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Sircana MC, Erre GL, Castagna F, Manetti R. Crosstalk between Inflammation and Atherosclerosis in Rheumatoid Arthritis and Systemic Lupus Erythematosus: Is There a Common Basis? Life (Basel) 2024; 14:716. [PMID: 38929699 PMCID: PMC11204900 DOI: 10.3390/life14060716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/28/2024] Open
Abstract
Cardiovascular disease is the leading cause of morbidity and mortality in patients with rheumatoid arthritis and systemic lupus erythematosus. Traditional cardiovascular risk factors, although present in lupus and rheumatoid arthritis, do not explain such a high burden of early cardiovascular disease in the context of these systemic connective tissue diseases. Over the past few years, our understanding of the pathophysiology of atherosclerosis has changed from it being a lipid-centric to an inflammation-centric process. In this review, we examine the pathogenesis of atherosclerosis in systemic lupus erythematosus and rheumatoid arthritis, the two most common systemic connective tissue diseases, and consider them as emblematic models of the effect of chronic inflammation on the human body. We explore the roles of the inflammasome, cells of the innate and acquired immune system, neutrophils, macrophages, lymphocytes, chemokines and soluble pro-inflammatory cytokines in rheumatoid arthritis and systemic lupus erythematosus, and the roles of certain autoantigens and autoantibodies, such as oxidized low-density lipoprotein and beta2-glycoprotein, which may play a pathogenetic role in atherosclerosis progression.
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Affiliation(s)
| | | | | | - Roberto Manetti
- Department of Medical, Surgical and Pharmacology, University of Sassari, 07100 Sassari, Italy; (G.L.E.); (F.C.)
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Arida A, Fragoulis GE, Terentes-Printzios D, Konstantonis G, Protogerou AD, Vlachopoulos C, Tektonidou M, Sfikakis PP. Progression of subclinical atherosclerosis in ankylosing spondylitis: a 10-year prospective study. Rheumatol Int 2024; 44:643-652. [PMID: 38349401 DOI: 10.1007/s00296-023-05528-7] [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: 10/23/2023] [Accepted: 12/23/2023] [Indexed: 03/06/2024]
Abstract
Chronic systemic inflammation contributes to increased CVD burden in Ankylosing Spondylitis (AS). Since long-term follow-up data on subclinical atherosclerosis acceleration are lacking, we examined its progression in contemporary AS patients during 10 years. Fifty-three (89% male, aged 50.4 (36.3-55.9) years,) non-diabetic, CVD-free AS patients and 53 age-sex-matched non-diabetic, control individuals were re-evaluated after 9.2-10.2 years by ultrasonography for carotid/femoral atheromatosis, pulse wave velocity (PWV) and intima-media thickness (IMT), performed by the same operator/protocol. New atheromatic plaque formation, PWV deterioration, and IMT increase were associated only with classical CVD risk factors, as reflected by the heartSCORE (age, gender, smoking status, blood pressure and cholesterol levels) by multivariate analysis, rather than disease presence. However, among AS patients, despite remission/low disease activity at follow-up end in 79%, atheromatosis progression was associated by multivariate analysis with higher BASDAI scores (p = 0.028), independently of biologic therapies administered in 2/3 of them. Moreover, in AS patients, but not in controls, PWV values at baseline were associated with plaque progression during the 10-year follow-up after taking into account baseline heartSCORE and plaque burden status (p = 0.033). Despite comparable prevalence of both hypertension and hypercholesterolemia at baseline between patients and controls, a lower percentage of AS patients had achieved "adequate" CVD risk factor control at follow-up end (11% vs 25% respectively, p = 0.076). Classical CVD risk factors and residual disease activity account for the progression of subclinical atherosclerosis in AS, pointing to the unmet needs in the contemporary management of these patients.
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Affiliation(s)
- Aikaterini Arida
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Agiou Thoma 17, 11527, Athens, Greece.
| | - George E Fragoulis
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Agiou Thoma 17, 11527, Athens, Greece
| | - Dimitrios Terentes-Printzios
- First Department of Cardiology Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - George Konstantonis
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Agiou Thoma 17, 11527, Athens, Greece
| | - Athanasios D Protogerou
- Cardiovascular Prevention and Research Unit, Clinic and Laboratory of Pathophysiology, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Charalambos Vlachopoulos
- First Department of Cardiology Hippokration Hospital, National and Kapodistrian University of Athens Medical School, Athens, Greece
| | - Maria Tektonidou
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Agiou Thoma 17, 11527, Athens, Greece
| | - Petros P Sfikakis
- First Department of Propaedeutic and Internal Medicine and Joint Rheumatology Program, National and Kapodistrian University of Athens Medical School, Agiou Thoma 17, 11527, Athens, Greece
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Karakasis P, Patoulias D, Stachteas P, Lefkou E, Dimitroulas T, Fragakis N. Accelerated Atherosclerosis and Management of Cardiovascular Risk in Autoimmune Rheumatic Diseases: An Updated Review. Curr Probl Cardiol 2023; 48:101999. [PMID: 37506959 DOI: 10.1016/j.cpcardiol.2023.101999] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 07/24/2023] [Indexed: 07/30/2023]
Abstract
Even though diagnosis and management pathways have been substantially improved over the last years, autoimmune rheumatic diseases (AIRDs) such as rheumatoid arthritis, systemic sclerosis, systemic lupus erythematosus, antiphospholipid syndrome, Sjögren's syndrome, and systemic vasculitides have been linked to elevated rates of cardiovascular morbidity and mortality, primarily secondary to accelerated atherosclerosis. This phenomenon can be partially attributed to the presence of established cardiovascular risk factors but may also be a result of other inflammatory and autoimmune mechanisms that are enhanced in AIRDs. According to the current guidelines, the recommendations regarding cardiovascular disease prevention in patients with AIRDs are not significantly different from those applied to the general population. Herein, we present a review of the current literature on the risk of accelerated atherosclerosis in AIRDs and provide a summary of available recommendations for the management of cardiovascular risk in rheumatic diseases.
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Affiliation(s)
- Paschalis Karakasis
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece.
| | - Dimitrios Patoulias
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece; Outpatient Department of Cardiometabolic Medicine, Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece; Second Department of Internal Medicine, European Interbalkan Medical Center, Thessaloniki, Greece
| | - Panagiotis Stachteas
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece
| | - Eleftheria Lefkou
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece; Perigenesis, Institute of Obstetric Haematology, Thessaloniki, Greece
| | - Theodoros Dimitroulas
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece; Fourth Department of Internal Medicine, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Nikolaos Fragakis
- Second Department of Cardiology, Aristotle University of Thessaloniki, General Hospital "Hippokration," Thessaloniki, Greece
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Lam TO, Cheng IT, Lam SH, Mok CC, Ho CT, Cheung TT, Lao VW, Pang HT, To CH, Yim CW, Ng A, Kwok KY, Lee KL, Ying SK, Wan MC, Lee JM, Tam LS. Five-year cardiovascular event risk in early rheumatoid arthritis patients who received treat-to-target management: a case-control study. Rheumatology (Oxford) 2023; 62:2998-3005. [PMID: 36707997 DOI: 10.1093/rheumatology/kead039] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 12/30/2022] [Accepted: 01/05/2023] [Indexed: 01/29/2023] Open
Abstract
OBJECTIVES This study explored whether the excess cardiovascular (CV) disease (CVD) risk in RA could be ameliorated by suppression of inflammation using a treat-to-target (T2T) approach. We compared the CV event (CVE) incidence among ERA patients managed by a T2T strategy with a CV risk factor-matched non-RA population and a historical RA cohort (HRA). METHODS This was an observational study using the city-wide hospital data and the ERA registry. ERA patients received T2T management while HRA patients received routine care. Each ERA/HRA patient was matched to three non-RA controls according to age, gender and CV risk factors. Patients on antiplatelet/anticoagulant agents, with pre-existing CVD, chronic kidney disease or other autoimmune diseases were excluded. All subjects were followed for up to 5 years. The primary end point was the first occurrence of a CVE. RESULTS The incidence of CVE in the ERA cohort (n = 261) and ERA controls were similar with a hazard ratio of 0.53 (95% CI 0.15, 1.79). In contrast, the incidence of CVE in the HRA cohort (n = 268) was significantly higher than that of the HRA controls with a hazard ratio of 1.9 (95% CI 1.16, 3.13). The incidence of CVE in the ERA cohort was significantly lower than that of the HRA cohort and the difference became insignificant after adjusting for inflammation, the use of methotrexate and traditional CV risk factors. CONCLUSION ERA patients managed by a T2T strategy did not develop excess CVE compared with CV risk factor-matched controls over 5 years.
