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Cecere A, Perazzolo Marra M, Zanatta E, Civieri G, Iliceto S, Tona F. Coronary microvascular dysfunction in autoimmune rheumatic diseases: beyond coronary flow velocity reserve. Front Cardiovasc Med 2024; 11:1372703. [PMID: 39234606 PMCID: PMC11371758 DOI: 10.3389/fcvm.2024.1372703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 07/31/2024] [Indexed: 09/06/2024] Open
Abstract
Autoimmune rheumatic diseases (ARDs) are a heterogeneous group of disorders characterized by an inappropriate immune reactivity against different body tissues. Patients affected by ARDs present increased cardiovascular morbidity and mortality, which significantly impacts long-term prognosis. Endothelial dysfunction, inflammation, oxidative stress, and autoimmunity are strictly involved in atherosclerosis progression and coronary microvascular dysfunction (CMD), both of which contribute to increased cardiovascular risk. CMD represents the inability of the coronary microvasculature to respond with vasodilation to increased cardiac metabolic demands and can be assessed by non-invasive and invasive imaging tests. Coronary flow velocity reserve assessed by echocardiography has been demonstrated to accurately identify ARDs patients with CMD. However, stress cardiac magnetic resonance (CMR) accurately assesses myocardial ischemia, perfusion, and viability in ARDs patients. The myocardial perfusion reserve index (MPRI) is a robust semiquantitative imaging marker that represents the vasodilatory capacity of the coronary microcirculation in response to a vasodilator stress. In the absence of significant coronary stenosis, ARDs patients revealed a reduced MPRI in comparison with the general population, regardless of the presence of myocardial fibrosis. Identification of CMD in asymptomatic patients could be crucial to precociously start targeted medical therapy, avoiding major adverse cardiac events in this clinical setting. This review aims to summarize the current evidence regarding CMD in ARDs patients, focusing on the role of stress CMR and the promising myocardial perfusion analysis.
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Affiliation(s)
- Annagrazia Cecere
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Martina Perazzolo Marra
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Elisabetta Zanatta
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Padova, Italy
- Department of Medicine, University of Padova, Padova, Italy
| | - Giovanni Civieri
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Sabino Iliceto
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Francesco Tona
- Department of Cardiac, Thoracic, and Vascular Sciences and Public Health, University of Padova, Padova, Italy
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Zou YW, Wu T, Li QH, Ma JD, Pan J, Lu Y, Lin JZ, Jia PW, Zheng HW, Gao JW, Dai W, Mo YQ, Dai J, Dai L. Association of serum concentrations of remnant cholesterol with incident cardiovascular disease in patients with rheumatoid arthritis: A real-world data from 2001 to 2022. Int J Cardiol 2024; 405:131947. [PMID: 38458390 DOI: 10.1016/j.ijcard.2024.131947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 01/05/2024] [Accepted: 03/05/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Remnant cholesterol (RC) promotes cardiovascular disease (CVD) in the general population, but its role among rheumatoid arthritis (RA) patients remains unknown. We aimed to investigate circulating RC levels associated with incident CVD among Chinese patients with RA. METHODS A total of 1018 RA patients free of baseline CVD were included and followed up in a prospective RA CVD cohort from 2001 to 2022. Fasting serum levels of triglycerides, total cholesterol (TC), low-density (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured, while RC and Non-HDL-C levels were calculated. The primary exposure was RC levels. A LASSO Cox model was used to select covariates. The Fine-Gray competing risk model was used to estimate hazard ratios (HRs). RESULTS RA patients had a mean age of 53.9 years, and 802 (78.8%) were females. After a median follow-up of 5.54 years, 131 patients developed CVD with an incidence rate of 21.6 per 1000 person-years. Continuous and quartile-categorized RC levels were associated with incident CVD before and after multivariate adjustment and Bonferroni correction (all P < 0.001). There were no robust associations of other lipids with incident CVD. The fully adjusted HRs for RC were 2.30 (95% CI 1.58-3.35) per 1 mmol/L increase, and 2.40 (1.36-4.25) and 2.81 (1.60-4.94) for patients in the 3rd and 4th versus the 1st quartile, respectively. CONCLUSIONS Circulating RC levels are positively associated with incident CVD among Chinese RA patients independent of known risk factors, implying its clinically preferable use for improving the stratification of CVD risk in RA patients.
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Affiliation(s)
- Yao-Wei Zou
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Tao Wu
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Qian-Hua Li
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Jian-Da Ma
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Jie Pan
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Ye Lu
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Jian-Zi Lin
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Pei-Wen Jia
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Hu-Wei Zheng
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Jing-Wei Gao
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Wei Dai
- Department of Biostatistics, School of Public Health, Yale University, New Haven, CT, USA
| | - Ying-Qian Mo
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China
| | - Jun Dai
- Department of Public Health, College of Health Sciences, Des Moines University, 8025 Grand Ave., West Des Moines, IA 50266, USA.
| | - Lie Dai
- Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, 107 Yan Jiang West Road, Guangzhou, Guangdong, China.
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Wang Z, Hu K, Wu M, Feng L, Liu C, Ding F, Li X, Ma B. Factors associated with secondary coronary artery disease in rheumatoid arthritis patients: A systematic review and meta-analysis based on observational studies. Musculoskeletal Care 2023. [PMID: 38047752 DOI: 10.1002/msc.1850] [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: 10/11/2023] [Revised: 11/16/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023]
Abstract
OBJECTIVE The main objective of this systematic review was to investigate the factors influencing the development of coronary artery disease (CAD) in patients with rheumatoid arthritis (RA). METHODS PubMed, Embase, Web of Science, Wan Fang Date, CBM, CNKI, and VIP databases were systematically searched to select the relevant literature. The quality of the incorporated studies was assessed with reference to the Newcastle-Ottawa Scale. Stata16 was adopted to summarise the odds ratios, risk ratios, hazard ratios, and 95% confidence intervals for meta-analysis. RESULTS A total of 29 studies were included in this analysis, wherein the average age of RA patients was 50.5-81 years and the proportion of women was 44.4%-92%. The present meta-analysis suggested that increased CAD risk in RA patients was associated with age, male gender, smoking, glucocorticoids, Health Assessment Questionnaire scores, hyperlipidaemia, hypertension, diabetes, and C-reactive protein concentration. CONCLUSION The present systematic review revealed the influencing factors of secondary CAD in RA patients, some of which could reduce the risk of secondary CAD through effective interventions, such as smoking cessation, exercise, and medications. However, the effects of age, RA severity, and different medication subgroups on CAD risk stratification warrant further investigation.
