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Keleşoğlu Dinçer AB, Şahan HF. Increased epicardial adipose tissue thickness as a sign of subclinical atherosclerosis in patients with rheumatoid arthritis and ıts relationship with disease activity ındices. Intern Emerg Med 2024; 19:1015-1024. [PMID: 38578429 PMCID: PMC11186901 DOI: 10.1007/s11739-024-03542-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 01/16/2024] [Indexed: 04/06/2024]
Abstract
Epicardial adipose tissue is a novel cardiometabolic risk factor and indicator of subclinical atherosclerosis. We aimed to evaluate the epicardial adipose tissue thickness in rheumatoid arthritis (RA) patients and its association with disease activity scores. A total of 81 rheumatoid arthritis patients and 70 age- and sex-matched healthy individuals were recruited for this cross-sectional study. Epicardial adipose tissue thickness (EATT) was measured by transthoracic two-dimensional echocardiography. Tender and swollen joint counts were recorded at the time of inclusion. The laboratory tests included erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), rheumatoid factor, anti-citrullinated protein antibodies, and serum lipid levels. Disease activity was calculated based on Disease Activity Scores for 28 joints (DAS-28) ESR and CRP, the Simple Disease Activity Index (SDAI), and the Clinical Disease Activity Index (CDAI). Epicardial adipose tissue thickness was significantly higher in the RA patients compared to the healthy controls (p < 0.001). We found statistically significant correlations of EATT with all disease activity indices (p < 0.001) and CRP (p = 0.002). According to a cut-off value of 6.4 mm determined for epicardial adipose tissue thickness, the RA patients with thickness ≥ 6.4 mm had higher disease activity scores and CRP levels. In the multivariable regression analysis, only SDAI score was found as an independent risk factor for increased EATT (OR, (95%CI), 13.70 (3.88-48.43), p < 0.001). Epicardial adipose tissue thickness measurement by echocardiography is a reliable method for assessing subclinical atherosclerosis in rheumatoid arthritis patients, and a higher disease activity score is an independent risk factor for coronary artery disease.
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Masson W, Lavalle-Cobo A, Barbagelata L, Lobo M, Nogueira JP. Relationship between epicardial adipose tissue, systemic inflammatory diseases, and subclinical atheromatosis: A systematic review. REUMATOLOGIA CLINICA 2023; 19:363-373. [PMID: 37661114 DOI: 10.1016/j.reumae.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 10/06/2022] [Indexed: 09/05/2023]
Abstract
BACKGROUND AND AIMS Systemic inflammatory diseases could act as an unfavorable condition in which epicardial adipose tissue (EAT) becomes harmful to cardiovascular health. The objectives were: (a) to quantitatively compare the presence of EAT between patients with systemic inflammatory diseases and controls; (b) to analyze the association between EAT and subclinical atheromatosis in individuals with systemic inflammatory diseases. METHODS Studies that have quantified EAT in a population with systemic inflammatory diseases compared to a control group, or that describe the association between EAT and the presence of subclinical atheromatosis in patients with systemic inflammatory diseases were included. A quantitative analysis was performed for the first objective. This systematic review was performed according to PRISMA guidelines. RESULTS Twenty-one studies including 1448 patients with systemic inflammatory diseases, were considered eligible for this study. Patients with systemic inflammatory disease have a higher volume (MD: 10.4cm3 [1.8-19.1]; p<0.01), higher thickness (MD: 1.0mm [0.8-1.2]; p<0.01), and a statistically non-significant higher area (MD: 3.1cm2 [1.0-5.2]; p=0.46) of EAT compared to the control group. Most studies reported a significant association between EAT and subclinical atheromatosis in patients with different systemic inflammatory diseases. CONCLUSION This study demonstrated that EAT is increased in patients with systemic inflammatory diseases compared with healthy controls, and that EAT measurement is closely correlated with subclinical atherosclerosis in these patients. The causality of this association should be tested in prospective studies.
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Affiliation(s)
- Walter Masson
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, Buenos Aires, Argentina; Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Augusto Lavalle-Cobo
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, Buenos Aires, Argentina; Cardiology Department, Sanatorio Finochietto, Av. Córdoba, 2678 Buenos Aires, Argentina
| | - Leandro Barbagelata
- Cardiology Department, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Martin Lobo
- Council of Epidemiology and Cardiovascular Prevention, Argentine Society of Cardiology, Azcuenaga 980, Buenos Aires, Argentina; Cardiology Department, Hospital Militar Campo de Mayo, Buenos Aires, Argentina
| | - Juan Patricio Nogueira
- Centro de Investigación en Endocrinología, Nutrición y Metabolismo (CIENM), Facultad de Ciencias de la Salud, Universidad Nacional de Formosa, Argentina; Universidad del Pacifico, Asunción, Paraguay.
