patients were clinically assessed, SCORE, Reynolds Risk Score, and Larsen score were calculated, and blood samples were drawn from all individuals at T0 and T5. Results. There was no significant difference in the level of Lp-PLA2 between patients with RA and controls (p > 0.05). In simple linear regression models among patients with RA, Lp-PLA2 at T0 was significantly associated with intima media thickness (IMT) at T0 and T5, flow mediated dilation (FMD) at T0 and T5, ever smoking, male sex, HDL-cholesterol (inversely), non-HDL-cholesterol, SCORE, Reynolds Risk Score, and Larsen score (p < 0.05). Conclusion. In this cohort of patients with early RA, the concentration of Lp-PLA2 was associated with both subclinical atherosclerosis and disease severity.
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Giles JT. Cardiovascular disease in rheumatoid arthritis: Current perspectives on assessing and mitigating risk in clinical practice. Best Pract Res Clin Rheumatol 2015; 29:597-613. [DOI: 10.1016/j.berh.2015.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Armstrong AW, Guérin A, Sundaram M, Wu EQ, Faust ES, Ionescu-Ittu R, Mulani P. Psoriasis and risk of diabetes-associated microvascular and macrovascular complications. J Am Acad Dermatol 2015; 72:968-77.e2. [DOI: 10.1016/j.jaad.2015.02.1095] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 01/29/2015] [Accepted: 02/04/2015] [Indexed: 10/24/2022]
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Methotrexate, Cyclosporine A, and Biologics Protect against Atherosclerosis in Rheumatoid Arthritis. J Immunol Res 2015; 2015:759610. [PMID: 26090499 PMCID: PMC4452098 DOI: 10.1155/2015/759610] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 12/29/2022] Open
Abstract
Introduction. The risk of cardiovascular disease is increased in rheumatoid arthritis (RA). A meta-analysis showed increased intima media thickness (IMT) in RA. It has been shown that disease modifying antirheumatic drugs (DMARDs) may influence the progression of atherosclerosis. However, it was suggested that biologics may be more efficient than other DMARDs (including methotrexate—MTX) in protecting against atherosclerosis. Objectives. The aim of this study was to assess the influence of different RA characteristics and treatment regimens on IMT and atherosclerotic plaques. Patients and Methods. 317 RA patients and 111 controls were included in the study. IMT was measured in carotid (CIMT) and femoral (FIMT) arteries. Arteries were screened for the presence of plaques. Results. CIMT, FIMT, and prevalence of plaques were lower in patients treated with methotrexate (MTX) ≥ 20 mg/wk, cyclosporine (CsA), or biologics than in patients treated with lower doses of MTX and other disease modifying antirheumatic drugs. No differences in IMT between patients treated with MTX ≥ 20 mg/wk, biologics, or CsA were found. Conclusions. We found a beneficial effect of MTX ≥ 20 mg/wk, biologics, and CsA on atherosclerosis. We do not confirm a stronger influence of biologics on IMT compared with therapeutic doses of MTX.
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Giles JT, Danielides S, Szklo M, Post WS, Blumenthal RS, Petri M, Schreiner PJ, Budoff M, Detrano R, Bathon JM. Insulin resistance in rheumatoid arthritis: disease-related indicators and associations with the presence and progression of subclinical atherosclerosis. Arthritis Rheumatol 2015; 67:626-36. [PMID: 25504899 DOI: 10.1002/art.38986] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 12/02/2014] [Indexed: 01/04/2023]
Abstract
OBJECTIVE Systemic inflammation and insulin resistance (IR) are linked, yet the determinants of IR and its impact on atherosclerosis in rheumatoid arthritis (RA) are incompletely understood. The aim of this study was to explore the prevalence of IR in RA and non-RA populations and investigate whether the associations of IR with measures of atherosclerosis differ between these groups. METHODS IR was quantified using the homeostatic model assessment of IR (HOMA-IR), and was compared between RA patients and demographically matched non-RA controls. Differences in the associations between the HOMA-IR index and the Agatston coronary artery calcium (CAC) score, ultrasound-determined intima-media thickness (IMT) of the common carotid artery (CCA) and internal carotid artery (ICA), and focal plaque in the ICA/carotid bulb were compared according to RA status. RESULTS Among the 195 RA patients and 198 controls studied, average HOMA-IR levels were higher in the RA group by 31%, and were consistently higher in the RA group regardless of stratification by demographic or cardiometabolic risk factors. While the HOMA-IR index was strongly and significantly associated with C-reactive protein (CRP) and interleukin-6 (IL-6) levels in the control group, the association was weaker in the RA group. Among RA patients, higher HOMA-IR levels were associated with rheumatoid factor (RF) seropositivity in men and women, and prednisone use in women only. Before adjustment, higher HOMA-IR levels were associated with all assessed measures of subclinical atherosclerosis in the control group only; associations were diminished and lost statistical significance after adjustment for cardiovascular risk factors. Among the RA patients, neither baseline nor average HOMA-IR levels were significantly associated with change in any of the atherosclerosis measures over an average of 3.2 years of followup. CONCLUSION Although IR was higher in RA patients than in non-RA controls, higher levels may not independently impart additional risk of atherosclerosis.