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Affiliation(s)
- Zhe Wang
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Kaiyan Hu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Mei Wu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Liyuan Feng
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Chen Liu
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Fengxing Ding
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
| | - Xiaohui Li
- The Second Clinical Medical College, Lanzhou University, Lanzhou, Gansu, China
| | - Bin Ma
- Evidence-Based Medicine Centre, School of Basic Medical Sciences, Lanzhou University, Lanzhou, Gansu, China
- Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, Gansu, China
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4
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Aronov A, Kim YJ, Sweiss NJ, Nazir NT. Cardiovascular disease risk evaluation impact in patients with rheumatoid arthritis. Am J Prev Cardiol 2022; 12:100380. [PMID: 36157554 PMCID: PMC9489492 DOI: 10.1016/j.ajpc.2022.100380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Although rheumatoid arthritis (RA) results in a 50% increased risk of cardiovascular disease mortality, comparable to the risk associated with diabetes mellitus, a significant care gap remains in cardiovascular risk management for this high-risk population. A retrospective cohort study was conducted at a minority-serving institution to assess demographic, clinical, and laboratory data associated with referral to cardiology by rheumatology. The results showed that a minority (5%) of patients were referred to cardiology during an outpatient rheumatology encounter. Patients referred were more likely to be on antihypertensive medication and aspirin. Differences in traditional cardiovascular risk factors such as systolic blood pressure, LDL cholesterol, smoking history, and diabetes mellitus were not significantly associated with being referred. Patients with RA who were evaluated by cardiology were more likely to be started on cardiovascular risk-reducing medications such as antihypertensive, lipid-lowering, and aspirin therapy. This study highlights a care gap in the evaluation and referral of patients with RA and recognizes the improved preventive cardiovascular care received by patients evaluated by a cardiologist.
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Affiliation(s)
- Avi Aronov
- Department of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Yoo Jin Kim
- College of Medicine, University of Illinois at Chicago, Chicago, IL, United States
| | - Nadera J Sweiss
- Division of Rheumatology, University of Illinois at Chicago, Chicago, IL, United States
| | - Noreen T. Nazir
- Division of Cardiology, University of Illinois at Chicago, Chicago, IL, United States
- Corresponding author at: University of Illinois at Chicago/UI Health, 840 S Wood Street Suite 920S, Chicago, IL 60612, United States.
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Mandel A, Schwarting A, Cavagna L, Triantafyllias K. Novel Surrogate Markers of Cardiovascular Risk in the Setting of Autoimmune Rheumatic Diseases: Current Data and Implications for the Future. Front Med (Lausanne) 2022; 9:820263. [PMID: 35847825 PMCID: PMC9279857 DOI: 10.3389/fmed.2022.820263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 05/30/2022] [Indexed: 11/25/2022] Open
Abstract
Patients suffering from rheumatologic diseases are known to have an increased risk for cardiovascular disease (CVD). Although the pathological mechanisms behind this excess risk have been increasingly better understood, there still seems to be a general lack of consensus in early detection and treatment of endothelial dysfunction and CVD risk in patients suffering from rheumatologic diseases and in particular in those who haven't yet shown symptoms of CVD. Traditional CVD prediction scores, such as Systematic Coronary Risk Evaluation (SCORE), Framingham, or PROCAM Score have been proposed as valid assessment tools of CVD risk in the general population. However, these risk calculators developed for the general population do not factor in the effect of the inflammatory burden, as well as other factors that can increase CVD risk in patients with rheumatic diseases, such as glucocorticoid therapy, abnormal lipoprotein function, endothelial dysfunction or accelerated atherosclerosis. Thus, their sole use could lead to underestimation of CVD risk in patients with rheumatic diseases. Therefore, there is a need for new biomarkers which will allow a valid and early assessment of CVD risk. In recent years, different research groups, including ours, have examined the value of different CVD risk factors such as carotid sonography, carotid-femoral pulse wave velocity, flow-mediated arterial dilation and others in the assessment of CVD risk. Moreover, various novel CVD laboratory markers have been examined in the setting of autoimmune diseases, such as Paraoxonase activity, Endocan and Osteoprotegerin. Dyslipidemia in rheumatoid arthritis (RA) is for instance better quantified by lipoproteins and apolipoproteins than by cholesterol levels; screening as well as pre-emptive carotid sonography hold promise to identify patients earlier, when prophylaxis is more likely to be effective. The early detection of subtle changes indicating CVD in asymptomatic patients has been facilitated through improved imaging methods; the inclusion of artificial intelligence (AI) shows promising results in more recent studies. Even though the pathophysiology of coronary artery disease in patients with autoimmune rheumatic diseases has been examined in multiple studies, as we continuously gain an increased understanding of this comorbidity, particularly in subclinical cases we still seem to fail in the stratification of who really is at risk—and who is not. A the time being, a multipronged and personalized approach of screening patients for traditional CVD risk factors, integrating modern imaging and further CV diagnostic tools and optimizing treatment seems to be a solid approach. There is promising research on novel biomarkers, likewise, methods using artificial intelligence in imaging provide encouraging data indicating possibilities of risk stratification that might become gold standard in the near future. The present review concentrates on showcasing the newest findings concerning CVD risk in patients with rheumatologic diseases and aims to evaluate screening methods in order to optimize CVD risk evaluation and thus avoiding underdiagnosis and undertreatment, as well as highlighting which patient groups are most at risk.
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Affiliation(s)
- Anna Mandel
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center, Mainz, Germany
| | - Andreas Schwarting
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center, Mainz, Germany
- Department of Rheumatology, Rheumatology Center RL-P, Bad Kreuznach, Germany
| | - Lorenzo Cavagna
- Division of Rheumatology, University and IRCCS Policlinico S. Matteo Foundation, Pavia, Italy
| | - Konstantinos Triantafyllias
- Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, Johannes Gutenberg University Medical Center, Mainz, Germany
- Department of Rheumatology, Rheumatology Center RL-P, Bad Kreuznach, Germany
- *Correspondence: Konstantinos Triantafyllias
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6
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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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7
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Ahmed S, Jacob B, Carsons SE, De Leon J, Reiss AB. Treatment of Cardiovascular Disease in Rheumatoid Arthritis: A Complex Challenge with Increased Atherosclerotic Risk. Pharmaceuticals (Basel) 2021; 15:ph15010011. [PMID: 35056068 PMCID: PMC8778152 DOI: 10.3390/ph15010011] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 12/13/2021] [Accepted: 12/17/2021] [Indexed: 12/24/2022] Open
Abstract
Rheumatoid arthritis (RA) carries significant risk for atherosclerotic cardiovascular disease (ASCVD). Traditional ASCVD risk factors fail to account for this accelerated atherosclerosis. Shared inflammatory pathways are fundamental in the pathogenesis of both diseases. Considering the impact of RA in increasing cardiovascular morbidity and mortality, the characterization of therapies encompassing both RA and ASCVD management merit high priority. Despite little progress, several drugs discussed here promote remission and or lower rheumatoid disease activity while simultaneously conferring some level of atheroprotection. Methotrexate, a widely used disease-modifying drug used in RA, is associated with significant reduction in cardiovascular adverse events. MTX promotes cholesterol efflux from macrophages, upregulates free radical scavenging and improves endothelial function. Likewise, the sulfonamide drug sulfasalazine positively impacts the lipid profile by increasing HDL-C, and its use in RA has been correlated with reduced risk of myocardial infraction. In the biologic class, inhibitors of TNF-α and IL-6 contribute to improvements in endothelial function and promote anti-atherogenic properties of HDL-C, respectively. The immunosuppressant hydroxychloroquine positively affects insulin sensitization and the lipid profile. While no individual therapy has elicited optimal atheroprotection, further investigation of combination therapies are ongoing.