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Ben Tekaya A, Boukriba S, Fendri A, Rouached L, Saidane O, Bouden S, Tekaya R, Ben Salem K, Mahmoud I, Habiba M, Abdelmoula L. Endothelial dysfunction and increased carotid intima-media thickness in patients with spondyloarthritis without traditional cardiovascular risk factors. RMD Open 2022; 8:rmdopen-2022-002270. [PMID: 35793876 PMCID: PMC9260841 DOI: 10.1136/rmdopen-2022-002270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 06/07/2022] [Indexed: 12/13/2022] Open
Abstract
Background The aim of our study was to assess subclinical atherosclerosis in spondyloarthritis (SpA) by combining three ultrasound methods (flow-mediated dilation (FMD), carotid intima–media thickness (cIMT) and Ankle Brachial Index (ABI)) and to determine the predictive factors of theses parameters. Methods This was a case control study conducted over 12 months including 47 patients with SpA-free-cardiovascular (CV) disease in comparison with age and sex matched 47 healthy controls. Sociodemographic, clinical and biological features as well as therapeutic modalities were recorded in our patients. All subjects had Doppler ultrasound with measurement of cIMT, FMD and ABI. Ultrasound measurements were compared between patients and controls. Linear regression was performed and assessed by machine learning to determine the predictive models of markers of subclinical atherosclerosis. Results We found higher cIMT (p<0.0001), lower FMD (p=0.008) and higher left ABI (0.048) in patients with SpA compared with controls. cIMT was positively correlated to patient-related parameters (age, systolic blood pressure) and disease parameters (age at onset of SpA, disease duration and renal involvement). Biologically, cIMT was positively correlated with creatinine, blood-glocose, total cholesterol (CT) and CT/cholesterol-high density lipoprotein ratio. FMD was negatively correlated with male gender, age, systolic blood pressure, creatinine, blood glucose and Left Lequesne Index. ABI was significantly associated with diastolic blood pressure. Multiple regression analysis identified age, CT and creatinine as independents predictive factors for increased cIMT. Regarding endothelial dysfunction, blood glucose and Left Lequesne Index were the independents predictive factors of decreased FMD. Conclusion Our study supported the accelerated subclinical atherosclerosis in patients with SpA. This subclinical atherosclerosis was mainly mediated by traditional CV risk factors.
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Affiliation(s)
- Aicha Ben Tekaya
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Seif Boukriba
- Radiology Department, La Rabta Hospital, Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ahmed Fendri
- Radiology Department, La Rabta Hospital, Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Leila Rouached
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Olfa Saidane
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Selma Bouden
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Rawdha Tekaya
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | | | - Ines Mahmoud
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Mizouni Habiba
- Radiology Department, La Rabta Hospital, Faculty of medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Leila Abdelmoula
- Rheumatology Department Charles Nicolle Hospital, Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Motawea KR, Kandil OA, Varney J, Aboelenein M, Ibrahim N, Shaheen A, Khairy LT, Bakkour A, Muwaili AHH, Muwaili DHH, Abdelmajid FAA, Ahmad EMS, Albuni MK, Battikh E, Sawaf B, Swed S, Ahmed SMA, Awad DM, Shah J, Aiash H. Association of familial Mediterranean fever and epicardial adipose tissue: A systematic review and meta‐analysis. Health Sci Rep 2022; 5:e693. [PMID: 35734339 PMCID: PMC9193962 DOI: 10.1002/hsr2.693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/15/2022] [Accepted: 05/12/2022] [Indexed: 12/03/2022] Open
Abstract
Background and Aim Some studies reported a positive link between familial Mediterranean fever (FMF) and epicardial adipose tissue. Our meta‐analysis aimed to evaluate whether there is a significant association between FMF and increased epicardial adipose tissue thickness. Methods We searched the following databases: PUBMED, WOS, OVID, SCOPUS, and EMBASE. Inclusion criteria were any original articles that reported epicardial adipose tissue in FMF patients with no age restriction, excluding reviews, case reports, editorials, animal studies, and non‐English studies. Thirty eligible studies were screened full text but only five studies were suitable. We used RevMan software (5.4) for the meta‐analysis. Results The total number of patients included in the meta‐analysis in the FMF patients group is 256 (mean age = 24.3), and the total number in the control group is 188 (mean age = 24.98). The pooled analysis between FMF patients and controls was [mean difference = 0.82 (95% CI = 0.25–1.39), p‐value = 0.005]. We observed heterogeneity that was not solved by random effects (p > 0.00001). We performed leave one out test by removing the Kozan et al. study, and the heterogeneity was solved (p = 0.07), and the results were (MD = 0.98, 95% CI = 0.52–1.43, p‐value < 0.0001). Conclusion FMF patients are at increased risk of developing epicardial adipose tissue compared to controls. More multicenter studies with higher sample sizes are needed to support our results.