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Affiliation(s)
- Tsz On Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Isaac T Cheng
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Steven H Lam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Chiu Mok
- Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China
| | - Carmen T Ho
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Tommy T Cheung
- Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | - Virginia W Lao
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Hin Ting Pang
- Department of Medicine and Geriatrics, Kwong Wah Hospital, Hong Kong, China
| | - Chi Hung To
- Department of Medicine and Geriatrics, Pok Oi Hospital, Hong Kong, China
| | - Cheuk Wan Yim
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Alexandra Ng
- Department of Medicine and Geriatrics, Caritas Medical Centre, Hong Kong, China
| | - Kitty Y Kwok
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Ka Lai Lee
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Shirley K Ying
- Department of Medicine and Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Man Choi Wan
- Department of Medicine and Geriatrics, Ruttonjee Hospital, Hong Kong, China
| | - Jolly M Lee
- Department of Medicine and Geriatrics, Tai Po Hospital, Hong Kong, China
| | - Lai-Shan Tam
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Crorkin P, Hao S, Ferreri NR. Responses to Ang II (Angiotensin II), Salt Intake, and Lipopolysaccharide Reveal the Diverse Actions of TNF-α (Tumor Necrosis Factor-α) on Blood Pressure and Renal Function. Hypertension 2022; 79:2656-2670. [PMID: 36129177 PMCID: PMC9649876 DOI: 10.1161/hypertensionaha.122.19464] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
TNF-α (tumor necrosis factor-alpha) is the best known as a proinflammatory cytokine; yet, this cytokine also has important immunomodulatory and regulatory functions. As the effects of TNF-α on immune system function were being revealed, the spectrum of its activities appeared in conflict with each other before investigators defined the settings and mechanisms by which TNF-α contributed to both host defense and chronic inflammation. These effects reflect self-protective mechanisms that may become harmful when dysregulated. The paradigm of physiological and pathophysiological effects of TNF-α has since been uncovered in the lung, colon, and kidney where its role has been identified in pulmonary edema, electrolyte reabsorption, and blood pressure regulation, respectively. Recent studies on the prohypertensive and inflammatory effects of TNF-α in the cardiovascular system juxtaposed to those related to NaCl and blood pressure homeostasis, the response of the kidney to lipopolysaccharide, and protection against bacterial infections are helping define the mechanisms by which TNF-α modulates distinct functions within the kidney. This review discusses how production of TNF-α by renal epithelial cells may contribute to regulatory mechanisms that not only govern electrolyte excretion and blood pressure homeostasis but also maintain the appropriate local hypersalinity environment needed for optimizing the innate immune response to bacterial infections in the kidney. It is possible that the wide range of effects mediated by TNF-α may be related to severity of disease, amount of inflammation and TNF-α levels, and the specific cell types that produce this cytokine, areas that remain to be investigated further.
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Affiliation(s)
- Patrick Crorkin
- Department of Pharmacology, New York Medical College, Valhalla, NY
| | - Shoujin Hao
- Department of Pharmacology, New York Medical College, Valhalla, NY
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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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The second decade of anti-TNF-a therapy in clinical practice: new lessons and future directions in the COVID-19 era. Rheumatol Int 2022; 42:1493-1511. [PMID: 35503130 PMCID: PMC9063259 DOI: 10.1007/s00296-022-05136-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/12/2022] [Indexed: 11/22/2022]
Abstract
Since the late 1990s, tumor necrosis factor alpha (TNF-α) inhibitors (anti-TNFs) have revolutionized the therapy of immune-mediated inflammatory diseases (IMIDs) affecting the gut, joints, skin and eyes. Although the therapeutic armamentarium in IMIDs is being constantly expanded, anti-TNFs remain the cornerstone of their treatment. During the second decade of their application in clinical practice, a large body of additional knowledge has accumulated regarding various aspects of anti-TNF-α therapy, whereas new indications have been added. Recent experimental studies have shown that anti-TNFs exert their beneficial effects not only by restoring aberrant TNF-mediated immune mechanisms, but also by de-activating pathogenic fibroblast-like mesenchymal cells. Real-world data on millions of patients further confirmed the remarkable efficacy of anti-TNFs. It is now clear that anti-TNFs alter the physical course of inflammatory arthritis and inflammatory bowel disease, leading to inhibition of local and systemic bone loss and to a decline in the number of surgeries for disease-related complications, while anti-TNFs improve morbidity and mortality, acting beneficially also on cardiovascular comorbidities. On the other hand, no new safety signals emerged, whereas anti-TNF-α safety in pregnancy and amid the COVID-19 pandemic was confirmed. The use of biosimilars was associated with cost reductions making anti-TNFs more widely available. Moreover, the current implementation of the “treat-to-target” approach and treatment de-escalation strategies of IMIDs were based on anti-TNFs. An intensive search to discover biomarkers to optimize response to anti-TNF-α treatment is currently ongoing. Finally, selective targeting of TNF-α receptors, new forms of anti-TNFs and combinations with other agents, are being tested in clinical trials and will probably expand the spectrum of TNF-α inhibition as a therapeutic strategy for IMIDs.
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Miura T, Miyakoshi N, Kashiwagura T, Tsuchie H, Sugimura Y, Shimada Y. The association between comorbidities and disease activity in patients with rheumatoid arthritis: a multicenter, cross-sectional cohort study in Japan with the highest proportion of elderly individuals. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-021-00109-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
This study aimed to assess the association of disease activity with the presence of comorbidities in patients with rheumatoid arthritis, using the Akita Orthopedic Group on Rheumatoid Arthritis (AORA) registry, a multicenter, cross-sectional registry in Japan with the highest proportion of elderly people. We included 1838 patients (mean age: 66.4 years old) who visited our affiliated institutions between April 2018 and March 2019. The patients were divided into two groups based on the disease activity in 28 joints based on the erythrocyte sedimentation rate (DAS28-ESR) into the remission or low disease activity group (L group) and the moderate or high disease activity group (H group). Patient demographics and comorbidities in the two groups were compared.
Results
The most common comorbidity was hypertension (33.7%), followed by renal disease (25.2%), respiratory disease (12.2%), diabetes mellitus (8.1%), cardiovascular disease (8.0%), malignancies (5.7%), and cerebrovascular disease (4.7%). The H group was older (p<0.0001); had a higher prevalence of hypertension (p<0.0001), diabetes (p=0.0011), respiratory disease (p<0.0001), cerebrovascular disease (p<0.0001), and cardiovascular disease (p=0.0030); and was less likely to use anti-rheumatic drugs. The prevalence of comorbidities other than renal disease and malignant tumor was higher in the H group. Multivariate logistic regression analysis showed that female sex (p=0.0054), advanced Steinbrocker class (p<0.0001), high anti-citrullinated protein antibody levels (p=0.0211), high prednisolone dose (p<0.0001), and absence of biologics’ or JAK inhibitors’ use (p<0.0001) were risk factors for high disease activity, and shorter treatment period was a low-risk factor for high disease activity (p=0.0041). Among comorbidities, the presence of cerebrovascular disease (p=0.0334) was the only independent risk factor for high disease activity.
