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Xu SZ, Wang P, Guan SY, Li HM, Leng RX, Pan HF, Ye DQ. Decreased flow-mediated dilatation in patients with rheumatoid arthritis: a meta-analysis. Postgrad Med J 2016; 93:260-265. [PMID: 27807003 DOI: 10.1136/postgradmedj-2016-134068] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 08/11/2016] [Accepted: 08/27/2016] [Indexed: 01/21/2023]
Abstract
OBJECTIVES To derive a more precise comparison of flow-mediated dilatation (FMD%) of the brachial artery between patients with rheumatoid arthritis (RA) and normal controls by performing a meta-analysis of appropriate studies. METHODS PubMed and EMBASE databases were searched for all relevant articles. STATA (V.12.0) software was used to perform the meta-analysis. Quality estimation of all appropriate studies was evaluated according to the Newcastle-Ottawa Scale (NOS). Standardised mean difference (SMD) with 95% CIs were calculated with a random-effects model. The Cochrane Q test and I2 statistic were used to evaluate the heterogeneity. Funnel plot and Egger's test were conducted to assess the publication bias. RESULTS In total, 464 articles were obtained after searching the two databases. Ten studies were included in the meta-analysis on the basis of the inclusion and exclusion criteria. Significant heterogeneity was observed among these 10 studies (Q=102.89, p<0.001, I2=91.3%) with random-effects modelling. The results showed that the RA group had significantly lower FMD% (SMD: -1.405; 95% CI -1.992 to -0.817; p<0.001) than the control group. Egger's test (p=0.004) indicated that the funnel plot showed a skewed or asymmetrical shape and publication bias existed. Sensitivity analyses suggested the robustness and credibility of our results. CONCLUSIONS FMD% in patients with RA is significantly decreased compared with healthy controls. FMD% is an important early marker of atherosclerosis. It may be used as a parameter to forecast cardiovascular disease in patients with RA.
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Affiliation(s)
- Shu-Zhen Xu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui, China
| | - Peng Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui, China
| | - Shi-Yang Guan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui, China
| | - Hong-Miao Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui, China
| | - Rui-Xue Leng
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui, China
| | - Hai-Feng Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui, China
| | - Dong-Qing Ye
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China.,Anhui Provincial Laboratory of Population Health & Major Disease Screening and Diagnosis, Anhui, China
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Berg IJ, van der Heijde D, Dagfinrud H, Seljeflot I, Olsen IC, Kvien TK, Semb AG, Provan SA. Disease activity in ankylosing spondylitis and associations to markers of vascular pathology and traditional cardiovascular disease risk factors: a cross-sectional study. J Rheumatol 2015; 42:645-53. [PMID: 25641897 DOI: 10.3899/jrheum.141018] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2014] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To compare the risk of cardiovascular disease (CVD) in ankylosing spondylitis (AS) and population controls, and to examine the associations between disease activity and CVD risk. METHODS A cross-sectional study was done of patients with AS grouped according to Ankylosing Spondylitis Disease Activity Score (ASDAS) into ASDAS-high and ASDAS-low. Markers of vascular pathology, impaired endothelial function [asymmetric dimethylarginine (ADMA)], and arterial stiffness [augmentation index (AIx) and pulse wave velocity (PWV)], and traditional CVD risk factors [blood pressure, lipids, body mass index (BMI), CVD risk scores] were compared between AS and controls as well as across ASDAS-high versus ASDAS-low versus controls using ANCOVA analyses. RESULTS Altogether, 151 patients with AS and 134 controls participated. Patients had elevated ADMA (µmol/l) and AIx (%) compared to controls: mean difference (95% CI): 0.05 (0.03, 0.07), p < 0.001 and 2.6 (0.8, 4.3), p = 0.01, respectively. AIx increased with higher ASDAS level, p(trend) < 0.04. There were no significant group differences of PWV. BMI was higher in ASDAS-high compared to ASDAS-low (p = 0.02). Total cholesterol was lower in AS compared to controls, and lower with higher ASDAS, p(trend) = 0.02. CVD risk scores were similar across groups except for Reynolds Risk Score, where the ASDAS-high group had a significantly higher score, compared to both ASDAS-low and controls. CONCLUSION Elevated ADMA and AIx in AS support a higher CVD risk in AS. Elevated AIx and BMI in AS with high ASDAS indicate an association between disease activity and CVD risk. Lower total cholesterol in AS may contribute to underestimation of CVD risk.
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Affiliation(s)
- Inger Jorid Berg
- From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo.
| | - Désirée van der Heijde
- From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo
| | - Hanne Dagfinrud
- From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo
| | - Ingebjørg Seljeflot
- From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo
| | - Inge Christoffer Olsen
- From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo
| | - Tore K Kvien
- From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo
| | - Anne Grete Semb
- From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo
| | - Sella A Provan
- From the Department of Rheumatology, Diakonhjemmet Hospital, and Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and University of Oslo, Oslo, Norway; Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.I.J. Berg, MD; H. Dagfinrud, PhD; I.C. Olsen, PhD; T.K. Kvien, MD, PhD; A.G. Semb, MD, PhD; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; D. van der Heijde, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital and Department of Rheumatology, Leiden University Medical Center; I. Seljeflot, PhD, Department of Cardiology, Center for Clinical Heart Research, Oslo University Hospital Ullevål, and Faculty of Medicine, University of Oslo
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