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Reumatol Clin. 2017 Apr 21. pii: S1699-258X(17)30083-9. doi: 10.1016/j.reuma.2017.03.013. [Epub ahead of print]

What role does rheumatoid arthritis disease activity have in cardiovascular risk.

[Article in English, Spanish]

Author information

1
Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España. Electronic address: maramirezh@sescam.jccm.es.
2
Servicio de Reumatología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
3
Servicio de Radiología, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
4
Servicio de Análisis Clínicos, Hospital General Universitario de Ciudad Real, Ciudad Real, España.
5
Servicio de Dermatología, Hospital General Universitario de Ciudad Real; Universidad de Castilla La-Mancha, Ciudad Real, España.

Abstract

Rheumatoid arthritis (RA) is associated with a 1.3 to 3-fold increase in mortality, being the major cause of death from cardiovascular complications (40%-50%). Therefore, the initial approach should include cardiovascular risk (CVR) assessment using algorithms adapted for this population. Although, SCOREM is an important advance, there are data indicating that subclinical atherosclerosis may be underdiagnosed.

OBJECTIVE:

To estimate the strength of association between carotid ultrasound and SCOREM in this population, as well as the implication of disease activity.

METHODOLOGY:

Cross-sectional, observational, analytical study performed at the General Hospital of Ciudad Real, Spain, between June 2013 and May 2014. The evaluation of CVR was performed and, according to SCOREM, the population was divided into low and high (medium, high and very high) risk. We studied the presence of subclinical atherosclerosis in low-risk patients.

RESULTS:

Of the total of 119 RA patients, 73.1% had traditional risk factors. Thirty-eight patients were excluded because of a previous cardiovascular event, diabetes mellitus and/or nephropathy. Atheromatous plaque was observed in 14.63% of the low-risk population. The factor with the strongest association to the presence of subclinical atherosclerosis was a moderate or high activity of RA measured by the simplified disease activity index with an odds ratio of 4.95 (95% CI: 1.53-16.01).

CONCLUSIONS:

Although there was an acceptable correlation between the presence of subclinical atherosclerosis and SCOREM, there was a considerable proportion of atheromatous plaques in low-risk patients. Disease activity was the risk factor most closely associated with increased CVR.

KEYWORDS:

Artritis reumatoide; Aterosclerosis subclínica; Cardiovascular risk; Carotid ultrasound; Chronic inflammation; Ecografía carotídea; Inflamación crónica; Rheumatoid arthritis; Riesgo cardiovascular; SCOREM; SCOREm; Subclinical atherosclerosis

PMID:
28438483
DOI:
10.1016/j.reuma.2017.03.013
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