Conclusions
In our registry study with a high proportion of elderly RA patients, cerebrovascular disease was associated with high disease activity in patients with RA. Therefore, when treating elderly patients with RA, we need to pay careful attention to cerebrovascular disease, and treatment should be aimed at achieving adequate control of RA.
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Subclinical Atherosclerosis Measure by Carotid Ultrasound and Inflammatory Activity in Patients with Rheumatoid Arthritis and Spondylarthritis. J Clin Med 2022; 11:jcm11030662. [PMID: 35160112 PMCID: PMC8836873 DOI: 10.3390/jcm11030662] [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: 12/23/2021] [Revised: 01/14/2022] [Accepted: 01/24/2022] [Indexed: 02/01/2023] Open
Abstract
Objective: To compare the effect of inflammation on subclinical atherosclerosis using carotid ultrasound in patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA). Methods: Cross-sectional study including 347 participants (148 RA, 159 SpA, and 40 controls). We measured the carotid intima media thickness (cIMT) and detection of atheromatous plaques using carotid ultrasound. We recorded disease activity (DAS28-CRP/ASDAS-CRP) and traditional cardiovascular risk factors. We performed descriptive, bivariate, and linear multivariate analyses (dependent variable: cIMT) to evaluate the influence of diagnosis on cIMT in all patients. Two additional multivariate analyses were performed by stratifying patients according to their inflammatory activity. Results: cIMT correlated with the mean CRP during the previous 5 years in RA, but not with CRP at the cut-off date. We did not find such differences in patients with SpA. The first multivariate model revealed that increased cIMT was more common in patients with RA than in those with SpA (β coefficient, 0.045; 95% confidence interval (95% CI), 0.0002–0.09; p = 0.048) after adjusting for age, sex, disease course, and differential cardiovascular risk factors (arterial hypertension, smoking, statins, and corticosteroids). The second model revealed no differences in cIMT between the 2 groups of patients classified as remission–low activity (β coefficient, 0.020; 95% CI, −0.03 to 0.080; p = 0.500). However, when only patients with moderate–high disease activity were analysed, the cIMT was 0.112 mm greater in those with RA (95% CI, 0.013–0.212; p = 0.026) than in those with SpA after adjusting for the same variables. Conclusions: Subclinical atherosclerosis measured by carotid ultrasound in patients with RA and SpA is comparable when the disease is well controlled. However, when patients have moderate–high disease activity, cIMT is greater in patients with RA than in those with SpA after adjusting for age, sex, disease course, and cardiovascular risk factors. Our results point to greater involvement of disease activity in subclinical atherosclerosis in patients with RA than in those with SpA.
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Dimitroulas T, Anyfanti P, Bekiari E, Angeloudi E, Pagkopoulou E, Kitas G. Arterial stiffness in rheumatoid arthritis: Current knowledge and future perspectivess. INDIAN JOURNAL OF RHEUMATOLOGY 2022. [DOI: 10.4103/injr.injr_254_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Rojas-Giménez M, López-Medina C, Calvo-Gutiérrez J, Puche-Larrubia MÁ, Gómez-García I, Seguí-Azpilcueta P, Ábalos-Aguilera MDC, Ruíz D, Collantes-Estévez E, Escudero-Contreras A. Association between Carotid Intima-Media Thickness and the Use of Biological or Small Molecule Therapies in Patients with Rheumatoid Arthritis. Diagnostics (Basel) 2021; 12:diagnostics12010064. [PMID: 35054229 PMCID: PMC8775122 DOI: 10.3390/diagnostics12010064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 12/23/2021] [Accepted: 12/27/2021] [Indexed: 11/16/2022] Open
Abstract
Objective: The objective of this study was to assess the association of carotid intima-media thickness (CIMT), and also the presence of atheromatous plaque, with biological and targeted synthetic disease-modifying antirheumatic drugs, in an established cohort of patients with rheumatoid arthritis (RA). Patients and Methods: We conducted a cross-sectional observational study based on a cohort of patients with RA and a registry of healthy controls, in whom the CIMT and presence of atheromatous plaque were assessed by ultrasound. Data were collected on disease activity, lab results and treatments. Descriptive and bivariate analyses were performed and two multivariate linear regression models (with CIMT as the dependent variable) were constructed to identify variables independently associated with CIMT in our sample of patients with RA. Results: A total of 176 individuals (146 patients with RA and 30 controls) were included. A higher percentage of patients than controls had atheromatous plaque (33.8% vs. 12.5%, p = 0.036), but no differences were found in terms of CIMT (0.64 vs. 0.61, p = 0.444). Compared to values in patients on other therapies, the CIMT was smaller among patients on tumour necrosis factor alpha (TNFα) inhibitors (mean [SD]: 0.58 [0.10] vs. 0.65 [0.19]; p = 0.013) and among those on Janus kinase inhibitors (mean [SD]: 0.52 [0.02] vs. 0.64 [0.18]; p < 0.001), while no differences were found as a function of the use of the other therapies considered. The multivariate linear regression analysis to identify factors associated with CIMT in our patients, adjusting for traditional cardiovascular risk factors such as hypertension, high levels of low-density lipoproteins, diabetes mellitus and smoking, showed that male sex, older age and having a greater cumulative erythrocyte sedimentation rate were independently associated with a larger CIMT, while patients on TNFα inhibitors had a CIMT 0.075 mm smaller than those on other treatments. Conclusions: The use of TNFα inhibitors may protect against subclinical atherosclerosis in patients with RA, patients on this biologic having smaller CIMTs than patients on other disease-modifying antirheumatic drugs. Nonetheless, these results should be confirmed in prospective studies with larger sample sizes.
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Affiliation(s)
- Marta Rojas-Giménez
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Clementina López-Medina
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
- Correspondence:
| | - Jerusalem Calvo-Gutiérrez
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - María Ángeles Puche-Larrubia
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Ignacio Gómez-García
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Pedro Seguí-Azpilcueta
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
| | - María del Carmen Ábalos-Aguilera
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
| | - Desirée Ruíz
- Rheumatology Department, Reina Sofía University Hospital, Maimonides Institute for Biomedical Research of Córdoba (IMIBIC), University of Córdoba (UCO), 14004 Cordoba, Spain; (M.R.-G.); (J.C.-G.); (M.Á.P.-L.); (I.G.-G.); (D.R.)
| | - Eduardo Collantes-Estévez
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
| | - Alejandro Escudero-Contreras
- Reina Sofia University Hospital, Maimonides Research Institute of Biomedical Medicine from Cordoba (IMIBIC), University of Córdoba, 14004 Cordoba, Spain; (P.S.-A.); (M.d.C.Á.-A.); (E.C.-E.); (A.E.-C.)
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12
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Radial BMD and serum CTX-I can predict the progression of carotid plaque in rheumatoid arthritis: a 3-year prospective cohort study. Arthritis Res Ther 2021; 23:258. [PMID: 34641970 PMCID: PMC8513174 DOI: 10.1186/s13075-021-02642-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 10/04/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) are almost twice as likely to develop cardiovascular disease (CVD) as those without. However, traditional CVD risks have been shown to underperform in RA patients; thus, we aimed to identify new surrogate risk factors to better reflect their atherosclerotic burden. METHODS A total of 380 RA patients with carotid atherosclerosis data were analyzed in this prospective cohort study. The primary outcome was carotid plaque progression over the 3-year follow-up period. Risk parameters assessed for the progression of carotid plaque were categorized as demographics, traditional CVD risks, RA-related risks, and bone parameters. RESULTS The progression of carotid plaque was associated with the level of rheumatoid factor (p = 0.025), serum C-terminal telopeptide of type-I collagen (CTX-I) (p = 0.014), and femur and distal radius bone mass density (BMD) (p = 0.007 and 0.004, respectively), as well as traditional CVD risk factors. In multivariable analyses, the bone parameters of serum CTX-I and distal radius BMD proved to be independent predictors of the progression of carotid plaque along with hyperlipidemia, smoking, and baseline carotid plaque (all, p < 0.05). Adding both serum CTX-I and distal radius BMD increased the carotid plaque progression prediction model's percentage of explained variance from 24 to 30%. CONCLUSION High serum CTX-I and lower radius BMD, reflecting high bone turnover, were independent risk factors for the progression of carotid plaque in RA patients, implicating the direct or indirect role of bone metabolism on the atherosclerotic burden.