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Affiliation(s)
| | | | - Joseph Varney
- School of Medicine American University of the Caribbean Cupecoy Sint Maarten
| | | | - Nancy Ibrahim
- Faculty of Medicine Alexandria University Alexandria Egypt
| | - Ahmed Shaheen
- Faculty of Medicine Alexandria University Alexandria Egypt
| | - Lina T. Khairy
- Faculty of Medicine The National Ribat University Al‐Ribat Sudan
| | | | - Ali H. H. Muwaili
- Faculty of Medicine Ivano‐Frankivsk National Medical University Ivano‐Frankivsk Ukraine
| | - Dhuha H. H. Muwaili
- Faculty of Medicine Ivano‐Frankivsk National Medical University Ivano‐Frankivsk Ukraine
| | | | - Eman M. S. Ahmad
- Departments of Obstetrics and Gynecology Nile Valley University Atbra Sudan
| | - Mhd K. Albuni
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Elias Battikh
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Bisher Sawaf
- Department of Internal Medicine Hamad Medical Corporation Doha Qatar
| | - Sarya Swed
- Faculty of Medicine Aleppo University Aleppo Syria
| | | | - Dina M. Awad
- Faculty of Medicine Alexandria University Alexandria Egypt
| | - Jaffer Shah
- Medical Research Center Kateb University Kabul Afghanistan
| | - Hani Aiash
- Cardiovascular perfusion Department Upstate Medical University Syracuse New York USA
- Family Medicine Department Suez Canal University Ismailia Governorate Egypt
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Tekaya AB, Mehmli T, Mrad IB, Fendri A, Boukriba S, Bouden S, Rouached L, Tekaya R, Saidane O, Mahmoud I, Abdelmoula L. Increased epicardial adipose tissue thickness correlates with endothelial dysfunction in spondyloarthritis. Clin Rheumatol 2022; 41:3017-3025. [PMID: 35776282 DOI: 10.1007/s10067-022-06261-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/13/2022] [Accepted: 06/17/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION We aimed to investigate the relationship between epicardial adipose tissue (EAT) thickness, flow-mediated dilation (FMD), and carotid intima-media thickness (cIMT) in spondyloarthritis (SpA) patients compared to healthy controls. METHODS We performed a cross-sectional study including SpA patients aged ≤ 50 years without traditional cardiovascular risk factors and healthy controls matched for age and gender. Baseline characteristics, laboratory data, and SpA-related parameters were recorded. All participants underwent ultrasound examination with measurement of EAT thickness, FMD, and cIMT by both an experienced cardiologist and radiologist blinded to clinical data. The relationships between the ultrasound measurements were analyzed using Spearman's correlation coefficient and Person correlation. RESULTS The study included 94 subjects (47 SpA and 47 healthy controls). The sex-ratio was 2.35; the median age of patients was 36 years (IQR: 28-46), and the median disease duration was 11 years (IQR: 5-16). Compared to the control group, SpA patients had significantly higher values of EAT thickness (p = 0.001) and cIMT (p < 0.0001). FMD values were significantly lower in SpA patients compared to controls (p = 0.008). The univariate analysis detected a significant negative association between EAT thickness and FMD (p = 0.026; r = - 0.325), and between left cIMT and FMD (p = 0.027; r = - 0.322). No association was found between EAT thickness and cIMT. CONCLUSION EAT thickness, FMD, and cIMT were significantly impaired in SpA patients compared with healthy controls supporting evidence of accelerated atherosclerosis in SpA. EAT thickness was correlated to endothelial dysfunction suggesting the role of EAT in predicting the early reversible stages of atherosclerosis. Key Points • Spondyloarthritis is associated with impaired subclinical atherosclerosis markers accurately increased epicardial fat and carotid intima-media thickness and endothelial dysfunction. • Increased epicardial fat thickness is correlated with impaired endothelial function in spondyloarthritis patients.
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Affiliation(s)
- Aicha Ben Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Takwa Mehmli
- Rheumatology Department, Charles Nicolle Hospital, Tunis, 1007, Tunisia.
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia.
