In patients with rheumatoid arthritis (RA), traditional cardiovascular (CV) risk factors and corticosteroids may increase the risk of worsening subclinical atherosclerosis indices over a 1-year period, according to a study in Hypertension Research.

Dalbeni and colleagues evaluated factors associated with the progression of subclinical atherosclerosis in RA patients with traditional cardiovascular (CV) risk factors who are under specific treatment.

The study enrolled 137 consecutive patients (age range, 18-75 years) with RA and stable sinus rhythm who had no prior CV events. Disease activity was assessed with the disease activity score-28 with c-reactive protein (DAS28[CRP]) systems. Ultrasound of the carotid arteries was performed in 105 patients (age, 59.34±11.65 years) after 1 year to identify atheromatous plaques and to measure intima-media thickness (cIMT) and carotid segmental distensibility (cCD). Plaques represented another group of atherosclerosis indices that were assessed at follow up.

After 1 year, the investigators observed worsening of cIMT (Δ-cIMT, 0.030±0.10 mm; P =.005), cCD (Δ-cCD, −1.64±4.83; P =.005), and plaques (Δ-plaques, 8.6%; P =.035) relative to baseline. Corticosteroid therapy as well as traditional CV risk factors, including age, mean arterial pressure, and diabetes, were associated with worsening subclinical atherosclerosis in this patient population. The worsening of subclinical atherosclerosis indices was only detectable in the group of patients with RA who had active disease, according to an analysis of patients with RA divided by the degree of DAS28(CRP).


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Limitations of this study included the lack of a control group, the lack of data on patients’ pack years of smoking, and the inclusion of patients who mostly had remitted or low-grade disease activity.

The researchers suggest that atherosclerotic disease may be slowed in patients with RA by achievement of remission of inflammatory activity of arthritis. They conclude that their “findings contribute to underlining the importance of a careful and regular CV risk assessment of arthritic patients and prompt us to consider all necessary measures,” including lifestyle changes, drug therapies, and management of hypertension.

Reference

Dalbeni A, Giollo A, Bevilacqua M, et al. Traditional cardiovascular risk factors and residual disease activity are associated with atherosclerosis progression in rheumatoid arthritis patients [published online Apr 27, 2020]. Hypertens Res. doi: 10.1038/s41440-020-0441-1