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Turgunova LG, Shalygina AA, Ibrayeva LK, Turmuhambetova AA. Metabolic Syndrome as a Factor Affecting on Intima-Media Thickness in Patients with Rheumatoid Arthritis. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5943] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM: The aim of the study was to assess the association of the thickness of the intima-media complex with metabolic syndrome (MetS) and the degree of disease activity in patients with rheumatoid arthritis (RA).
MATERIALS AND METHODS: The study included 101 patients with RA. All patients underwent a biochemical examination, the presence of MetS was determined, and the carotid thickness of the intima-media was determined. Statistical processing was performed using SPSS for Windows, version 18.0.
RESULTS: Among 101 patients with RA, 41 (40.5%) had MetS. The frequency of detecting an increased value of the intima-media complex thickness was significantly higher in the group with MetS (n = 31 [75.6%]) than in the group without MetS (n = 21 [35.0%] p ≤ 0.0001). In the group of patients with MetS, the median carotid intima-media thickness (CIMT) was 1.2 mm, while this indicator in the group without MetS was 0.78 mm (U = 727, p = 0.001). In the regression model, MetS (B = 1.05; p = 0.027) and DAS28-ESR (B = 0.506; p = 0.021) were influenced by CIMT.
CONCLUSIONS: The results of our study show the effect of MetS and RA activity on the increase of intima-media thickness.
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Fragoulis GE, Soulaidopoulos S, Sfikakis PP, Dimitroulas T, D Kitas G. Effect of Biologics on Cardiovascular Inflammation: Mechanistic Insights and Risk Reduction. J Inflamm Res 2021; 14:1915-1931. [PMID: 34017189 PMCID: PMC8131071 DOI: 10.2147/jir.s282691] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 04/14/2021] [Indexed: 12/17/2022] Open
Abstract
It is increasingly recognized that atherosclerosis and consequently cardiovascular disease (CVD) are closely linked with inflammatory processes. The latter is in the center of the pathogenic mechanism underlying autoimmune rheumatic diseases (ARD). It follows then, that optimal control of inflammation in ARDs may lead to a decrease of the accompanied CVD risk. Major trials (eg, CANTOS, CIRT), aimed at examining the possible benefits of immunomodulatory treatments in CVD, demonstrated conflicting results. On the other hand, substantial evidence is accumulating about the possible beneficial effects of biologic disease modifying antirheumatic drugs (bDMARDs) in patients with ARDs, particularly those with rheumatoid arthritis (RA). It seems that bDMARDs (some more than others) alter the lipid profile in RA patients but do not adversely affect, in most cases, the TC/HDL ratio. Favorable effects are noted for arterial stiffness and endothelial function. This is reflected in the lower risk for CVD events, seen in observational studies of RA patients treated with bDMARDs. It should be stressed that more data exist for the TNF-inhibitors than for other bDMARDs, such as tocilizumab, abatacept and rituximab. As regards the spondyloarthropathies (SpA), data are less robust. For TNF-inhibitors, effects appear to be on par with those seen in RA but no conclusions can be drawn for newer biologic drugs used in SpA (eg, IL-17 blockers). Finally, there is accumulating evidence for a beneficial effect of immunosuppressive treatment in cardiac inflammation and function in several ARDs. Introduction of newer therapeutic options in clinical practice seem to have a positive impact on CVD in the setting of ARD. This is probably due to better control of inflammation, but direct improvement in vascular pathology is also a valid hypothesis. Most data are derived from observational studies and, therefore, randomized controlled trials are needed to assess the possible favorable effect of bDMARDs on CVD outcomes.
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Affiliation(s)
- George E Fragoulis
- Rheumatology Unit, Joint Rheumatology Program, Medical School, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, 115 27, Greece
| | - Stergios Soulaidopoulos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippokration General Hospital, Athens, 115 27, Greece
| | - Petros P Sfikakis
- Rheumatology Unit, Joint Rheumatology Program, Medical School, First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, "Laiko" General Hospital, Athens, 115 27, Greece
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokration Hospital, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, 546 41, Greece
| | - George D Kitas
- Department of Rheumatology, Russells Hall Hospital, Dudley Group NHS FT, Dudley, DY1 2HQ, UK.,Arthritis Research UK Epidemiology Unit, University of Manchester, Manchester, M13 9PT, UK
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15
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Kerola AM, Rollefstad S, Semb AG. Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Impact of Inflammation and Antirheumatic Treatment. Eur Cardiol 2021; 16:e18. [PMID: 34040652 PMCID: PMC8145075 DOI: 10.15420/ecr.2020.44] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 02/19/2021] [Indexed: 11/16/2022] Open
Abstract
Patients with rheumatoid arthritis (RA) are at approximately 1.5-fold risk of atherosclerotic cardiovascular disease (CVD) compared with the general population, a phenomenon resulting from combined effects of traditional CVD risk factors and systemic inflammation. Rheumatoid synovitis and unstable atherosclerotic plaques share common inflammatory mechanisms, such as expression of proinflammatory cytokines interleukin (IL)-1, tumour necrosis factor (TNF)-α and IL-6. RA patients are undertreated in terms of CVD prevention, and structured CVD prevention programmes are warranted. Alongside management of traditional risk factors, suppressing systemic inflammation with antirheumatic medication is fundamental for the reduction of CVD risk among this high-risk patient group. Many antirheumatic drugs, especially methotrexate, TNF-α-inhibitors and IL-6-inhibitors are associated with reduced risk of CVD in observational studies among RA patients, but randomised controlled trials with hard CVD endpoints are lacking. In patients without rheumatic disease, anti-inflammatory therapies targeting nucleotide-binding oligomerisation domain, leucine-rich repeat and pyrin domain-containing protein 3 inflammasome and the IL-1/IL-6 pathway arise as potential therapies after an atherosclerotic CVD event.