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Södergren A, Karp K, Bengtsson C, Möller B, Rantapää-Dahlqvist S, Wållberg-Jonsson S. The Extent of Subclinical Atherosclerosis Is Partially Predicted by the Inflammatory Load: A Prospective Study over 5 Years in Patients with Rheumatoid Arthritis and Matched Controls. J Rheumatol 2015; 42:935-42. [DOI: 10.3899/jrheum.140694] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 11/22/2022]
Abstract
Objective.This prospective followup study investigated subclinical atherosclerosis in relation to traditional cardiovascular disease (CVD) risk factors and inflammation in patients with rheumatoid arthritis (RA) recruited at diagnosis compared with controls.Methods.Patients diagnosed with early RA were consecutively recruited into a prospective study. From these, a subgroup aged ≤ 60 years (n = 71) was consecutively included for ultrasound measurement of intima-media thickness (IMT) and flow-mediated dilation (FMD) at inclusion (T0) and after 5 years (T5). Age- and sex-matched controls (n = 40) were also included.Results.In the Wilcoxon signed-rank test, both IMT and FMD were significantly aggravated at T5 compared to baseline in patients with RA, whereas only IMT was significantly increased in controls. In univariate linear regression analyses among patients with RA, the IMT at T5 was significantly associated with age, systolic blood pressure (BP), cholesterol, triglycerides, Systematic Coronary Risk Evaluation (SCORE), and Reynolds Risk Score at baseline (p < 0.05). Similarly, FMD at T5 was significantly inversely associated with age, smoking, systolic BP, SCORE, and Reynolds Risk Score (p < 0.05). A model with standardized predictive value from multiple linear regression models including age, smoking, BP, and blood lipids at baseline significantly predicted the observed value of IMT after 5 years. When also including the area under the curve for the 28-joint Disease Activity Score over 5 years, the observed value of IMT was predicted to a large extent.Conclusion.This prospective study identified an increased subclinical atherosclerosis in patients with RA. In the patients with RA, several traditional CVD risk factors at baseline significantly predicted the extent of subclinical atherosclerosis 5 years later. The inflammatory load over time augmented this prediction.
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Gravani F, Papadaki I, Antypa E, Nezos A, Masselou K, Ioakeimidis D, Koutsilieris M, Moutsopoulos HM, Mavragani CP. Subclinical atherosclerosis and impaired bone health in patients with primary Sjogren's syndrome: prevalence, clinical and laboratory associations. Arthritis Res Ther 2015; 17:99. [PMID: 25886059 PMCID: PMC4416325 DOI: 10.1186/s13075-015-0613-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 03/30/2015] [Indexed: 12/17/2022] Open
Abstract
Introduction To determine the prevalence and clinical/laboratory associations of subclinical atherosclerosis and impaired bone health in primary Sjogren’s syndrome (SS). Methods 64 consecutive patients with primary SS, 77 with rheumatoid arthritis (RA) and 60 healthy controls (HC) οf similar age and sex distribution were enrolled. Demographics, clinical/laboratory features, classical risk factors for atherosclerosis and osteoporosis (OP) were recorded. Intima-medial thickness scores (IMT) and carotid/femoral (C/F) plaque formation, as well as bone mineral density (BMD) and fractures were evaluated. Determinants of IMT/BMD levels and the presence of plaque were assessed by univariate and multivariate models. Serum levels of the Wnt signaling mediators Dickkopf-related protein 1(DKK1) and sclerostin were determined in primary SS patients and HC. Results Increased arterial wall thickening (IMT > 0.90 mm) and impaired bone health (defined as OP or osteopenia), were detected in approximately two-thirds of primary SS and RA patients, with a mean IMT value being significantly increased compared to HC. The presence of primary SS emerged as an independent risk factor for arterial wall thickening when traditional risk factors for cardiovascular disease (CVD) including age, sex, hypertension, smoking (pack/years), LDL and HDL levels were taken into account in a multivariate model [adjusted OR 95% (CI): 2.8 (1.04-7.54)]. In primary SS, age was revealed as independent predictor of increased IMT scores; age and lymphopenia as well as increased urine pH as independent determinants of C/F plaque formation and OP/osteopenia, respectively. An independent association of OP/osteopenia with plaque formation was observed when independent predictors for both variables were considered, with low DKK1 levels being associated with both plaque formation and lower BMD levels. Conclusions Comorbidities such as subclinical atherosclerosis and impaired bone health occur frequently in primary SS, in association with disease related features and traditional risk factors. Wnt signaling mediators are potentially involved in the pathogenesis of both entities. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0613-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Fotini Gravani
- Department of Rheumatology, General Hospital of Athens "G.Gennimatas", Athens, Greece. .,Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece.