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Desmarais J, Rosenbaum JT, Costenbader KH, Ginzler EM, Fett N, Goodman S, O'Dell J, Pineau CA, Schmajuk G, Werth VP, Link MS, Kovacs R. American College of Rheumatology White Paper on Antimalarial Cardiac Toxicity. Arthritis Rheumatol 2021; 73:2151-2160. [PMID: 34697918 DOI: 10.1002/art.41934] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 07/22/2021] [Indexed: 12/14/2022]
Abstract
Hydroxychloroquine (HCQ) and chloroquine (CQ) are well-established medications used in treating systemic lupus erythematosus and rheumatoid arthritis, as well as skin conditions such as cutaneous lupus erythematosus. In rare cases, arrhythmias and conduction system abnormalities, as well as cardiomyopathy, have been reported in association with HCQ/CQ use. Recently, however, the corrected QT interval (QTc)-prolonging potential of these medications, and risk of torsade de pointes (TdP) in particular, have been highlighted in the setting of their experimental use for COVID-19 infection. This report was undertaken to summarize the current understanding of HCQ/CQ cardiac toxicity, describe QTc prolongation and TdP risks, and discuss areas of priority for future research. A working group of experts across rheumatology, cardiology, and dermatology performed a nonsystematic literature review and offered a consensus-based expert opinion. Current data clearly indicate that HCQ and CQ are invaluable medications in the management of rheumatic and dermatologic diseases, but they are associated with QTc prolongation by directly affecting cardiac repolarization. Prescribing clinicians should be cognizant of this small effect, especially in patients taking additional medications that prolong the QTc interval. Long-term use of HCQ/CQ may lead to a cardiomyopathy associated with arrhythmias and heart failure. Risk and benefit assessment should be considered prior to initiation of any medication, and both initial and ongoing risk-benefit assessments are important with regard to prescription of HCQ/CQ. While cardiac toxicity related to HCQ/CQ treatment of rheumatic diseases is rarely reported, it can be fatal. Awareness of the potential adverse cardiac effects of HCQ and CQ can increase the safe use of these medications. There is a clear need for additional research to allow better understanding of the cardiovascular risk and safety profile of these therapies used in the management of rheumatic and cutaneous diseases.
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Affiliation(s)
| | - James T Rosenbaum
- Oregon Health & Science University and Legacy Devers Eye Institute, Portland, Oregon
| | | | - Ellen M Ginzler
- State University of New York Downstate Health Sciences University, Brooklyn
| | - Nicole Fett
- Oregon Health & Science University, Portland
| | - Susan Goodman
- Hospital for Special Surgery, Weill Cornell Medicine, New York, New York
| | - James O'Dell
- University of Nebraska Medical Center and Omaha VA Hospital, Omaha, Nebraska
| | | | - Gabriela Schmajuk
- University of California San Francisco, San Francisco VA Medical Center, and Philip R. Lee Institute for Health Policy, San Francisco, California
| | - Victoria P Werth
- University of Pennsylvania and Corporal Michael J. Crescenz VAMC, Philadelphia, Pennsylvania
| | - Mark S Link
- University of Texas Southwestern Medical Center, Dallas
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9
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Konst RE, Guzik TJ, Kaski JC, Maas AHEM, Elias-Smale SE. The pathogenic role of coronary microvascular dysfunction in the setting of other cardiac or systemic conditions. Cardiovasc Res 2020; 116:817-828. [PMID: 31977015 PMCID: PMC7526753 DOI: 10.1093/cvr/cvaa009] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 12/09/2019] [Accepted: 01/21/2020] [Indexed: 12/13/2022] Open
Abstract
Coronary microvascular dysfunction (CMD) plays a pathogenic role in cardiac and systemic conditions other than microvascular angina. In this review, we provide an overview of the pathogenic role of CMD in the setting of diabetes mellitus, obesity, hypertensive pregnancy disorders, chronic inflammatory and autoimmune rheumatic disorders, chronic kidney disease, hypertrophic cardiomyopathy, and aortic valve stenosis. In these various conditions, CMD results from different structural, functional, and/or dynamic alterations in the coronary microcirculation associated with the primary disease process. CMD is often detectable very early in the course of the primary disease, before clinical symptoms or signs of myocardial ischaemia are present, and it portrays an increased risk for cardiovascular events.
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Affiliation(s)
- Regina E Konst
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, British Heart Foundation Glasgow Cardiovascular Research Centre, Glasgow, UK
| | - Juan-Carlos Kaski
- The Queen Elizabeth Hospital Discipline of Medicine, University of Adelaide, Central Adelaide Local Health Network, Coronary Vasomotion Disorders International Study Group (COVADIS), Adelaide, Australia.,Molecular and Clinical Sciences Research Institute, St George's, University of London, London, UK
| | - Angela H E M Maas
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Suzette E Elias-Smale
- Department of Cardiology, Radboud University Medical Center, Nijmegen, the Netherlands
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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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11
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Bordy R, Totoson P, Prati C, Marie C, Wendling D, Demougeot C. Microvascular endothelial dysfunction in rheumatoid arthritis. Nat Rev Rheumatol 2019; 14:404-420. [PMID: 29855620 DOI: 10.1038/s41584-018-0022-8] [Citation(s) in RCA: 108] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The systemic autoimmune disease rheumatoid arthritis (RA) is characterized by increased cardiovascular mortality and morbidity and is an independent cardiovascular risk factor. Cardiovascular diseases (CVDs) result from accelerated atherogenesis, which is a consequence of endothelial dysfunction in the early stages of the disease. Endothelial dysfunction is a functional and reversible alteration of endothelial cells and leads to a shift in the properties of the endothelium towards reduced vasodilation, a pro-inflammatory state, and proliferative and prothrombotic properties. In RA, endothelial dysfunction can occur in the large vessels (such as the conduit arteries) and in the small vessels of the microvasculature, which supply oxygen and nutrients to the tissue and control inflammation, repair and fluid exchange with the surrounding tissues. Growing evidence suggests that microvascular endothelial dysfunction contributes to CVD development, as it precedes and predicts the development of conduit artery atherosclerosis and associated risk factors. As such, numerous studies have investigated microvascular endothelial dysfunction in RA, including its link with disease activity, disease duration and inflammation, the effect of treatments on endothelial function, and possible circulating biomarkers of microvascular endothelial dysfunction. Such findings could have important implications in the cardiovascular risk management of patients with RA.
