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Ann Intern Med. 2006 Feb 21;144(4):249-56.

Preclinical carotid atherosclerosis in patients with rheumatoid arthritis.

Author information

1
Division of Cardiology, Weill Medical College of Cornell University, Hospital for Special Surgery, and The Rogosin Institute, New York, New York 10021, USA. mroman@med.cornell.edu

Erratum in

  • Ann Intern Med. 2006 Dec 5;145(11):868.

Abstract

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% CI, 3.4% to 15.2%) for the control group and 38.5% (CI, 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-alpha 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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