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Affiliation(s)
- Anne Mirjam Kerola
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital Oslo, Norway.,Department of Rheumatology, Päijät-Häme Joint Authority for Health and Wellbeing Lahti, Finland
| | - Silvia Rollefstad
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital Oslo, Norway
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital Oslo, Norway
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16
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Fomicheva OA, Popkova TV, Krougly LB, Gerasimova EV, Novikova DS, Pogorelova OA, Tripoten MI, Balakhonova TV, Karpov YA, Nasonov EL. Factors of Progression and Occurrence of Atherosclerosis in Rheumatoid Arthritis. ACTA ACUST UNITED AC 2021; 61:12-21. [PMID: 33734051 DOI: 10.18087/cardio.2021.1.n1331] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/09/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
Aim To determine in a prospective study factors of progressive atherosclerotic lesion of blood vessels in patients with rheumatoid arthritis (RA).Material and methods This prospective study included 124 patients with RA and suspected ischemic heart disease (IHD) and 30 patients with IHD (comparison group) aged 58 [52; 63] years. On enrollment to the study and at 3 years of follow-up, all patients underwent clinical and instrumental examination according to European and Russian guidelines for diagnosis and treatment of stable IHD (2013), including coronography as indicated. For all RA patients of the comparison group, risk factors (RF) were evaluated, including arterial hypertension, smoking, excessive body weight, family history of cardiovascular diseases (CVD), diabetes mellitus, and dyslipidemia. The following laboratory data were evaluated: blood count; biochemistry, including total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol (LDL-C), triglycerides (TG), rheumatoid factor (RhF), cyclic citrullinated peptide antibodies, and high-sensitivity C-reactive protein (hsCRP). Proinflammatory cytokines, including interleukin (IL)-1β, IL-6, and tumor necrosis factor-α (TNF- α), were measured in RA patients once, at 3 years of follow-up.Results Incidence of FRs for CVD was similar in RA patients and in the comparison group. Median RA duration before inclusion into the study was 11 years, and median DAS28 index score was 3.8. Incidence of dyslipidemia due to increased TC, LDL-C, and HDL-C was higher for RA patients at baseline. The LDL-C goal (<1.8 mmol/l) was achieved only in 3 (10 %) patients of the comparison group and 10 (8 %) RA patients. RA patients had higher levels of the inflammation indexes, hsCRP (0.75 mg/dl vs. 0.16 mg/dl; p<0.05) and erythrocyte sedimentation rate (ESR) (15 mm/h vs. 11.5 mm/h; p<0.05). In the RA group at baseline, atherosclerotic plaques with carotid artery (CTA) stenosis of 20% or more were found in 94 (77 %) patients; in 3 of them, CA stenosis was >50%. Patients with RA frequently had unchanged or slightly changed coronary arteries (CA) (47% of patients), and less frequently they had hemodynamically significant multi-arterial coronary atherosclerotic lesions (7 % vs. 57 % of patients in comparison group). At 37.5 months, 21 (23 %) of 94 RA patients had progressive atherosclerosis in CA and/or CTA; 12 (13 %) RA patients had only progressive CA atherosclerosis; 7 (8 %) had only progressive CTA atherosclerosis; and 2 (2 %) had simultaneous progression of CA and CTA atherosclerosis. Two groups of RA patients were formed, with the progression of atherosclerosis (n=21) and without the progression of atherosclerosis (n=69). RFs for the development/progression of atherosclerosis in RA patients included smoking, family history of CVD, and duration of the disease. Levels of lipids did not differ. Levels of proinflammatory cytokines (IL-1β, IL-6, TNF-α) were higher in RA patients with progressive atherosclerosis. No effects of the anti-rheumatic therapy on the progression of atherosclerosis were observed.Conclusion Progression of atherosclerosis in RA remains in disease with low and moderate activity during the anti-rheumatic and hypolipidemic treatment. The development of atherosclerosis in RA is determined by lipid, inflammatory, and immune disorders.
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Affiliation(s)
- O A Fomicheva
- National medical research center of cardiology of Russian Federation Ministry of Health, Moscow
| | - T V Popkova
- V.A. Nasonova Research Institute of Rheumatology, Moscow
| | - L B Krougly
- National medical research center of cardiology of Russian Federation Ministry of Health, Moscow
| | - E V Gerasimova
- V.A. Nasonova Research Institute of Rheumatology, Moscow
| | - D S Novikova
- V.A. Nasonova Research Institute of Rheumatology, Moscow
| | - O A Pogorelova
- National medical research center of cardiology of Russian Federation Ministry of Health, Moscow
| | - M I Tripoten
- National medical research center of cardiology of Russian Federation Ministry of Health, Moscow
| | - T V Balakhonova
- National medical research center of cardiology of Russian Federation Ministry of Health, Moscow
| | - Yu A Karpov
- National medical research center of cardiology of Russian Federation Ministry of Health, Moscow
| | - E L Nasonov
- V.A. Nasonova Research Institute of Rheumatology, Moscow
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Carbone F, Bonaventura A, Liberale L, Paolino S, Torre F, Dallegri F, Montecucco F, Cutolo M. Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents. Clin Rev Allergy Immunol 2020; 58:1-14. [PMID: 30259381 DOI: 10.1007/s12016-018-8714-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Substantial epidemiological data identified cardiovascular (CV) diseases as a main cause of mortality in patients with rheumatoid arthritis (RA). In light of this, RA patients may benefit from additional CV risk screening and more intensive prevention strategies. Nevertheless, current algorithms for CV risk stratification still remain tailored on general population and are burdened by a significant underestimation of CV risk in RA patients. Acute CV events in patients with RA are largely related to an accelerated atherosclerosis. As pathophysiological features of atherosclerosis overlap those occurring in the inflamed RA synovium, the understanding of those common pathways represents an urgent need and a leading challenge for CV prevention in patients with RA. Genetic background, metabolic status, gut microbiome, and systemic inflammation have been also suggested as additional key pro-atherosclerotic factors. The aim of this narrative review is to update the current knowledge about pathophysiology of atherogenesis in RA patients and potential anti-atherosclerotic effects of disease-modifying anti-rheumatic drugs.
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Affiliation(s)
- Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Center for Molecular Cardiology, University of Zürich, 12 Wagistrasse, 8952, Schlieren, Switzerland
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, San Martino Polyclinic Hospital, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132, Genoa, Italy
| | - Francesco Torre
- IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132, Genoa, Italy.,Clinic of Emergency Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Maurizio Cutolo
- IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132, Genoa, Italy. .,Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, San Martino Polyclinic Hospital, Genoa, Italy.
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Abstract
PURPOSE OF REVIEW To review the data on the role of endothelial dysfunction and the impact of hypertension as a potent mediator of cardiovascular disease in patients with rheumatoid arthritis (RA). RECENT FINDINGS RA represents the most common autoimmune rheumatic disorder and is characterized by chronic systemic inflammation predisposing to cardiovascular complications. Cardiovascular mortality is increased among patients with RA and represents the leading cause of death. Although the exact prevalence is debated, hypertension is increased in RA. Hypertension acts synergistically with chronic inflammation and accounts, at least partially, for the increased cardiovascular morbidity in this group of patients. Endothelial dysfunction is considered a primary process in the pathogenesis of hypertension and cardiovascular diseases and contributes significantly to the development and progression of the associated micro- and macrovascular complications. Even though several studies in patients with RA have shown the presence of endothelial dysfunction with traditional methods, novel biochemical and vascular methods for the evaluation of endothelial dysfunction have been scarcely applied. In addition, it remains unclear whether and to which extent endothelial dysfunction in RA is present regardless of concomitant hypertension, even in well-controlled patients. Hypertension, endothelial dysfunction, and chronic systemic inflammation appear as a mutually reinforcing triad aggravating cardiovascular risk in patients with RA. Detection of endothelial dysfunction in patients with RA in the early stages further aiming at the development of novel therapeutic targets might contribute to prevention of cardiovascular complications and remains under investigation.
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19
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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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20
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Wang P, Huang L, Xu Q, Xu L, Deng FY, Lei SF. Assessment of Aortic Stiffness in Patients with Rheumatoid Arthritis Using Pulse Wave Velocity: An Update Meta-analysis. Arch Med Res 2019; 50:401-412. [DOI: 10.1016/j.arcmed.2019.10.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/16/2019] [Accepted: 10/29/2019] [Indexed: 12/16/2022]
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21
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Kitas GD, Nightingale P, Armitage J, Sattar N, Belch JJF, Symmons DPM. A Multicenter, Randomized, Placebo-Controlled Trial of Atorvastatin for the Primary Prevention of Cardiovascular Events in Patients With Rheumatoid Arthritis. Arthritis Rheumatol 2019; 71:1437-1449. [PMID: 30983166 PMCID: PMC6771601 DOI: 10.1002/art.40892] [Citation(s) in RCA: 65] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2018] [Accepted: 03/12/2019] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is associated with increased cardiovascular event (CVE) risk. The impact of statins in RA is not established. We assessed whether atorvastatin is superior to placebo for the primary prevention of CVEs in RA patients. METHODS A randomized, double-blind, placebo-controlled trial was designed to detect a 32% CVE risk reduction based on an estimated 1.6% per annum event rate with 80% power at P < 0.05. RA patients age >50 years or with a disease duration of >10 years who did not have clinical atherosclerosis, diabetes, or myopathy received atorvastatin 40 mg daily or matching placebo. The primary end point was a composite of cardiovascular death, myocardial infarction, stroke, transient ischemic attack, or any arterial revascularization. Secondary and tertiary end points included plasma lipids and safety. RESULTS A total of 3,002 patients (mean age 61 years; 74% female) were followed up for a median of 2.51 years (interquartile range [IQR] 1.90, 3.49 years) (7,827 patient-years). The study was terminated early due to a lower than expected event rate (0.70% per annum). Of the 1,504 patients receiving atorvastatin, 24 (1.6%) experienced a primary end point, compared with 36 (2.4%) of the 1,498 receiving placebo (hazard ratio [HR] 0.66 [95% confidence interval (95% CI) 0.39, 1.11]; P = 0.115 and adjusted HR 0.60 [95% CI 0.32, 1.15]; P = 0.127). At trial end, patients receiving atorvastatin had a mean ± SD low-density lipoprotein (LDL) cholesterol level 0.77 ± 0.04 mmoles/liter lower than those receiving placebo (P < 0.0001). C-reactive protein level was also significantly lower in the atorvastatin group than the placebo group (median 2.59 mg/liter [IQR 0.94, 6.08] versus 3.60 mg/liter [IQR 1.47, 7.49]; P < 0.0001). CVE risk reduction per mmole/liter reduction in LDL cholesterol was 42% (95% CI -14%, 70%). The rates of adverse events in the atorvastatin group (n = 298 [19.8%]) and placebo group (n = 292 [19.5%]) were similar. CONCLUSION Atorvastatin 40 mg daily is safe and results in a significantly greater reduction of LDL cholesterol level than placebo in patients with RA. The 34% CVE risk reduction is consistent with the Cholesterol Treatment Trialists' Collaboration meta-analysis of statin effects in other populations.