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Affiliation(s)
- Romain Bordy
- PEPITE EA4267, FHU INCREASE, Universitaire Bourgogne Franche-Comté, UFR Santé, F-25000, Besançon, France
| | - Perle Totoson
- PEPITE EA4267, FHU INCREASE, Universitaire Bourgogne Franche-Comté, UFR Santé, F-25000, Besançon, France
| | - Clément Prati
- PEPITE EA4267, FHU INCREASE, Universitaire Bourgogne Franche-Comté, UFR Santé, F-25000, Besançon, France.,Service de Rhumatologie, Centre Hospitalier Régional et Universitaire de Besançon, F-25000, Besançon, France
| | - Christine Marie
- INSERM UMR1093 CAPS, Universitaire Bourgogne Franche-Comté, UFR des Sciences de Santé, F-21000, Dijon, France
| | - Daniel Wendling
- Service de Rhumatologie, Centre Hospitalier Régional et Universitaire de Besançon, F-25000, Besançon, France.,EA 4266, Universitaire Bourgogne Franche-Comté, UFR Santé, F-25000, Besançon, France
| | - Céline Demougeot
- PEPITE EA4267, FHU INCREASE, Universitaire Bourgogne Franche-Comté, UFR Santé, F-25000, Besançon, France.
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Chouk M, Bordy R, Moretto J, Wendling D, Totoson P, Demougeot C. Pristane-induced arthritis in dark Agouti rat is a relevant model for mimicking vascular dysfunction and lipid paradox in rheumatoid arthritis. Joint Bone Spine 2019; 86:483-490. [DOI: 10.1016/j.jbspin.2018.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Revised: 11/19/2018] [Accepted: 12/05/2018] [Indexed: 12/25/2022]
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13
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Pinto MRC, Kakehasi AM, Souza AJ, Tavares WC, Rocha MA, Trant CGMC, Andrade MV. Methotrexate use, not interleukin 33, is associated with lower carotid intima-media thickness in patients with rheumatoid arthritis. Adv Rheumatol 2019; 59:15. [DOI: 10.1186/s42358-019-0060-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 03/26/2019] [Indexed: 01/08/2023] Open
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14
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Karanam VC, Tamariz L, Batawi H, Wang J, Galor A. Functional slit lamp biomicroscopy metrics correlate with cardiovascular risk. Ocul Surf 2018; 17:64-69. [PMID: 30253248 DOI: 10.1016/j.jtos.2018.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 08/31/2018] [Accepted: 09/12/2018] [Indexed: 01/14/2023]
Abstract
PURPOSE Our aim was to correlate cardiovascular risk factor estimation with bulbar conjunctival blood flow metrics as measured through Functional Slit Lamp Biomicroscopy (FSLB). METHODS Cross-sectional study of individuals with otherwise healthy eyelid and corneal anatomy recruited from the Miami Veterans Affairs (VA) Healthcare System eye clinic. We measured conjunctival microvascular hemodynamics by mounting a camera on a slit lamp and cardiovascular risk using the Framingham risk score. Our main outcome measures were correlations between conjunctival vessel parameters (axial and cross-sectional blood flow velocity, blood flow rate) and Framingham score. RESULTS We included 84 patients who underwent FSLB. The mean age was 60 years, the majority were male (88%) and approximately half the patients were black (54%). Mean vessel diameter was similar between all Framingham score categories. Axial and cross-sectional blood flow velocities and blood flow rate were lower in individuals with higher Framingham risk score. Specifically, mean cross-sectional blood flow velocity in individuals with a low Framingham risk score was 0.37 ± 0.0.9 mm/s, with an intermediate score was 0.30 ± 0.09 mm/s, and with a high score was 0.29 ± 0.10 mm/s, p = 0.04. Mean blood flow rate in individuals with a low Framingham risk score was 133.4 ± 59.6 pl/s, with an intermediate score was 123.6 ± 39.3 pl/s, and with a high score was 121.9 ± 52.6 pl/s, p = 0.04. The beta coefficient of the blood flow rate for change in Framingham score was -0.73; 95% CI-1.34-0.13, p = 0.02, adjusted for race. CONCLUSION FSLB correlates with cardiovascular risk estimation. Future studies should evaluate if FSLB can predict cardiovascular outcomes.
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Affiliation(s)
| | - Leonardo Tamariz
- Miami VA, Veterans Affairs Medical Center, Miami, FL, USA; Division of Population Health and Computational Medicine, USA
| | - Hatim Batawi
- Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Jianhua Wang
- Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, FL, USA
| | - Anat Galor
- Miami VA, Veterans Affairs Medical Center, Miami, FL, USA; Bascom Palmer Eye Institute, Miller School of Medicine at the University of Miami, Miami, FL, USA.
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15
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England BR, Thiele GM, Anderson DR, Mikuls TR. Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications. BMJ 2018; 361:k1036. [PMID: 29685876 PMCID: PMC6889899 DOI: 10.1136/bmj.k1036] [Citation(s) in RCA: 271] [Impact Index Per Article: 45.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Rheumatoid arthritis is a systemic autoimmune disease characterized by excess morbidity and mortality from cardiovascular disease. Mechanisms linking rheumatoid arthritis and cardiovascular disease include shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, alterations in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction. Despite a growing understanding of these mechanisms and their complex interplay with conventional cardiovascular risk factors, optimal approaches of risk stratification, prevention, and treatment in the context of rheumatoid arthritis remain unknown. A multifaceted approach to reduce the burden posed by cardiovascular disease requires optimal management of traditional risk factors in addition to those intrinsic to rheumatoid arthritis such as increased disease activity. Treatments for rheumatoid arthritis seem to exert differential effects on cardiovascular risk as well as the mechanisms linking these conditions. More research is needed to establish whether preferential rheumatoid arthritis therapies exist in terms of prevention of cardiovascular disease. Ultimately, understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.
