THE FACTORS OF THE HIGH CARDIOVASCULAR RISK IN RA | Arthritis Information

AB0178 RISK FACTORS FOR SUBCLINICAL CAROTID ATHEROSCLEROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS

N. Fouda*¹, H. Abdelaziz², E. Mahmoud³
¹Rheumatology, ²radiodiagnosis, ³internal medicine, Ain Shams University, Cairo, Egypt

Background: Cardiovascular event rates are markedly increased in Rheumatoid Arthritis (RA) and become an increasingly recognized contributor to excess morbidity and mortality in RA patients. Traditional cardiovascular risk factors do not adequately account for the extent of cardiovascular diseases ( CVD) in RA.Measurement of the intima-media thickness (IMT) of the common carotid artery by high-resolution ultrasonography has been established as a radiological useful index for identifying subclinical atherosclerosis.The role of insulin resistance has not been extensively investigated in RA patients and conflict have been found regarding the relationship between it and subclinical atherosclerosis.
Objectives: to assess the carotid artery intima–media thickness (IMT) as an index of subclinical carotid atherosclerosis in patients with rheumatoid arthritis (RA)and its correlation with clinical severity and insulin resistance(IR).
Methods: This study included 30 patients with RA fulfilled the American college of Rheumatology(ACR) criteria and 15 age and sex matched controls. Patients with hypertension, diabetes mellitus,dyslipidemia,history of cardiovascular diseases or other connective tissue diseases were excluded .All patients were non smokers and all females were non menopausal.They were subjected to full medical history, thorough clinical examination , evaluation of the disease activity using Disease Activity Score 28(DAS28) and radiological assessment by plain x rays of both hands (postero-anterior views).For patients and controls, insulin resistance (IR)was calculated by the homeostasis model assessment (HOMA) based on fasting plasma glucose and serum insulin concentration .Also,they were investigated by carotid ultrasonography for measurement of intima media thickness (IMT).
Results: There was a significant increased carotid IMT thickness in RA patients (0.82 ± 0.12 mm) compared to controls (0.61 ± 0.02 mm) (P < 0.001))with cut off value of 0.65 mm.There was also significant higher mean value of HOMA in RA patients(2.55+0.80 )
compared to controls(1.79 +0.44 ) (p <0.001).Also, it was found that RA patients with IMT >0.65mm(n=24) had longer duration of illness (11±2.56), higher score of DAS28(5.2±0.97) and higher mean value of HOMA(3.8±0.53) compared to those with RA patients with IMT< 0.65 mm(n=6)( 5.41±2.09, 2.55±0.22 and 2.23±0.32)respectively. Stepwise multiple regression analysis of factors associated with incresed carotid IMT in RA patients showed that the duration of RA, DAS28 and HOMA are most sensitive independent predictors for subclinical atherosclerosis.

Disclosure of Interest: none

Thank-you Lynn, I hope all are listening. Education on this aspect of the disease is invaluable. If we are aware, perhaps we can prevent! [QUOTE=waddie]Thank-you Lynn, I hope all are listening. Education on this aspect of the disease is invaluable. If we are aware, perhaps we can prevent! [/QUOTE]

This is another one of those issues that is near and dear to me. I lost my father to a massive heart attack. He had RA and the info concerning RA/cardiovascular disease was not so well known back then.

In my opinion, everyone would be wise to keep this info in mind!

so help me understand exactly what we should do now that we have this info?[QUOTE=MJ]so help me understand exactly what we should do now that we have this info?[/QUOTE]

Has your RD spoken to you about the risks concerning RA/cardiovascular disease? Is he/she aware of any family history concerning heart disease? Does he/she listen to your cartotid artery when you have your check-ups? Has your RD suggested a Carotid ultrasonography ? Have you had a full cardio work-up?

Lynn492009-06-21 15:13:54

RA patients at high risk for preclinical carotid atherosclerosis

http://www.medscape.com/viewarticle/538509

[QUOTE=MJ]so help me understand exactly what we should do now that we have this info?[/QUOTE]

If you have RA then a baseline cariovascular workup should be done by a cardiologist. Believe me when I say it will be beneficial.

Inflammation is the culprit. My doctors feel that if you have RA, controlled or not that you should have a cardio workup. I have cardiac issues that were found on a routine EKG at my yearly exam. My primary was going to refer me to a cardiologist after my routine yearly exam as a preventative measure. Well, it turned out to be a referral due to an EKG finding. The testing confirmed that RA has affected my heart. Right now it's asymptomatic and I don't need drugs but that can change at any time.

Don't take this lightly and think it can only happen to someone else or think you're not old enough to have cardiac issues. Lindy