| | - Imtinene Ben Mrad
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Cardiology Department, Habib Thameur Hospital, Tunis, Tunisia
| | - Ahmed Fendri
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Radiology Department, La Rabta Hospital, Tunis, Tunisia
| | - Seif Boukriba
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
- Radiology Department, La Rabta Hospital, Tunis, Tunisia
| | - Selma Bouden
- Rheumatology Department, Charles Nicolle Hospital, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Leila Rouached
- Rheumatology Department, Charles Nicolle Hospital, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Rawdha Tekaya
- Rheumatology Department, Charles Nicolle Hospital, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Olfa Saidane
- Rheumatology Department, Charles Nicolle Hospital, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Ines Mahmoud
- Rheumatology Department, Charles Nicolle Hospital, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
| | - Leila Abdelmoula
- Rheumatology Department, Charles Nicolle Hospital, Tunis, 1007, Tunisia
- Faculty of Medicine of Tunis, University Tunis El Manar, Tunis, Tunisia
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Ekmen N, Can G, Yozgat A, Can H, Bayraktar MF, Demirkol ME, Akdoğan Kayhan M, Sasani H. Evaluation of epicardial adipose tissue and carotid intima-media thickness as a marker of atherosclerosis in patients with inflammatory bowel disease. REVISTA ESPANOLA DE ENFERMEDADES DIGESTIVAS 2021; 113:643-648. [PMID: 33393342 DOI: 10.17235/reed.2020.7394/2020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND AIM this study aimed to compare carotid intima media (CIMT) and epicardial adipose tissue (EAT) measurements, which are considered as markers for the detection of early atherosclerosis in healthy controls and inflammatory bowel disease (IBD) cases. METHODS a total of 60 IBD patients (25 Crohn's disease and 35 ulcerative colitis) and 60 healthy patients (as a control group) were included in the study. The measurements of CIMT and EAT were performed using echocardiography and ultrasonography, respectively. Statistical analysis was used to determine the relationship between the parameters. RESULTS the thickness of bilateral (right and left) CIMT and EAT were significantly higher in IBD than in the control group (p < 0.05). There was a positive correlation between EAT and bilateral (right and left) CIMT in IBD patients (p < 0.05). CONCLUSION IBD is associated with an increased thickness of EAT and CIMT. Chronic inflammation in IBD may increase the risk of atherosclerotic heart disease. Thus, only measuring the thickness of EAT and CIMT can be used as an objective, easy, simple, affordable, non-invasive and accessible assessment method in order to screen for this risk.
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Affiliation(s)
- Nergiz Ekmen
- Gastroenterogy, Faculty of Medicine. Gazi University, Turkey
| | - Güray Can
- Gastroenterology, Faculty of Medicine. Abant Izzet Baysal University, Turkey
| | - Ahmet Yozgat
- Gastroenterology, Faculty of Medicine. Ufuk University, Türkiye
| | - Hatice Can
- Nephrology, Faculty of Medicine. Inönü University, Turkey
| | | | | | - Meral Akdoğan Kayhan
- Gastroenterology, Ankara Bilkent City Hospital. University of Health Sciences, Turkey
| | - Hadi Sasani
- Radiology, Faculty of Medicine. Tekirdağ Namik Kemal University, Turkey
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Demir K, Avcı A, Ergulu Esmen S, Tuncez A, Yalcın MU, Yılmaz A, Yılmaz S, Altunkeser BB. Assessment of arterial stiffness and epicardial adipose tissue thickness in predicting the subclinical atherosclerosis in patients with ankylosing spondylitis. Clin Exp Hypertens 2020; 43:169-174. [PMID: 33028113 DOI: 10.1080/10641963.2020.1833025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Atherosclerosis is a chronic, progressive, inflammatory disease. Recognition of subclinical atherosclerotic vascular changes before clinical manifestation in an asymptomatic population is important for risk stratification and optimal management, which finally leads to the prevention of cardiovascular disease. We aimed to determine the risk of premature subclinical atherosclerosis by evaluating epicardial adipose tissue thickness (EATT) and arterial stiffness parameters in patients with ankylosing spondylitis (AS). METHODS We performed a prospective study of 60 consecutive patients meeting modified New York criteria for AS compared to 60 controls matched for age and sex. Patients with traditional cardiovascular risk factors were excluded. Arterial stiffness parameters and EATT (examined via echocardiography) values of all patients and control groups were measured. RESULTS There was no difference between basal characteristic and echocardiographic parameters in patients with AS and in the control group. EATT and pulse wave velocity (PWV) were higher in the AS patients compared to the control group. EATT was 5.74 ± 1.22 mm and 4.91 ± 1.21 mm (p < .001) and PWV was 9.90 ± 0.98 m/s and 6.46 ± 0.83 m/s (p = .009) in the AS and control groups, respectively. Also, PWV was significantly correlated with EATT, age, and central blood pressure in patients with AS. CONCLUSIONS EATT and PWV, markers of atherosclerosis and cardiovascular disease, were significantly higher in patients with AS than the control group. In addition, in this study, it has been shown that there is a significant relationship between PWV and EATT in patients with AS.
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Affiliation(s)
- Kenan Demir
- Faculty of Medicine Cardiology Department, Selcuk University , Konya, Turkey
| | - Ahmet Avcı
- Faculty of Medicine Cardiology Department, Zonguldak Bülent Ecevit University , Zonguldak, Turkey
| | - Serpil Ergulu Esmen
- Department of Rheumatology, Konya Education Research Hospital , Konya, Turkey
| | - Abdullah Tuncez
- Faculty of Medicine Cardiology Department, Selcuk University , Konya, Turkey
| | | | - Ahmet Yılmaz
- , Department of Cardiology, Karaman State Hospital , Karaman, Turkey
| | - Sema Yılmaz
- Faculty of Medicine Rheumatology Department, Selcuk University , Konya, Turkey
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Packer M. Link Between Synovial and Myocardial Inflammation: Conceptual Framework to Explain the Pathogenesis of Heart Failure with Preserved Ejection Fraction in Patients with Systemic Rheumatic Diseases. Card Fail Rev 2020. [DOI: 10.15420/cfr.2019.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Patients with a broad range of systemic rheumatic diseases are at increased risk of heart failure (HF), an event that is not related to traditional cardiovascular risk factors or underlying ischaemic heart disease. The magnitude of risk is linked to the severity of arthritic activity, and HF is typically accompanied by a preserved ejection fraction. Subclinical evidence for myocardial fibrosis, microcirculatory dysfunction and elevated cardiac filling pressures is present in a large proportion of patients with rheumatic diseases, particularly those with meaningful systemic inflammation. Drugs that act to attenuate pro-inflammatory pathways (methotrexate and antagonists of tumour necrosis factor and interleukin-1) may ameliorate myocardial inflammation and cardiac structural abnormalities and reduce the risk of HF events.