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Affiliation(s)
- Bryant R England
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Geoffrey M Thiele
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Daniel R Anderson
- Division of Cardiology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Ted R Mikuls
- Veterans Affairs (VA) Nebraska-Western Iowa Health Care System, Omaha, NE, USA
- Division of Rheumatology and Immunology, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE, USA
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16
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Taverner D, Vallvé JC, Ferré R, Paredes S, Masana L, Castro A. Variables associated with subclinical atherosclerosis in a cohort of rheumatoid arthritis patients: Sex-specific associations and differential effects of disease activity and age. PLoS One 2018; 13:e0193690. [PMID: 29494666 PMCID: PMC5832263 DOI: 10.1371/journal.pone.0193690] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 02/19/2018] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVE To advance the study of variables associated with subclinical atherosclerosis in rheumatoid arthritis (RA) with special consideration for the degree of disease activity, age and gender. METHODS The carotid intima-media thickness (cIMT) and the presence of carotid atherosclerotic plaques along with clinical and biochemical characteristics were determined in 214 RA patients. RESULTS Adjusted analysis reveals that men had a 0.059 mm significantly increased cIMT compared with women (p = 0.001; R2 = 3.8%) and that age was associated with cIMT (β = 0.0048 mm; p = 0.0001; R2 = 16%). Interestingly, we observed a significant interaction between gender and age. Thus, the effect of age on cIMT was significantly increased (12%) in men compared with women (p-value for interaction term = 0.041). Moreover, adjusted multivariable linear regression analysis revealed that disease activity score (DAS28) was significantly associated with cIMT in women (β = 0.021; p = 0.018: R2 = 0.03) but not men. In particular, women with high disease activity had a 0.079 mm increased cIMT compared with women in remission (p = 0.026). In addition, men in remission had a 0.134 mm increased cIMT compared with women in remission (p = 0.003; R2 = 8.7%). Active patients did not exhibit differences in cIMT values. Furthermore, 43% of patients presented carotid plaques. The variables independently associated with carotid plaques were age, smoking, health assessment questionnaire, erythrocyte sedimentation rate and rheumatoid factor (p<0.0001; R2 = 46%). CONCLUSION In our cohort of patients with RA, DAS28 and age are differentially associated with cIMT in men and women. Our findings could explain the contradictory results that have previously been published in the literature.
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Affiliation(s)
- Delia Taverner
- Secció de Reumatologia, Servei de Medicina Interna, Hospital Universitari Sant Joan, Institut Investigació Sanitària Pere Virgili. Reus, Catalonia, Spain
| | - Joan-Carles Vallvé
- Facultat de Medicina, Universitat Rovira i Virgili, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Institut Investigació Sanitària Pere Virgili. Reus, Catalonia, Spain
| | - Raimón Ferré
- Facultat de Medicina, Universitat Rovira i Virgili, Servei de Medicina Interna, Hospital Universitari Sant Joan, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Institut Investigació Sanitària Pere Virgili. Reus, Catalonia, Spain
| | - Silvia Paredes
- Secció de Reumatologia, Servei de Medicina Interna, Hospital Universitari Sant Joan, Institut Investigació Sanitària Pere Virgili. Reus, Catalonia, Spain
| | - Lluís Masana
- Facultat de Medicina, Universitat Rovira i Virgili, Servei de Medicina Interna, Hospital Universitari Sant Joan, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Institut Investigació Sanitària Pere Virgili. Reus, Catalonia, Spain
| | - Antoni Castro
- Facultat de Medicina, Universitat Rovira i Virgili, Servei de Medicina Interna, Hospital Universitari Sant Joan, CIBER de Diabetes y Enfermedades Metabólicas Asociadas, Institut Investigació Sanitària Pere Virgili. Reus, Catalonia, Spain
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Soulaidopoulos S, Nikiphorou E, Dimitroulas T, Kitas GD. The Role of Statins in Disease Modification and Cardiovascular Risk in Rheumatoid Arthritis. Front Med (Lausanne) 2018; 5:24. [PMID: 29473041 PMCID: PMC5809441 DOI: 10.3389/fmed.2018.00024] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Accepted: 01/24/2018] [Indexed: 01/22/2023] Open
Abstract
Rheumatoid arthritis (RA) is an autoimmune, inflammatory disorder associated with excess cardiovascular morbidity and mortality. A complex interplay between traditional risk factors (dyslipidemia, insulin resistance, arterial hypertension, obesity, smoking) and chronic inflammation is implicated in the development of premature atherosclerosis and consequently in the higher incidence of cardiovascular events observed in RA patients. Despite the acknowledgment of elevated cardiovascular risk among RA individuals, its management remains suboptimal. While statin administration has a crucial role in primary and secondary cardiovascular disease prevention strategies as lipid modulating factors, there are limited data concerning the precise benefit of such therapy in patients with RA. Systemic inflammation and anti-inflammatory treatments influence lipid metabolism, leading to variable states of dyslipidemia in RA. Hence, the indications for statin therapy for cardiovascular prevention may differ between RA patients and the general population and the precise role of lipid lowering treatment in RA is yet to be established. Furthermore, some evidence supports a potential beneficial impact of statins on RA disease activity, attributable to their anti-inflammatory and immunomodulatory properties. This review discusses existing data on the efficacy of statins in reducing RA-related cardiovascular risk as well as their potential beneficial effects on disease activity.