| | - Ioanna Papadaki
- Department of Rheumatology, General Hospital of Athens "G.Gennimatas", Athens, Greece.
| | - Eleni Antypa
- Department of Radiology, General Hospital of Athens "G.Gennimatas", Athens, Greece.
| | - Andrianos Nezos
- Department of Physiology, School of Medicine, University of Athens, M. Asias 75, Athens, 11527, Greece.
| | - Kyriaki Masselou
- Department of Immunology, General Hospital of Athens "G. Gennimatas", Athens, Greece.
| | - Dimitrios Ioakeimidis
- Department of Rheumatology, General Hospital of Athens "G.Gennimatas", Athens, Greece.
| | - Michael Koutsilieris
- Department of Physiology, School of Medicine, University of Athens, M. Asias 75, Athens, 11527, Greece.
| | | | - Clio P Mavragani
- Department of Pathophysiology, School of Medicine, University of Athens, Athens, Greece. .,Department of Physiology, School of Medicine, University of Athens, M. Asias 75, Athens, 11527, Greece.
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Skeoch S, Bruce IN. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat Rev Rheumatol 2015; 11:390-400. [PMID: 25825281 DOI: 10.1038/nrrheum.2015.40] [Citation(s) in RCA: 204] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Rheumatoid arthritis (RA) has long been associated with increased cardiovascular risk, but despite substantial improvements in disease management, mortality remains high. Atherosclerosis is more prevalent in RA than in the general population, and atherosclerotic lesions progress at a faster rate and might be more prone to rupture, causing clinical events. Cells and cytokines implicated in RA pathogenesis are also involved in the development and progression of atherosclerosis, which is generally recognized as an inflammatory condition. The two diseases also share genetic and environmental risk factors, which suggests that patients who develop RA might also be predisposed to developing cardiovascular disease. In RA, inflammation and atherosclerosis are closely linked. Inflammation mediates its effects on atherosclerosis both through modulation of traditional risk factors and by directly affecting the vessel wall. Treatments such as TNF inhibitors might have a beneficial effect on cardiovascular risk. However, whether this benefit is attributable to effective control of inflammation or whether targeting specific cytokines, implicated in atherosclerosis, provides additional risk reduction is unclear. Further knowledge of the predictors of cardiovascular risk, the effects of early control of inflammation and of drug-specific effects are likely to improve the recognition and management of cardiovascular risk in patients with RA.