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Affiliation(s)
- George D. Kitas
- Dudley Group NHS Foundation Trust, Russells Hall Hospital, Stourbridge, UKand Research UK Centre for EpidemiologyManchesterUK
| | | | | | - Naveed Sattar
- University of Glasgow, Glasgow, UKand Oxford Centre for Diabetes, Endocrinology and MetabolismOxfordUK
| | - Jill J. F. Belch
- University of Dundee and Ninewells Hospital and Medical SchoolDundeeUK
| | - Deborah P. M. Symmons
- Arthritis Research UK Centre for Epidemiology, University of Manchesterand NIHR Manchester Biomedical Research CenterManchester NHS Foundation TrustManchesterUK
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Sidiropoulos P, Sfikakis PP, Boumpas DD, Vassilopoulos D. Twenty Years of Targeted Treatment in Rheumatoid Arthritis in the Greek Databases: Achievements and Unmet Needs. Mediterr J Rheumatol 2019; 30:141-146. [PMID: 32185356 PMCID: PMC7045862 DOI: 10.31138/mjr.30.3.141] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 06/05/2019] [Accepted: 06/22/2019] [Indexed: 11/25/2022] Open
Abstract
Rheumatoid arthritis (RA) is a chronic autoimmune disease associated with substantial morbidity and mortality especially in difficult to treat cases. Biologic agents were introduced 20 years ago in Greece and RA management has paralleled the European experience. Several publications from the country have captured important aspects of the disease from its epidemiology to the clinical use of biologics and management of comorbidities. In this communication we review the management of RA and its evolution over the last 20 years in Greece, discussing the major achievements and the unmet needs of the disease in an effort to put this into a perspective. We conclude that introduction of biologic therapy has substantially changed the treatment of difficult to treat rheumatoid arthritis in-spite of the multiple unmet needs. While striving for even better outcomes, we cannot lose sight of the major impact of biologic therapies on the lives of patients with rheumatoid arthritis.
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Affiliation(s)
- Prodromos Sidiropoulos
- Department of Rheumatology and Clinical Immunology, School of Medicine, University of Crete, Greece
- Laboratory of Rheumatology, Inflammation and Autoimmunity, Institute of Molecular Biology and Biotechnology, Foundation for Research and Technology, Heraklion, Greece
| | - Petros P. Sfikakis
- First Department of Propaedeutic and Internal Medicine & Rheumatology Unit, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
| | - Dimitrios D. Boumpas
- 4th Department of Internal Medicine, School of Medicine, National & Kapodistrian University of Athens, Athens, Greece
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
- Laboratory of Immune Regulation and Tolerance, Autoimmunity and Inflammation, Biomedical Research Foundation of the Academy of Athens, Athens, Greece
| | - Dimitrios Vassilopoulos
- 2nd Department of Medicine and Laboratory, Hippokration General Hospital, Medical School, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
- Joint Rheumatology Program, National and Kapodistrian University of Athens, School of Medicine, Athens, Greece
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23
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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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Shi N, Zhang S, Silverman G, Li M, Cai J, Niu H. Protective effect of hydroxychloroquine on rheumatoid arthritis-associated atherosclerosis. Animal Model Exp Med 2019; 2:98-106. [PMID: 31392302 PMCID: PMC6600633 DOI: 10.1002/ame2.12065] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/04/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis (RA) have an increased risk for cardiovascular disease. We examined the effect of gut microbiota in a mouse model of RA that develops atherosclerosis. METHODS We created three groups of K/BxN female mice that were positive for the anti-glucose-6-phosphate isomerase (GPI) antibody: control diet (CD), high fat diet (HFD), and HFD with hydroxychloroquine (HFD + HCQ). Serological tests were used to detect the serum levels of total cholesterol (TCHO), low-density lipoprotein cholesterol (LDL-C), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C), anti-GPI antibody titers, and serum cytokines. Atherosclerotic plaque was determined by histological analysis, and gut microbiota were determined by 16sV4 sequencing. RESULTS Relative to mice given the CD, those receiving the HFD had increased serum levels of LDL-C, TCHO, and TG, decreased serum levels of HDL-C, increased atherosclerotic lesions in the aortic root, and altered gut microbiota. Addition of HCQ to HFD decreased the serum levels of LDL-C, TCHO, and TG, increased serum levels of HDL-C, and decreased the atherosclerotic lesions in the aortic root. Mice receiving HFD + HCQ also had the greatest bacterial diversity among the three experimental groups. Moreover, HCQ treatment significantly increased the abundance of Akkermansia and Parabacteroides, and decreased the abundance of Clostridium sensu stricto cluster 1, and therefore may be responsible for the reduced RA-associated atherosclerosis and dyslipidemia. CONCLUSION Our mouse model of RA indicated that HFD increased ankle width and aggravated atherosclerosis and dyslipidemia, and that HCQ alleviated the dyslipidemia and atherosclerosis, but had no effect on ankle width.
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Affiliation(s)
- Na Shi
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences, CAMS&PUMC), Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Shuangyue Zhang
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences, CAMS&PUMC), Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
| | - Gregg Silverman
- Department of Rheumatology, Langone Medical CenterNew York UniversityNew York CityNew York
| | - Mengtao Li
- Peking Union Medical College HospitalBeijingChina
| | - Jun Cai
- Fuwai HospitalChinese Academy of Medical SciencesBeijingChina
| | - Haitao Niu
- NHC Key Laboratory of Human Disease Comparative Medicine (The Institute of Laboratory Animal Sciences, CAMS&PUMC), Key Laboratory of Human Diseases Animal Model, State Administration of Traditional Chinese MedicineBeijing Engineering Research Center for Experimental Animal Models of Human Critical DiseasesBeijingChina
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Gender Differences in Cardiovascular Risk Profile in Rheumatoid Arthritis Patients with Low Disease Activity. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3265847. [PMID: 31032342 PMCID: PMC6458929 DOI: 10.1155/2019/3265847] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Accepted: 03/17/2019] [Indexed: 01/08/2023]
Abstract
Objective Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular (CV) disease (CVD). The objective of the study was to compare CV risk profile in female and male RA patients with low disease activity. Materials and Methods The study group consisted of 70 RA patients with continuous low disease activity and no CVD (54 women, 16 men) and 33 healthy controls of comparable age. The groups were assessed for blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography, ejection fraction (EF), and diastolic dysfunction (DD). Results Significantly higher burden of atherosclerosis, as revealed by higher cIMT, was found in males [0.93 (0.2) mm] vs females [0.80 (0.2) mm]. The risk of 10-year CVD was significantly higher in men than in women with RA. High/very high risk of fatal CVD was found in 62.5% of male patients. Males were significantly more often current/ex-smokers and had lower HDL-cholesterol and higher atherogenic index. There were no significant differences in NT-proBNP, QTc duration, and parameters of EF and DD. Conclusions In RA patients with continued low disease activity, a higher burden of atherosclerosis was found in males than in females. The data suggest a significant impact of traditional CV risk factors.
