Preclinical carotid atherosclerosis in patients with rheumatoid arthritis

被引:224
作者
Roman, MJ
Moeller, E
Davis, A
Paget, SA
Crow, MK
Lockshin, MD
Sammaritano, L
Devereux, RB
Schwartz, JE
Levine, DM
Salmon, JE
机构
[1] Cornell Univ, Hosp Special Surg, Weill Med Coll, New York, NY 10021 USA
[2] SUNY Stony Brook, Stony Brook, NY 11794 USA
关键词
D O I
10.7326/0003-4819-144-4-200602210-00006
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Rheumatoid arthritis is associated with increased morbidity and mortality because of cardiovascular disease, independent of traditional risk factors. Objective: To determine the prevalence of preclinical atherosclerosis in patients with rheumatoid arthritis and to identify clinical and biological markers for atherosclerotic disease in this patient population. Design: Matched, cross-sectional study. Setting: Hospital for Special Surgery in New York City Patients: 98 consecutive outpatients with rheumatoid arthritis who were followed by rheumatologists and 98 controls matched on age, sex, and ethnicity. Measurements: Cardiovascular risk factor ascertainment and carotid ultrasonography in all participants; disease severity, disease treatment, and inflammatory markers in patients with rheumatoid arthritis. Results: Despite a more favorable risk factor profile, patients with rheumatoid arthritis had a 3-fold increase in carotid atherosclerotic plaque (44% vs. 15%; p < 0.001). The relationship between rheumatoid arthritis and carotid atherosclerotic plaque remained after accounting for age, serum cholesterol levels, smoking history, and hypertensive status; adjusted predicted prevalence was 7.4% (95% Cl, 3.4% to 15.2%) for the control group and 38.5% (Cl, 25.4% to 53.5%) for patients with rheumatoid arthritis. Age (P < 0.001) and current cigarette use (P < 0.014) were also significantly associated with carotid atherosclerotic plaque. Among patients with rheumatoid arthritis, atherosclerosis was related to age, hypertension status, and use of tumor necrosis factor-a inhibitors (a possible marker of disease severity). Limitations: The study had a cross-sectional design, and inflammatory markers were determined only once. Conclusions: Patients with rheumatoid arthritis have a high prevalence of preclinical atherosclerosis independent of traditional risk factors, suggesting that chronic inflammation and, possibly, disease severity are atherogenic in this population.
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页码:249 / 256
页数:8
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