Investigators from Columbia have identified cardiovascular risk factors that are specific to patients with rheumatoid arthritis (RA) and could help ascertain their risk of heart disease.
“Ischemic heart disease secondary to atherosclerosis is the most prevalent cause of death associated with cardiovascular disease (CVD) in patients with RA,” Adriana Rojas-Villarraga (Universidad del Rosario, Bogotá) and colleagues observe.
Given that patients with RA often exhibit signs such as increased carotid intima-media thickness (IMT) and impaired endothelial function in the absence of clinically evident CVD, the researchers examined whether alterative CVD risk factors might be more useful for determining the presence and severity of atherosclerosis in this context.
The team studied a group of 140 patients with RA, none of whom had a history of myocardial infarction or stroke. Endothelial function and carotid IMT were assessed using flow-mediated vasodilation and ultrasonography, and traditional cardiovascular risk factors including hypertension, diabetes, and dyslipidemia were also evaluated.
Rojas-Villarraga and team also measured laboratory variables relevant to RA, including rheumatoid factor levels, white blood cell count, platelet count, and serum high sensitivity C-reactive protein levels. Finally, polymorphisms of tumor necrosis factor and the human leukocyte antigen (HLA) receptor HLA-DRB1 genes, which have been associated with susceptibility to RA, were genotyped.
The authors report in the journal Seminars in Arthritis and Rheumatism that rheumatoid factor seropositivity was a significant predictor of endothelial dysfunction, even after taking traditional cardiovascular risk factors into account (odds ratio=3.0).
Multivariate analysis further revealed that the development of atherosclerotic plaque was associated with a duration of RA greater than 10 years (odds ratio=29.0), and with being a carrier of an HLA-DRB1 shared epitope allele (odds ratio=4.8).
“Although the lack of prospective follow-up and inclusion of patients with longstanding disease could be considered as shortcomings of this study, our results indicate the presence of RA-related risk factors for CVD in our population, which act independently of traditional risk factors,” say Rojas-Villarraga et al.
“These factors can be used by clinicians to predict CVD in RA patients, and this data should assist in the development of public health policies in our population for the improvement of patient outcomes,” they conclude.