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Affiliation(s)
- Sarah Skeoch
- Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Institute of Inflammation and Repair, The University of Manchester, Manchester Academic Health Science Centre, Brunswick Street, Manchester M13 9PL, UK
| | - Ian N Bruce
- NIHR Manchester Musculoskeletal Biomedical Research Unit, and Kellgren Centre for Rheumatology, Central Manchester University Hospitals NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester M13 9WL, UK
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Shen J, Shang Q, Li EK, Leung YY, Kun EW, Kwok LW, Li M, Li TK, Zhu TY, Yu CM, Tam LS. Cumulative inflammatory burden is independently associated with increased arterial stiffness in patients with psoriatic arthritis: a prospective study. Arthritis Res Ther 2015; 17:75. [PMID: 25890227 PMCID: PMC4384323 DOI: 10.1186/s13075-015-0570-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Accepted: 02/20/2015] [Indexed: 11/22/2022] Open
Abstract
Introduction The aim of this study was to examine whether the cumulative inflammatory burden is associated with an increase in arterial stiffness in a prospective cohort of psoriatic arthritis (PsA) patients. Methods In total, 72 PsA patients were followed for a median of 6.5 years. Cumulative inflammatory burden was represented by the cumulative averages of repeated measures of erythrocyte sedimentation rate (ca-ESR) and C-reactive protein (ca-CRP). Brachial-ankle pulse wave velocity (PWV) was measured at the last visit. We also included 47 healthy controls for PWV assessment. Results PWV was significantly higher in PsA patients compared with healthy controls after adjustment for age, gender and body weight (1466 ± 29 cm/s versus 1323 ± 38 cm/s, P = 0.008). PsA patients were divided into two groups based on whether their PWV value is ≥1450 cm/s (High PWV group, N = 38) or <1450 cm/s (Low PWV group, N = 34). The High PWV group had a significantly higher ca-ESR (29 (19 to 44) versus 18 (10 to 32) mm/1st hour, P = 0.005) and ca-CRP (0.7 (0.3 to 1.4) versus 0.4 (0.2 to 0.7) mg/dl, P = 0.029). Using regression analysis, high ca-ESR (defined as ≥75th percentile: 37 mm/1st hour) was associated with a higher likelihood of being in the High PWV group (odds ratio (OR): 9.455 (1.939 to 46.093), P = 0.005, adjusted for baseline clinical and cardiovascular risk factors; and 9.111 (1.875 to 44.275), P = 0.006, adjusted for last visit parameters). Conclusions Cumulative inflammatory burden, as reflected by ca-ESR, was associated with increased arterial stiffness in PsA patients even after adjustment for cardiovascular risk factors, emphasizing the important role of chronic inflammation in accelerating the development of cardiovascular risks in PsA patients.
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Affiliation(s)
- Jiayun Shen
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Qing Shang
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Edmund K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Ying-Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Outram Road, Singapore 169608, Singapore, Singapore.
| | - Emily W Kun
- Department of Medicine and Geriatrics, Taipo Hospital, Taipo, Hong Kong, China.
| | - Lai-Wa Kwok
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Martin Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Tena K Li
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Tracy Y Zhu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Cheuk-Man Yu
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
| | - Lai-Shan Tam
- Department of Medicine & Therapeutics, The Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, China.
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Arida A, Zampeli E, Konstantonis G, Fragiadaki K, Kitas GD, Protogerou AD, Sfikakis PP. Rheumatoid arthritis is sufficient to cause atheromatosis but not arterial stiffness or hypertrophy in the absence of classical cardiovascular risk factors. Clin Rheumatol 2015; 34:853-9. [PMID: 25754335 DOI: 10.1007/s10067-015-2914-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/24/2015] [Accepted: 02/01/2015] [Indexed: 12/16/2022]
Abstract
Rheumatoid arthritis (RA) associates with increased cardiovascular disease (CVD) mortality thought to be due to accelerated arterial disease. Different components of arterial disease, namely, atheromatosis, arteriosclerosis, and arterial wall hypertrophy, are differentially affected by classical CVD risk factors, which are highly prevalent in these patients. We hypothesized that RA disease per se may also differentially affect these components. Of 267 consecutive RA patients, we selected specifically those who were free of established CVD and CVD risk factors (18 %); of them, 41 patients (36 women, 49 ± 13 years) could be matched effectively 1:1 for age and gender to healthy controls. Atheromatosis was assessed by the presence of carotid and/or femoral artery plaques, arteriosclerosis by pulse wave velocity and local wall elasticity, and arterial hypertrophy by intima-media thickness and cross-sectional area. More patients had atheromatic plaques than controls (29 vs. 12 %, p = 0.039), and multiarterial atheromatosis was more prevalent in RA (22 vs. 2 %, p = 0.026). Accelerated atheromatosis was not associated with rheumatoid factor, or anti-cyclic citrullinated peptide (CCP) autoantibody status. Plaque burden in patients with less than 5 years disease duration (aged 41 ± 13 years) was comparable to their matched controls. In contrast, all indices of arterial stiffness and hypertrophy were similar between controls and RA patients, even in those with long-standing disease. RA per se is sufficient to cause atheromatosis in the absence of classical CVD risk factors, but has minimal, if any, effect on arteriosclerosis and arterial wall hypertrophy.
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Affiliation(s)
- Aikaterini Arida
- First Department of Propaedeutic Internal Medicine, Laikon Hospital, Athens University Medical School, Ag Thoma, 17, 11527, Athens, Greece
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