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Affiliation(s)
- Stergios Soulaidopoulos
- 4th Department of Internal Medicine, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Elena Nikiphorou
- Department of Academic Rheumatology, King’s College London, London, United Kingdom
- Department of Rheumatology, Whittington NHS Health, London, United Kingdom
| | - Theodoros Dimitroulas
- 4th Department of Internal Medicine, Hippokration University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - George D. Kitas
- Arthritis Research UK Centre for Epidemiology, University of Manchester, Manchester, United Kingdom
- Department of Rheumatology, Dudley Group NHS Fountation Trust, Dudley, United Kingdom
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Nieto-Lima B, Cano-Martínez A, Rubio-Ruiz ME, Pérez-Torres I, Guarner-Lans V. Age-, Gender-, and in Vivo Different Doses of Isoproterenol Modify in Vitro Aortic Vasoreactivity and Circulating VCAM-1. Front Physiol 2018; 9:20. [PMID: 29416512 PMCID: PMC5787582 DOI: 10.3389/fphys.2018.00020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 01/09/2018] [Indexed: 12/28/2022] Open
Abstract
Different human-like cardiomyopathies associated to β-adrenergic stimulation are experimentally modeled in animals through variations in dose, route, and duration of administration of different cardiotoxic drugs. However, associated changes in the vasculature and their relation to systemic inflammation, and the influence of cardiovascular diseases risk factors (gender and age) upon them are seldom analyzed. Here we studied the effect of age and gender on the vasoreactivity of aortas from mice subjected to in vivo repeated β-adrenergic stimulation with different doses of isoproterenol (ISO) in association with circulating inflammatory cytokines. Young (2 months) and old (18 months) male and female mice received 0 (control), 5, 40, 80 or 160 μg/g/d of ISO (7 days, s.c.). IL-1α, IL-4 and vascular cell adhesion molecule-1 (VCAM-1) were quantified in plasma. In vitro, norepinephrine-induced vasoconstriction and acetylcholine-induced relaxation were measured in aortas. No differences in contraction, relaxation, IL-1α, and IL-4 were found between control young males and females. Age decreased contraction in males and relaxation was lower in females and abolished in males. VCAM-1 was higher in young males than in females and increased in old mice. Vasoconstriction in ISO-treated mice results as a bell-shaped curve on contraction in young and old males, with lower values in the latter. In females, ISO-160 increased contraction in young females but decreased it in old females. Vasorelaxation was reduced in ISO-treated young males and females. ISO-80 and 160 reduced vasorelaxation in old females, and intermediate doses relaxed aortas from old males. VCAM-1 was higher in young and old males with ISO-80 and 160; while VCAM-1 was higher only with ISO-160 in old females. Our results demonstrate that repeated β-adrenergic stimulation modifies vascular reactivity depending on gender, age, and dose. Females were less sensitive to alterations in vasoreactivity, and young females required a higher amount of the adrenergic stimuli than old females to show vascular alterations. Changes were independent of IL-1α and IL-4. VCAM-1 only changed in old females stimulated with ISO 160. Our results highlight the relevance of considering and comparing in the same study females and aged organisms to improve the accuracy of applications to clinical studies.
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Affiliation(s)
- Betzabé Nieto-Lima
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico
| | - Agustina Cano-Martínez
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico
| | - María E Rubio-Ruiz
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico
| | - Israel Pérez-Torres
- Department of Pathology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico
| | - Verónica Guarner-Lans
- Department of Physiology, Instituto Nacional de Cardiología "Ignacio Chávez", Mexico City, Mexico
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Sandoo A. Important Considerations for Examining Endothelial Dysfunction in Rheumatoid Arthritis. Mediterr J Rheumatol 2017; 28:112-115. [PMID: 32185268 PMCID: PMC7046061 DOI: 10.31138/mjr.28.3.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 06/09/2017] [Indexed: 12/12/2022] Open
Affiliation(s)
- Aamer Sandoo
- School of Sport, Health and Exercise Sciences, Bangor University, Bangor, Wales, United Kingdom.,Dudley Group of Hospitals NHS Trust, Russells Hall Hospital, Dudley, United Kingdom
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20
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Cardiovascular disease in rheumatoid arthritis: medications and risk factors in China. Clin Rheumatol 2017; 36:1023-1029. [PMID: 28342151 DOI: 10.1007/s10067-017-3596-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
This study aims to assess the risk factors of cardiovascular disease (CVD) and to determine the association of traditional and biologic disease-modifying anti-rheumatic drugs (DMARDs) with risk for CVD in Chinese rheumatoid arthritis (RA) patients. A cross-sectional cohort of 2013 RA patients from 21 hospitals around China was established. Medical history of CVD was documented. The patients' social background, clinical manifestations, comorbidities, and medications were also collected. Of the 2013 patients, 256 had CVD with an incidence of 12.7%. Compared with non-CVD controls, RA patients with CVD had a significantly advanced age, long-standing median disease duration, more often male and more deformity joints. Patients with CVD also had higher rates of smoking, rheumatoid nodules, interstitial lung disease, and anemia. The prevalence of comorbidities, including hypothyroidism, diabetes mellitus (DM), hypertension, and hyperlipidemia, was also significant higher in the CVD group. In contrast, patients treated with methotrexate, hydroxychloroquine (HCQ), and TNF blockers had lower incidence of CVD. The multivariate analysis showed that the use of HCQ was a protective factor of CVD, while hypertension, hyperlipidemia, and interstitial lung disease were independent risk factors of CVD. Our study shows that the independent risk factors of CVD include hypertension, hyperlipidemia, and interstitial lung disease. HCQ reduces the risk of CVD in patients with RA.
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21
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Treat-to-target therapy does not prevent excessive progression of carotid intima media thickness during the first year of therapy in early rheumatoid arthritis. ACTA ACUST UNITED AC 2016; 1:e36-e43. [PMID: 28905017 PMCID: PMC5421530 DOI: 10.5114/amsad.2016.60225] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Accepted: 05/13/2016] [Indexed: 12/15/2022]
Abstract
Introduction The aim of the study was to investigate the presence of subclinical atherosclerosis and predictors of change in carotid intima-media measures in early rheumatoid arthritis patients (eRA) as compared to chronic RA patients and patients without arthritis. Material and methods Fifty-five consecutive eRA patients were assessed at the time of diagnosis and after 1 year of therapy. Fifty-five sex- and age-matched chronic RA patients and 29 patients without inflammatory disease were used as controls. Carotid artery intima-media thickness (CIMT) and carotid plaques were measured at baseline and after follow-up. In eRA patients ultrasound assessment of hand joints was performed before and after treatment. Carotid artery intima-media thickness was assessed again after 2 years in 44 eRA patients. Results Carotid artery intima-media thickness progression after 1 year of therapy was higher in eRA patients compared to both control groups (p = 0.017) and correlated with symptoms duration (p = 0.017) and DMARD monotherapy (p = 0.015). Ultrasound progression of hand joint erosions was associated with longer symptoms duration (p = 0.006). After 2 years of observation CIMT progression was similar in all examined groups. Conclusions We observed rapid CIMT progression during the first year of RA therapy. Longer symptoms duration and less aggressive therapy were associated with CIMT increase.