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Affiliation(s)
- Milton Packer
- Baylor Heart and Vascular Institute, Baylor University Medical Center, Dallas, TX, US and Imperial College, London, UK
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9
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Drugs That Ameliorate Epicardial Adipose Tissue Inflammation May Have Discordant Effects in Heart Failure With a Preserved Ejection Fraction as Compared With a Reduced Ejection Fraction. J Card Fail 2019; 25:986-1003. [DOI: 10.1016/j.cardfail.2019.09.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 08/28/2019] [Accepted: 09/03/2019] [Indexed: 02/08/2023]
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Surucu GD, Yildirim A, Yetisgin A, Akturk E. Epicardial adipose tissue thickness as a new risk factor for atherosclerosis in patients with ankylosing spondylitis. J Back Musculoskelet Rehabil 2019; 32:237-243. [PMID: 30248026 DOI: 10.3233/bmr-160650] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE The aim of this study was to compare epicardial adipose tissue thickness (EATT), which is a novel cardiometabolic risk factor in patients with ankylosing spondylitis (AS), and carotid intima media thickness (CIMT) with healthy controls to assess the relationship between these markers and disease activity. MATERIALS AND METHODS This study involved 38 patients with AS and 38 controls with no history of cardiovascular disease. CIMT was measured by Doppler ultrasound, and EATT by echocardiography, in all participants. Total cholesterol (TC), low density lipoprotein (LDL) cholesterol, high density lipoprotein cholesterol, triglycerides, thyroid stimulating hormone, erythrocyte sedimentation rate, C-reactive protein, and hemogram measurements were performed in all subjects after 8 hours of fasting. In addition, the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and the Bath Ankylosing Spondylitis Functional Index (BASFI) scores of the patients with AS were recorded. RESULTS EATT was significantly higher in patients with AS (0.45 ± 0.17 mm) compared with healthy (0.37 ± 0.10 mm) controls (p= 0.01). Significant positive correlations were detected between EAT thickness and BASFI, CIMT, and disease duration in patients with AS (p= 0.008, p= 0.024, and p= 0.012, respectively). Significant negative correlations were observed between EATT and TC and LDL cholesterol concentrations (p= 0.016 and p= 0.009, respectively). No significant difference was detected in CIMT between the patients (0.515 ± 0.08 mm) and the controls (0.517 ± 0.094 mm, p= 0.98). No significant correlation was observed between CIMT of the patients with AS and the BASDAI, BASFI, TC, HDL cholesterol, systolic blood pressure, or diastolic blood pressure values. Significant positive correlations were observed between CIMT and waist circumference, weight, body mass index, and LDL cholesterol in patients with AS and the controls. CONCLUSIONS This study demonstrated increased EATT in patients with AS compared with a healthy population, which was positively correlated with disease duration and BASFI.