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Cardiac and vascular complications in rheumatoid arthritis. Reumatologia 2019; 57:27-36. [PMID: 30858628 PMCID: PMC6409824 DOI: 10.5114/reum.2019.83236] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 01/23/2019] [Indexed: 12/25/2022] Open
Abstract
Rheumatoid arthritis (RA) is an independent risk factor for the development of a variety of cardiovascular diseases, with a 1.5-factor increase in risk. This literature review aims to provide a global overview of the pathogenesis, effects of anti-rheumatoid treatment on cardiovascular risk, a description of the cardiovascular complications associated with RA, and current opinion on cardiovascular risk assessment and management in patients with RA. Author conducted a literature search in PubMed, Scopus, Web of Science and Embase regarding RA and associated cardiovascular complications. The mechanism of increased risk of cardiovascular disease in patients with RA is complex. There are specific genetic factors associated with both diseases, and traditional cardiovascular risk factors may be more prevalent in patients with RA. Most anti-rheumatic drugs decrease cardiovascular risk, and general recommendations focus on reduction of disease activity and strict management of cardiovascular risk as per the general population.
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Derakhshan MH, Goodson NJ, Packham JC, Sengupta R, Molto A, Marzo-Ortega H, Siebert S. Increased Risk of Hypertension Associated with Spondyloarthritis Disease Duration: Results from the ASAS-COMOSPA Study. J Rheumatol 2019; 46:701-709. [PMID: 30647169 DOI: 10.3899/jrheum.180538] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/28/2018] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Spondyloarthritis (SpA) is associated with a number of cardiovascular (CV) comorbidities. We examined the association of SpA disease duration and delay in diagnosis with CV-related conditions. METHODS Using data from the COMOSPA study, the associations between SpA disease duration and CV-related conditions were evaluated in univariable and multivariable logistic regression models. Each model examined 1 CV-related factor as dependent and "SpA disease duration" as a predictor, adjusted for relevant confounders. RESULTS Data from 3923 subjects (median SpA disease duration 5.1 yrs, interquartile range 1.3-11.8 yrs) were available for analysis. The main CV-related conditions were hypertension (HTN; 22.4%), ischemic heart disease (2.6%), stroke (1.3%), and diabetes mellitus (5.5%). HTN was associated with SpA disease duration in both univariable and multivariable analysis, with an OR of 1.129 (95% CI 1.072-1.189; p < 0.001) for each 5-year increase in SpA disease duration. Other factors associated with HTN were age, male sex, current body mass index, ever steroid therapy, and ever synthetic disease-modifying antirheumatic drug therapy, but not nonsteroidal antiinflammatory drugs (NSAID). In subgroup analysis, the strongest association of HTN and disease duration was seen in subjects with the axial-only SpA phenotype (OR 1.202, 95% CI 1.053-1.372) but not in those with peripheral-only SpA (OR 0.902, 95% CI 0.760-1.070). The other CV conditions were not associated with SpA disease duration. CONCLUSION Duration of SpA disease in the ASAS-COMOSPA cohort is associated with higher odds of HTN, particularly in those with axial disease, but not with other CV-related conditions. The association with HTN does not appear to be related to NSAID exposure.
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Affiliation(s)
- Mohammad H Derakhshan
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Nicola J Goodson
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Jonathan C Packham
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Raj Sengupta
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Anna Molto
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Helena Marzo-Ortega
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK.,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow
| | - Stefan Siebert
- From the Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow; Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool, Liverpool; Haywood Rheumatology Centre, Stoke on Trent; Keele University, Keele; Royal National Hospital for Rheumatic Diseases, Bath, UK; Paris Descartes University, Hôpital Cochin, Paris, France; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, and Leeds Institute of Rheumatic and Musculoskeletal Medicine (LIRMM), University of Leeds, Leeds, UK. .,M.H. Derakhshan, MD, FRCP, Clinical Epidemiologist, Institute of Infection, Immunity and Inflammation, University of Glasgow; N.J. Goodson, MRCP, PhD, Senior Lecturer in Rheumatology, Academic Rheumatology, Musculoskeletal Biology, Institute of Chronic Disease and Ageing, University of Liverpool; J.C. Packham, DM, FRCP, Senior Lecturer in Rheumatology, Haywood Rheumatology Centre, and Keele University; R. Sengupta, MBBS, FRCP, Consultant Rheumatologist, Royal National Hospital for Rheumatic Diseases; A. Molto, MD, PhD, Consultant Rheumatologist, Paris Descartes University, Hôpital Cochin; H. Marzo-Ortega, MRCP, PhD, Consultant Rheumatologist, NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust and LIRMM, University of Leeds; S. Siebert, PhD, FRCP, Senior Lecturer in Rheumatology, Institute of Infection, Immunity and Inflammation, University of Glasgow.
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Bissell LA, Erhayiem B, Fent G, Hensor EMA, Burska A, Donica H, Plein S, Buch MH, Greenwood JP, Andrews J. Carotid artery volumetric measures associate with clinical ten-year cardiovascular (CV) risk scores and individual traditional CV risk factors in rheumatoid arthritis; a carotid-MRI feasibility study. Arthritis Res Ther 2018; 20:266. [PMID: 30509325 PMCID: PMC6278168 DOI: 10.1186/s13075-018-1761-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 11/04/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Common carotid artery intima-media thickness (CIMT), as measured by ultrasound, has utility in stratification of the accelerated cardiovascular risk seen in rheumatoid arthritis (RA); however, the technique has limitations. Carotid magnetic resonance imaging (MRI) is emerging as a useful research tool in the general population, but has yet to be applied in RA populations. Our objectives were to describe the utility of carotid artery MRI (carotid-MRI) in patients with RA in comparison to healthy controls and to describe the association with RA disease phenotype. METHODS Sixty-four patients with RA and no history of cardiovascular (CV) disease/diabetes mellitus were assessed for RA and CV profile, including homeostasis model assessment-estimated insulin resistance (HOMA-IR) and N-terminal pro-brain natriuretic peptide (NT-proBNP). All underwent carotid-MRI (3 T), and were compared to 24 healthy controls. Univariable analysis (UVA) and multivariable linear regression models (MVA) were used to determine associations between disease phenotype and carotid-MRI measures. RESULTS There were no significant differences in carotid arterial wall measurements between patients with RA and controls. Wall and luminal volume correlated with 10-year CV risk scores (adjusted as per 2017 European League Against Rheumatism (EULAR) guidance); rho = 0.33 (p = 0.012) and rho = 0.35 (p = 0.008), respectively, for Joint British Societies-2 risk score. In UVA, carotid-MRI volumetric measures predominantly were associated with traditional CV risk factors including age, ever-smoking and HOMA-IR (p < 0.05). Lower body mass index was associated with wall maximum thickness (r = - 0.25 p = 0.026). In MVA, age was independently associated with wall volume (B 1.13 (95% CI 0.32, 1.93), p = 0.007) and luminal volume (B 3.69 (95% CI 0.55, 6.83, p = 0.022), and RA disease duration was associated with luminal volume (B 3.88 (95% CI 0.80, 6.97), p = 0.015). CONCLUSIONS This study demonstrates the utility of carotid-MRI in RA, reporting an association between three-dimensional measures in particular and CV risk scores, individual traditional CV risk factors and RA disease duration. Carotid-MRI in RA is a promising research tool in the investigation of CVD.