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22
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Dimitroulas T, Sandoo A, Hodson J, Smith JP, Kitas GD. In vivo microvascular and macrovascular endothelial function is not associated with circulating dimethylarginines in patients with rheumatoid arthritis: a prospective analysis of the DRACCO cohort. Scandinavian Journal of Clinical and Laboratory Investigation 2016; 76:331-7. [PMID: 27166512 DOI: 10.1080/00365513.2016.1177852] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To examine associations between asymmetric (ADMA), symmetric dimethylarginine (SDMA) and ADMA:SDMA ratio with assessments of endothelial function and coronary artery perfusion in RA patients. METHODS ADMA and SDMA levels were measured in 197 RA individuals [144 (77.4%) females, median age: 66 years (quartiles: 59-73)]. Patients underwent assessments of microvascular endothelium-dependent and endothelium-independent function, macrovascular endothelium-dependent and endothelium-independent function and vascular morphology (pulse wave analysis, carotid intima-media thickness (cIMT), and carotid plaque). Coronary perfusion was assessed by subendocardial viability ratio (SEVR). RESULTS SEVR correlated with SDMA (r = 0.172, p = 0.026) and ADMA:SDMA (r = -0.160, p = 0.041) in univariable analysis, but not in multivariable analysis accounting for confounding factors. Neither ADMA:SDMA ratio nor SDMA were significantly correlated with microvascular or macrovascular endothelial function, or with arterial stiffness and cIMT. Within subgroup of patients (n = 26) with high inflammatory markers, a post-hoc analysis showed that SDMA and the ADMA:SDMA ratio were significantly associated with endothelium-dependent microvascular function in univariable analysis, with Pearson's r correlation coefficients of -0.440 (p = 0.031) and 0.511 (p = 0.011), respectively. Similar finding were established between ADMA:SDMA ratio and arterial stiffness in univariable analysis, with Pearson's r of 0.493, (p = 0.024). CONCLUSION Dimethylarginines were not found to be significantly associated with several assessments of vascular function and morphology in patients with RA, however, post-hoc analysis indicates that there may be associations in patients with raised inflammatory markers. Our results suggest that dysregulated NO metabolism may not be the sole mechanism for the development of preclinical atherosclerosis in RA.
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Affiliation(s)
- Theodoros Dimitroulas
- a Department of Rheumatology , Dudley Group NHS Foundation Trust, Russells Hall Hospital , Dudley , UK
| | - Aamer Sandoo
- a Department of Rheumatology , Dudley Group NHS Foundation Trust, Russells Hall Hospital , Dudley , UK ;,b School of Sport, Health and Exercise Sciences, Bangor University, Bangor , Gwynedd , Wales , UK
| | - James Hodson
- c Wolfson Computer Laboratory , University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , Birmingham , UK
| | - Jacqueline P Smith
- a Department of Rheumatology , Dudley Group NHS Foundation Trust, Russells Hall Hospital , Dudley , UK
| | - George D Kitas
- a Department of Rheumatology , Dudley Group NHS Foundation Trust, Russells Hall Hospital , Dudley , UK ;,d Arthritis Research UK Epidemiology Unit, University of Manchester , Manchester , UK
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Abstract
While the most obvious manifestations of rheumatoid arthritis (RA) involve inflammation and damage in the synovial joints, the systemic effects of the condition are widespread and life-threatening. Of particular interest is the 'lipid paradox' of RA, where patients with a numerically equivocal starting lipid profile have a significantly raised risk of cardiovascular (CV) events and response to therapy results in a 'normalization' of lipid levels and reduction in events. Changes in lipids can be seen before overt disease manifestations which suggest that they are closely linked to the more widespread inflammation-driven metabolic changes associated with tumour necrosis factor (TNF). Cachexia involves a shift in body mass from muscle to fat, which may or may not directly increase the cardiovascular risk. However, since TNF inhibition is associated with reduction in cardiovascular events, it does suggest that these widespread metabolic changes involving lipids are of importance. Analysis of single lipids or metabolites have been used to identify some of the key changes, but more recently, metabolomic and lipidomic approaches have been applied to identify a broad spectrum of small molecule changes and identify potentially altered metabolic pathways. Further work is needed to understand fully the metabolic changes in lipid profiles and identify novel ways of targeting desired profile changes, but work so far does suggest that a better understanding may allow management of patients to downregulate the systemic effects of their disease that puts them at risk of cardiovascular complications.
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Affiliation(s)
- Catherine M McGrath
- School of Immunity and Infection, Rheumatology Research Group, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK,
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Giles JT. Cardiovascular disease in rheumatoid arthritis: Current perspectives on assessing and mitigating risk in clinical practice. Best Pract Res Clin Rheumatol 2015; 29:597-613. [DOI: 10.1016/j.berh.2015.09.003] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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Cheng X, Wang X, Wan Y, Zhou Q, Zhu H, Wang Y. Myosin light chain kinase inhibitor ML7 improves vascular endothelial dysfunction via tight junction regulation in a rabbit model of atherosclerosis. Mol Med Rep 2015; 12:4109-4116. [PMID: 26096176 PMCID: PMC4526030 DOI: 10.3892/mmr.2015.3973] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Accepted: 05/08/2015] [Indexed: 01/06/2023] Open
Abstract
Vascular endothelial dysfunction (VED) is an important factor in the initiation and development of atherosclerosis (AS). Previous studies have demonstrated that endothelial permeability is increased in diet‑induced AS. However, the precise underlying mechanisms remain poorly understood. The present study aimed to analyze whether the myosin light chain kinase (MLCK) inhibitor ML7 is able to improve VED and AS by regulating the expression of the tight junction (TJ) proteins zona occludens (ZO)‑1 and occludin via mechanisms involving MLCK and MLC phosphorylation in high‑fat diet‑fed rabbits. New Zealand white rabbits were randomly divided into three groups: Control group, AS group and ML7 group. The rabbits were fed a standard diet (control group), a high‑fat diet (AS group) or a high‑fat diet supplemented with 1 mg/kg/day ML7 (ML7 group). After 12 weeks, endothelium‑dependent relaxation and endothelium‑independent relaxation were measured using high-frequency ultrasound. Administration of a high‑fat diet significantly increased the levels of serum lipids and inflammatory markers in the rabbits in the AS group, as compared with those in the rabbits in the control group. Furthermore, a high‑fat diet contributed to the formation of a typical atherosclerotic plaque, as well as an increase in endothelial permeability and VED. These symptoms of AS were significantly improved following treatment with ML7, as demonstrated in the ML7 group. Hematoxylin & eosin and immunohistochemical staining indicated that ML7 was able to decrease the expression of MLCK and MLC phosphorylation in the arterial wall of rabbits fed a high‑fat diet. A similar change was observed for the TJ proteins ZO‑1 and occludin. In addition, western blot analysis demonstrated that ML7 increased the expression levels of occludin in the precipitate, but reduced its expression in the supernatant of lysed aortas. These results indicated that occludin, which is a dynamic protein at the TJ, is associated with remodeling from cell membrane to cytoplasm. The present study was the first, to the best of our knowledge, to indicate that ML7 may ameliorate VED and AS by regulating the TJ proteins ZO‑1 and occludin via mechanisms involving MLCK and MLC phosphorylation.