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Affiliation(s)
- Gulseren Dost Surucu
- Department of Physical Medicine and Rehabilitation, Adiyaman University Medical School, Adiyaman, Turkey
| | - Adem Yildirim
- Department of Physical Medicine and Rehabilitation, Adiyaman University Medical School, Adiyaman, Turkey
| | - Alparslan Yetisgin
- Department of Physical Medicine and Rehabilitation, Harran University Medical School, Sanliurfa, Turkey
| | - Erdal Akturk
- Department of Cardiology, Adiyaman University Medical School, Adiyaman, Turkey
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11
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Bai R, Zhang Y, Liu W, Ma C, Chen X, Yang J, Sun D. The Relationship of Ankylosing Spondylitis and Subclinical Atherosclerosis: A Systemic Review and Meta-Analysis. Angiology 2018; 70:492-500. [PMID: 30497278 DOI: 10.1177/0003319718814309] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Ruocen Bai
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yanfen Zhang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Wen Liu
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Chunyan Ma
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Xin Chen
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Jun Yang
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Dandan Sun
- Department of Cardiovascular Ultrasound, The First Affiliated Hospital of China Medical University, Shenyang, China
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12
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Yuan Y, Yang J, Zhang X, Han R, Chen M, Hu X, Ma Y, Wu M, Wang M, Xu S, Pan F. Carotid Intima-Media Thickness in Patients with Ankylosing Spondylitis: A Systematic Review and Updated Meta-Analysis. J Atheroscler Thromb 2018; 26:260-271. [PMID: 30089757 PMCID: PMC6402883 DOI: 10.5551/jat.45294] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Aim: Inflammatory arthritis (IA) diseases are relevant with subclinical atherosclerosis, but the data in ankylosing spondylitis (AS) were inconsistent. Therefore, we performed this meta-analysis to explore the relationship between the marker of subclinical atherosclerosis (carotid intima-media thickness (IMT)) and AS. Methods: We performed a systematic literature review using PubMed, Web of Science, Chinese National Knowledge Infrastructure (CNKI) and Chinese Biomedical Database (CBM) databases up to March 2018. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) were calculated to assess the association between carotid IMT and AS. Subgroup analysis, sensitivity analysis, and meta-regression were applied to explore the sources of heterogeneity, and publication bias was calculated to access the quality of pooled studies. Results: A total of 24 articles were collected. The carotid IMT was significantly increased in AS compared with healthy controls (SMD = 0.725, 95% CI = 0.443–1.008, p < 0.001). Subgroup analyses showed the Bath Ankylosing Spondylitis Activity Index (BASDAI) was the source of heterogeneity. Notably, IMT was not significantly increased in those studies that included > 50% patients treated with anti-TNF. Meta-regression revealed severe inflammation status (BASDAI and C-reactive protein (CRP)) could significantly impact carotid IMT in AS. Conclusions: Carotid IMT was significantly increased in patients with AS compared with healthy controls, which suggested subclinical atherosclerosis is related to AS.
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Affiliation(s)
- Yaping Yuan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Jiajia Yang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Xu Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Renfang Han
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Mengya Chen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Xingxing Hu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Yubo Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Meng Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Mengmeng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
| | - Shengqian Xu
- Department of Rheumatism and Immunity, the First Affiliated Hospital of Anhui Medical University
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University.,The Key Laboratory of Major Autoimmune Diseases, Anhui Medical University
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Popkova TV, Novikova DS. ACCORDING TO THE MATERIALS OF THE 2015/2016 NEW EUROPEAN LEAGUE AGAINST RHEUMATISM (EULAR) GUIDELINES FOR REDUCING CARDIOVASCULAR RISK IN PATIENTS WITH INFLAMMATORY ARTHRITIS: GENERAL CHARACTERIZATION AND DISCUSSION PROBLEMS. RHEUMATOLOGY SCIENCE AND PRACTICE 2018. [DOI: 10.14412/1995-4484-2018-272-279] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
According to the materials of the 2015/2016 new European League Against Rheumatism (EULAR) guidelines for reducing cardiovascular risk in patients with inflammatory arthritis. The authors identify three main principles of prevention of cardiovascular diseases in rheumatoid arthritis and other chronic inflammatory arthritis and provide a general characterization of the guidelines, by reviewing the discussion problems.
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Chang H, Zhao X, Zhu Q, Hou Q, Li Y. Removal of epicardial adipose tissue after myocardial infarction improves cardiac function. Herz 2017; 43:258-264. [DOI: 10.1007/s00059-017-4555-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 02/12/2017] [Accepted: 02/19/2017] [Indexed: 12/11/2022]
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Agca R, Heslinga SC, Rollefstad S, Heslinga M, McInnes IB, Peters MJL, Kvien TK, Dougados M, Radner H, Atzeni F, Primdahl J, Södergren A, Wallberg Jonsson S, van Rompay J, Zabalan C, Pedersen TR, Jacobsson L, de Vlam K, Gonzalez-Gay MA, Semb AG, Kitas GD, Smulders YM, Szekanecz Z, Sattar N, Symmons DPM, Nurmohamed MT. EULAR recommendations for cardiovascular disease risk management in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update. Ann Rheum Dis 2016; 76:17-28. [DOI: 10.1136/annrheumdis-2016-209775] [Citation(s) in RCA: 683] [Impact Index Per Article: 85.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2016] [Revised: 07/24/2016] [Accepted: 09/08/2016] [Indexed: 12/28/2022]
Abstract
Patients with rheumatoid arthritis (RA) and other inflammatory joint disorders (IJD) have increased cardiovascular disease (CVD) risk compared with the general population. In 2009, the European League Against Rheumatism (EULAR) taskforce recommended screening, identification of CVD risk factors and CVD risk management largely based on expert opinion. In view of substantial new evidence, an update was conducted with the aim of producing CVD risk management recommendations for patients with IJD that now incorporates an increasing evidence base. A multidisciplinary steering committee (representing 13 European countries) comprised 26 members including patient representatives, rheumatologists, cardiologists, internists, epidemiologists, a health professional and fellows. Systematic literature searches were performed and evidence was categorised according to standard guidelines. The evidence was discussed and summarised by the experts in the course of a consensus finding and voting process. Three overarching principles were defined. First, there is a higher risk for CVD in patients with RA, and this may also apply to ankylosing spondylitis and psoriatic arthritis. Second, the rheumatologist is responsible for CVD risk management in patients with IJD. Third, the use of non-steroidal anti-inflammatory drugs and corticosteroids should be in accordance with treatment-specific recommendations from EULAR and Assessment of Spondyloarthritis International Society. Ten recommendations were defined, of which one is new and six were changed compared with the 2009 recommendations. Each designated an appropriate evidence support level. The present update extends on the evidence that CVD risk in the whole spectrum of IJD is increased. This underscores the need for CVD risk management in these patients. These recommendations are defined to provide assistance in CVD risk management in IJD, based on expert opinion and scientific evidence.