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Affiliation(s)
- Lesley-Anne Bissell
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Bara Erhayiem
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Graham Fent
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Elizabeth M A Hensor
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - Agata Burska
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | | | - Sven Plein
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Maya H Buch
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK.,NIHR Leeds Biomedical Research Centre, Leeds, UK
| | - John P Greenwood
- Multidisciplinary Cardiovascular Research Centre & The Division of Biomedical Imaging, Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Jacqueline Andrews
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK. .,NIHR Leeds Biomedical Research Centre, Leeds, UK.
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Systemic Inflammatory Response and Atherosclerosis: The Paradigm of Chronic Inflammatory Rheumatic Diseases. Int J Mol Sci 2018; 19:ijms19071890. [PMID: 29954107 PMCID: PMC6073407 DOI: 10.3390/ijms19071890] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 06/17/2018] [Accepted: 06/20/2018] [Indexed: 12/17/2022] Open
Abstract
Patients with Chronic Inflammatory Rheumatic diseases (CIRD) are at increased risk of cardiovascular disease (CVD), ascribed not only to classical risk factors, but also to the presence of chronic systemic inflammatory response. Αtherosclerosis, the cornerstone of CVD, is known to be accelerated in CIRD; rheumatoid arthritis promotes atheromatosis and associates with preclinical atherosclerosis equivalent to Diabetes Mellitus, which also seems to apply for systemic lupus erythematosus. Data on ankylosing spondylitis and psoriatic arthritis, albeit more limited, also support an increased CV risk in these patients. The association between inflammation and atherosclerosis, has been thoroughly investigated in the last three decades and the role of inflammation in the pathogenesis and progression of atherogenesis has been well established. Endothelial dysfunction, oxidative stress in vascular endothelial cells and macrophage accumulation, toll-like receptor signaling, NLPR-3 formation and subsequent pro-inflammatory cytokine production, such as TNFa, IL-1β, IL-6, and TNF-like cytokine 1A, are few of the mechanisms implicated in the atherogenic process. Moreover, there is evidence that anti-inflammatory biologic drugs, such as anti-TNF and anti-IL1β agents, can decelerate the atherogenic process, thus setting new therapeutic targets for early and effective disease control and suppression of inflammation, in addition to aggressive management of classical CV risk factors.
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Biskup M, Biskup W, Majdan M, Targońska-Stępniak B. Cardiovascular system changes in rheumatoid arthritis patients with continued low disease activity. Rheumatol Int 2018; 38:1207-1215. [PMID: 29774373 PMCID: PMC6006198 DOI: 10.1007/s00296-018-4053-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Accepted: 05/14/2018] [Indexed: 01/08/2023]
Abstract
Systemic inflammation and disease activity seem to contribute to excessive prevalence of cardiovascular (CV) diseases (CVDs) in patients with rheumatoid arthritis (RA). The objective of the study was to assess chosen CV parameters in RA patients who have continuous low disease activity. The study group consisted of 70 RA patients without known CVD and 33 healthy controls, of a comparable age. All RA patients had continued low disease activity (DAS28 ≤ 3.2) from 2 to 7 years. The groups were assessed for: blood pressure, serum amino-terminal pro-brain natriuretic peptide (NT-proBNP), carotid intima media thickness (cIMT), electrocardiography (ECG), ejection fraction (EJ) and diastolic dysfunction (E/A ratio) in echocardiography. In RA patients in comparison with controls, significantly greater values of cIMT [0.83 (0.21) vs 0.62 (0.1) mm, p < 0.001] were found, as well as higher incidence of atherosclerotic plaques [43 (61.4%) vs 10 (30.3%), p = 0.003], prolonged QTc interval [439.6 (23.7) vs 414.0 (27.9) ms, p < 0.001]. High or very high Systemic Coronary Risk Evaluation (SCORE) was found in 32.9% of patients with RA and increased serum NT-proBNP in 71.4%. The mean values of CV parameters (cIMT, E/A, NT-proBNP, SCORE) were associated with age, disease duration, rheumatoid factor (RF-IgM), erythrocyte sedimentation rate (ESR). The results of our study indicate, that RA with continued low disease activity is associated with atherosclerosis and heart dysfunction. Strong relationships were found between CV parameters and patients' age, disease duration. Deterioration of CV parameters was associated with higher DAS28, ESR, RF-IgM concentration and bone erosions.
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Affiliation(s)
| | | | - Maria Majdan
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland
| | - Bożena Targońska-Stępniak
- Department of Rheumatology and Connective Tissue Diseases, Medical University of Lublin, Ul. Jaczewskiego 8, 20-950, Lublin, Poland.
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Bradham W, Ormseth MJ, Elumogo C, Palanisamy S, Liu CY, Lawson MA, Soslow JH, Kawel-Boehm N, Bluemke DA, Stein CM. Absence of Fibrosis and Inflammation by Cardiac Magnetic Resonance Imaging in Rheumatoid Arthritis Patients with Low to Moderate Disease Activity. J Rheumatol 2018; 45:1078-1084. [PMID: 29657146 DOI: 10.3899/jrheum.170770] [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] [Accepted: 01/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The prevalence of heart failure is increased 2-fold in patients with rheumatoid arthritis (RA); this is not explained by ischemic heart disease or other risk factors for heart failure. We hypothesized that in patients with RA without known heart disease, cardiac magnetic resonance imaging (cMRI) would detect altered cardiac structure, function, and fibrosis. METHODS We performed 1.5-T cMRI in 59 patients with RA and 56 controls frequency-matched for age, race, and sex, and compared cMRI indices of structure, function, and fibrosis [late gadolinium enhancement (LGE), native T1 mapping, and extracellular volume (ECV)] using Mann-Whitney U tests and linear regression, adjusting for age, race, and sex. RESULTS Most patients with RA had low to moderate disease activity [28-joint count Disease Activity Score-C-reactive protein median 3.16, interquartile range (IQR) 2.03-4.05], and 49% were receiving anti-tumor necrosis factor agents. Left ventricular (LV) mass, LV end-diastolic and -systolic volumes indexed to body surface area, and LV ejection fraction and left atrial size were not altered in RA compared to controls (all p > 0.05). Measures of fibrosis were not increased in RA: LGE was present in 2 patients with RA and 1 control subject; native T1 mapping was similar comparing RA and control subjects, and ECV (median, IQR) was lower (26.6%, 24.7-28.5%) in patients with RA compared to control subjects (27.5%, 25.4-30.4%, p = 0.03). CONCLUSION cMRI measures of cardiac structure and function were not significantly altered, and measures of fibrosis were similar or lower in RA patients with low to moderate disease activity compared to a matched control group.
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Affiliation(s)
- William Bradham
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work
| | - Michelle J Ormseth
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA. .,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work.
| | - Comfort Elumogo
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work
| | - Srikanth Palanisamy
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work
| | - Chia-Ying Liu
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work
| | - Mark A Lawson
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work
| | - Jonathan H Soslow
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work
| | - Nadine Kawel-Boehm
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work
| | - David A Bluemke
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work
| | - C Michael Stein
- From the Vanderbilt University Medical Center; Veterans Health Administration Tennessee Valley Healthcare System, Nashville, Tennessee; Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland, USA.,W. Bradham, MD, PhD, Vanderbilt University Medical Center; M.J. Ormseth, MD, MSCI, Vanderbilt University Medical Center, and Veterans Health Administration Tennessee Valley Healthcare System; C. Elumogo, BS, Radiology and Imaging Sciences, NIH; S. Palanisamy, BS, Radiology and Imaging Sciences, NIH; C.Y. Liu, PhD, Radiology and Imaging Sciences, NIH; M.A. Lawson, MD, Vanderbilt University Medical Center; J.H. Soslow, MD, MSCI, Vanderbilt University Medical Center; N. Kawel-Boehm, MD, Radiology and Imaging Sciences, NIH; D.A. Bluemke, MD, PhD, Radiology and Imaging Sciences, NIH; C.M. Stein, MBChB, Vanderbilt University Medical Center. W. Bradham and M.J. Ormseth contributed equally to this work
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