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Affiliation(s)
- Xiaowen Cheng
- Department of Clinical Laboratory, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Xiaobian Wang
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Yufeng Wan
- Department of Otolaryngology, The Affiliated Chaohu Hospital of Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Qing Zhou
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Huaqing Zhu
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University, Hefei, Anhui 230032, P.R. China
| | - Yuan Wang
- Laboratory of Molecular Biology and Department of Biochemistry, Anhui Medical University, Hefei, Anhui 230032, P.R. China
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Methotrexate, Cyclosporine A, and Biologics Protect against Atherosclerosis in Rheumatoid Arthritis. J Immunol Res 2015; 2015:759610. [PMID: 26090499 PMCID: PMC4452098 DOI: 10.1155/2015/759610] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Revised: 01/16/2015] [Accepted: 01/20/2015] [Indexed: 12/29/2022] Open
Abstract
Introduction. The risk of cardiovascular disease is increased in rheumatoid arthritis (RA). A meta-analysis showed increased intima media thickness (IMT) in RA. It has been shown that disease modifying antirheumatic drugs (DMARDs) may influence the progression of atherosclerosis. However, it was suggested that biologics may be more efficient than other DMARDs (including methotrexate—MTX) in protecting against atherosclerosis. Objectives. The aim of this study was to assess the influence of different RA characteristics and treatment regimens on IMT and atherosclerotic plaques. Patients and Methods. 317 RA patients and 111 controls were included in the study. IMT was measured in carotid (CIMT) and femoral (FIMT) arteries. Arteries were screened for the presence of plaques. Results. CIMT, FIMT, and prevalence of plaques were lower in patients treated with methotrexate (MTX) ≥ 20 mg/wk, cyclosporine (CsA), or biologics than in patients treated with lower doses of MTX and other disease modifying antirheumatic drugs. No differences in IMT between patients treated with MTX ≥ 20 mg/wk, biologics, or CsA were found. Conclusions. We found a beneficial effect of MTX ≥ 20 mg/wk, biologics, and CsA on atherosclerosis. We do not confirm a stronger influence of biologics on IMT compared with therapeutic doses of MTX.
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Włoch A, Wieczorek-Surdacka E, Sulicka-Grodzicka J, Kruszelnicka O, Surdacki A. Asymmetric dimethylarginine reflects cumulative inflammatory burden in rheumatoid arthritis. A novel mechanism of excessive cardiovascular morbidity? Rheumatology (Oxford) 2015; 54:1135-6. [PMID: 25922548 DOI: 10.1093/rheumatology/kev104] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2015] [Indexed: 11/14/2022] Open
Affiliation(s)
- Alicja Włoch
- Małopolska Center for Rheumatology, Immunology and Rehabilitation, J. Dietl Hospital in Kraków, Department of Nephrology, Department of Rheumatology and Balneology, Jagiellonian University Medical College and University Hospital, Department of Coronary Artery Disease and Heart Failure, John Paul II Hospital in Kraków and Second Department of Cardiology, Jagiellonian University Medical College and University Hospital, Kraków, Poland
| | - Ewa Wieczorek-Surdacka
- Małopolska Center for Rheumatology, Immunology and Rehabilitation, J. Dietl Hospital in Kraków, Department of Nephrology, Department of Rheumatology and Balneology, Jagiellonian University Medical College and University Hospital, Department of Coronary Artery Disease and Heart Failure, John Paul II Hospital in Kraków and Second Department of Cardiology, Jagiellonian University Medical College and University Hospital, Kraków, Poland
| | - Joanna Sulicka-Grodzicka
- Małopolska Center for Rheumatology, Immunology and Rehabilitation, J. Dietl Hospital in Kraków, Department of Nephrology, Department of Rheumatology and Balneology, Jagiellonian University Medical College and University Hospital, Department of Coronary Artery Disease and Heart Failure, John Paul II Hospital in Kraków and Second Department of Cardiology, Jagiellonian University Medical College and University Hospital, Kraków, Poland
| | - Olga Kruszelnicka
- Małopolska Center for Rheumatology, Immunology and Rehabilitation, J. Dietl Hospital in Kraków, Department of Nephrology, Department of Rheumatology and Balneology, Jagiellonian University Medical College and University Hospital, Department of Coronary Artery Disease and Heart Failure, John Paul II Hospital in Kraków and Second Department of Cardiology, Jagiellonian University Medical College and University Hospital, Kraków, Poland
| | - Andrzej Surdacki
- Małopolska Center for Rheumatology, Immunology and Rehabilitation, J. Dietl Hospital in Kraków, Department of Nephrology, Department of Rheumatology and Balneology, Jagiellonian University Medical College and University Hospital, Department of Coronary Artery Disease and Heart Failure, John Paul II Hospital in Kraków and Second Department of Cardiology, Jagiellonian University Medical College and University Hospital, Kraków, Poland
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Luo KQ, Feng XW, Xu BC, Long HB. Association between arterial stiffness and risk of coronary artery disease. Pak J Med Sci 2015; 30:1314-8. [PMID: 25674130 PMCID: PMC4320722 DOI: 10.12669/pjms.306.5584] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2014] [Revised: 07/15/2014] [Accepted: 07/29/2014] [Indexed: 11/15/2022] Open
Abstract
Objective: To investigate the role of Brachial ankle Pulse Wave Relocity (baPWV) and cfPWV on the risk of Coronary artery disease and the interaction between baPWV and risk factors of Coronary artery disease (CAD). Methods: A case-control study was conducted at Department of Emergency, SunYat-Sen memorial Hospital, China. We collected 332 cases with coronary artery disease and 328 subjects without CAD between February 2012 and October 2013. A multivariate logistic regression analysis was performed to analyze the risk factors of CAD. Results: CAD subjects were more likely to be old age, and have higher BMI, waist-hip ratio, hypertension, fasting glucose, TG, carotid-femoral PWV (cfPWV) and baPWV, and CAD subjects had a lower TC, HDL–C and LDL-C. We found that older age, smoking, higher hypertension, TC, TG, HDL-C, LDL-C, carotid-femoral PWV (CfPWV) and baPWV were associated with risk of CAD. baPWV had significant interaction with age, TC, TG, HDL-C and LDL-C, carotid-femoral PWV (cfWV) was correlated with age, HDL-C and LDL-C. Conclusion: This study showed that baPWV and cfPWV are two independent factors for the risk of Coronary artery disease, and baPWV and cfPWV have interaction with age, TC, TG, HDL-C and LDL-C.
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Affiliation(s)
- Ke-Qin Luo
- Ke-qin Luo, Department of Emergency, SunYat-Sen memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Xiao-Wei Feng
- Xiao-wei Feng, Department of Emergency, SunYat-Sen memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Bing-Can Xu
- Bing-can Xu, Department of Emergency, SunYat-Sen memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
| | - Hui-Bao Long
- Hui-bao Long. Department of Emergency, SunYat-Sen memorial Hospital, Sun Yat-Sen University, Guangzhou, 510120, China
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