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Uysal F, Akbal E, Akbal A, Cevizci S, Arık K, Gazi E. Epicardial Adipose Tissue Is Increased in Patients With Inflammatory Bowel Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2016; 35:1859-1864. [PMID: 27417739 DOI: 10.7863/ultra.14.09040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Accepted: 12/21/2015] [Indexed: 06/06/2023]
Abstract
OBJECTIVES Patients with inflammatory bowel disease (IBD) have high cardiovascular morbidity, and, in general, epicardial adipose tissue thickness is related to atherosclerotic vascular disease. This study aimed to investigate the association between epicardial adipose tissue thickness and carotid intima-media thickness as markers of early atherosclerosis in patients with IBD. METHODS The study comprised 47 patients with IBD (25 with Crohn disease and 22 with ulcerative colitis) and 35 control participants. In all individuals, epicardial adipose tissue and carotid intima-media thickness values were measured by sonography. RESULTS The mean age ± SD of the 47 patients with IBD was 42.3 ± 11.2 years, versus 41.4 ± 10.1 years for the control group. The epicardial adipose tissue thickness was higher in both the Crohn disease and ulcerative colitis groups compared to the control group (P < .001), but not the carotid intima-media thickness (P = .695 and .917, respectively). There was a strong positive correlation between the carotid intima-media and epicardial adipose tissue thickness values in the Crohn disease and ulcerative colitis groups (r = 0.757; 95% confidence interval, 0.711-0.901; r = 0.786; 95% confidence interval, 0.364-0.615; both P < .001). However, there was no significant difference between the patients who were in the active and inactive disease periods in both groups in terms of carotid intima-media and epicardial adipose tissue thickness values. CONCLUSIONS Our findings suggest that epicardial adipose tissue thickness might be a marker for detection of early atherosclerosis in patients with IBD. There was a strong positive correlation between carotid intima-media thickness and epicardial adipose tissue thickness values in the patients with IBD. However, there was no correlation between IBD activity and carotid intima-media or epicardial adipose tissue thickness.
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Affiliation(s)
- Fatma Uysal
- Department of Radiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Erdem Akbal
- Department of Gastroenterology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Ayla Akbal
- Department of Physical Medicine and Rehabilitation, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Sibel Cevizci
- Department of Public Health, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Kasım Arık
- Department of General Surgery, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
| | - Emine Gazi
- Department of Cardiology, Çanakkale Onsekiz Mart University, Çanakkale, Turkey
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Evaluation of Atrial Conduction Times, Epicardial Fat Thickness and Carotid Intima-Media Thickness in Patients With Ankylosing Spondylitis. Arch Rheumatol 2016; 31:353-358. [PMID: 29901030 DOI: 10.5606/archrheumatol.2016.5867] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 12/22/2016] [Indexed: 01/20/2023] Open
Abstract
Objectives This study aims to determine the relationship between atrial electromechanical delay (EMD), carotid intima-media thickness (CIMT), and epicardial fat thickness (EFT) in ankylosing spondylitis (AS), which has a complicated inflammatory nature. Patients and methods The study population included 42 consecutive patients with AS (28 males, 14 females; mean age 39.3±8.5 years; range 22 to 60 years) and 40 healthy subjects as controls (24 males, 16 females; mean age 37.2±8.7 years; range 22 to 60 years) (p>0.05). All patients underwent a standard tissue Doppler echocardiography to assess the left ventricular diastolic dysfunction, atrial EMD, CIMT, and EFT. All values were compared between the groups. Results Interatrial (29.5±5.8 ms vs. 17.9±5.3 ms) left and right intraatrial EMD (18.2±4.6 ms and 11.7±3.5 ms vs. 11.9±3.2 ms and 7.1±3.2 ms, respectively) intervals were longer in AS patients than in healthy controls (all p<0.001). Left and right CIMT (0.50±0.11 mm and 0.44±0.06 mm vs. 0.51±0.11 mm and 0.43±0.04 mm, respectively) and EFT (0.73±0.15 cm and 0.63±0.07 cm) values were higher in AS patients than in healthy controls (all p<0.01). Conclusion To our best knowledge, this is the first report evaluating the atrial EMD, CIMT, and EFT values together in AS patients. As indicators of cardiovascular involvement, all parameters were higher in AS patients.
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Uluca Ü, Demir F, Ece A, Şen V, Güneş A, Aktar F, Tan İ, Karabel D, Yazgan Ü, Sabaz MN. Assessment of epicardial adipose tissue thickness and the mean platelet volume in children with familial Mediterranean fever. Ital J Pediatr 2015; 41:15. [PMID: 25887962 PMCID: PMC4348162 DOI: 10.1186/s13052-015-0120-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/11/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Familial Mediterranean fever (FMF) is an inflammatory disease, which is suggested to be associated with increased risk of atherosclerosis. Epicardial adipose tissue (EAT) thickness and the mean platelet volume (MPV) are parameters used in prediction of atherosclerotic risk in various conditions. These parameters were evaluated in children with FMF and compared with healthy controls. METHODS Forty-five patients with FMF and 54 age- and gender-matched healthy controls were assessed. Duration of symptoms, age at diagnosis, duration of delay in diagnosis, frequency and duration of FMF attacks, disease severity scores, response to colchicine therapy, MEditerraneanFeVer (MEFV) gene mutations, and MPV values were recorded. EAT thicknesses were measured by echocardiography. RESULTS Epicardial adipose tissue thicknesses of the children with FMF were found to be significantly greater than that of controls (5.1 ± 1.4 vs. 4.5 ± 0.9 mm, p=0.036). FMF patients had significantly higher MPV values compared with the controls (7.8 ± 1.1 vs. 7.3 ± 1.4 fl, p=0.044). Age at diagnosis, duration of delay in diagnosis, and MPV values were found to be correlated with EAT thickness in the patient group (r=0.49, p=0.001 for the former parameters and r=0.32, p=0.04 for MPV). CONCLUSION Epicardial adipose tissue thickness and MPV values seem to be increased in children with FMF. These findings may indicate an increased risk of atherosclerosis in FMF patients.
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Affiliation(s)
- Ünal Uluca
- Department of Pediatrics, Dicle University Medical School, Diyarbakir, Turkey.
| | - Fikri Demir
- Department of Pediatric Cardiology, Dicle University Medical School, Diyarbakir, Turkey.
| | - Aydın Ece
- Department of Pediatric Rheumatology, Dicle University Medical School, Diyarbakir, Turkey.
| | - Velat Şen
- Department of Pediatrics, Dicle University Medical School, Diyarbakir, Turkey.
| | - Ali Güneş
- Department of Pediatrics, Dicle University Medical School, Diyarbakir, Turkey.
| | - Fesih Aktar
- Department of Pediatrics, Dicle University Medical School, Diyarbakir, Turkey.
| | - İlhan Tan
- Department of Pediatrics, Dicle University Medical School, Diyarbakir, Turkey.
| | - Duran Karabel
- Department of Pediatrics, Dicle University Medical School, Diyarbakir, Turkey.
| | - Ümitcan Yazgan
- Department of Physiology, Dicle University Medical School, Diyarbakir, Turkey.
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Drug retention rates and treatment discontinuation among anti-TNF-α agents in psoriatic arthritis and ankylosing spondylitis in clinical practice. Mediators Inflamm 2014; 2014:862969. [PMID: 25110401 PMCID: PMC4119698 DOI: 10.1155/2014/862969] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 05/26/2014] [Accepted: 05/29/2014] [Indexed: 01/19/2023] Open
Abstract
Objective. The study aim was to determine treatment persistence rates and to identify causes of discontinuation in psoriatic arthritis (PsA) and ankylosing spondylitis (AS) patients in clinical practice. Methods. Patients treated with adalimumab (ADA), etanercept (ETA), or infliximab (INF) were retrospectively included. Treatment persistence rates were analyzed by means of a stepwise logistic regression. Differences between therapy duration were assessed by means of an analysis of variance model (ANOVA), while a chi-square test was used to evaluate relationships between therapies and causes of treatment discontinuation and the administration of concomitant disease-modifying antirheumatic drugs (DMARDs) among therapies and types of disease considering completed courses of therapy versus courses that were discontinued. Results. 268 patients received a total of 353 anti-TNF treatment courses (97 ADA, 180 ETA, and 76 INF). Comparison among therapies showed significant difference regarding the treatment persistence rates due to the contrast between ETA and INF (P = 0.0062). We observed that 84.7% of patients were still responding after 6 months of follow-up. Comparison among diseases showed that there were significant differences between PsA and AS (P = 0.0073) and PsA and PsA with predominant axial involvement (P = 0.0467) in terms of duration of the therapy, while there were no significant differences with regard to the persistence rate. Conclusions. In this cohort, anti-TNF-α therapy was associated with high drug persistence rates. As in rheumatoid arthritis, switching to another anti-TNF-α agent can be an effective option when, during the treatment of AS or PsA, therapy is suspended because of inefficacy or an adverse event. Combination therapy with DMARDs was associated with a better persistence rate.
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