According to a study published recently in the Journal of Rheumatology, traditional cardiovascular risk factors and disease characteristics are consistently associated with vascular hemodynamic alterations in rheumatoid arthritis (RA).

Researchers have identified potential determinants of arterial function in patients with RA. Previous studies have shown that RA increases cardiovascular event and mortality rates, as well as disease characteristics — including high-grade inflammation, unfavorable cardiovascular (CV) risk factor profiles, and genetic factors —associated with cardiovascular disease (CVD) in patients with RA.

In this study, the researchers used multivariable backward regression models in 177 patients (118 white, 32 Asian, 22 black, and 5 mixed ancestry) without established CVD to identify relationships between traditional CV risk factors and RA characteristics. Variables investigated included arterial stiffness (pulse wave velocity), wave reflection (augmentation index, reflected wave pressure and reflection magnitude), and pressure pulsatility (central systolic and pulse pressure, peripheral pulse pressure, pulse pressure amplification, and forward wave pressure).

Results of the study showed that recorded characteristics accounted for 37% (pulse wave velocity) to 71% (reflected wave pressure) of the variability in arterial function. Researchers found the following factors to be significantly associated with wave reflection and pressure pulsatility: RA duration (P =.04), rheumatoid factor status (P =.01 to .03), leukocyte counts (P =.02 to .05) and total cholesterol (P <.01 to .03).

High Yield Data Summary

  • Traditional cardiovascular risk factors and disease characteristics were consistently associated with vascular hemodynamic alterations in RA.
  • Researchers found RA duration (P =.04), rheumatoid factor status (P =.01 to .03), leukocyte counts (P =.02 to .05) and total cholesterol (P <.01 to .03) to be significantly associated with wave reflection and pressure pulsatility.

Other associations studied included body mass index (P <.01 to .02) and insulin resistance (P <.01 to .01) to reduced wave reflection and peripheral pulse pressure; exercise (P =.02) and alcohol consumption

(P <.01) to increased pulse pressure amplification and decreased peripheral pulse pressure, respectively; tumor necrosis factor-α inhibition (P <.01) to reduced pulse wave velocity; and tetracycline use (P =.02) to decreased peripheral pulse pressure.

Although this study found that traditional CV risk factors and disease characteristics were consistently associated with vascular hemodynamic alterations in RA, the relative effect of arterial stiffness, wave reflection, and pressure pulsatility on CVD risk in RA requires further investigation.

Summary & Clinical Applicability

Traditional CV risk factors and disease characteristics were consistently associated with vascular hemodynamic alterations in RA. Prior studies have shown that RA increases CV events and disease characteristics are associated with CVD in patients with RA.

Researchers used multivariable backward regression models in patients without established CVD to identify relationships of CV risk factors and RA characteristics.

Researchers found RA duration (P =.04), rheumatoid factor status

(P =.01 to .03), leukocyte counts (P =.02 to .05), and total cholesterol

(P <.01 to .03) to be significantly associated with wave reflection and pressure pulsatility.

Relative effects of arterial stiffness, wave reflection and pressure pulsatility on CVD risk in RA requires further investigation.

Limitations

By using backward regression models on data obtained with a cross-sectional design to assess a large number of associations, drawing conclusions on the direction of causality is precluded — which may have contributed to the finding of an inverse relationship between CRP concentrations with pulse wave velocity and central pulse pressure, and a direct association of statin therapy with central systolic BP. Also, a healthy control group was not included in the study.

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Reference

Gunter S, Robinson C, Norton GR, et al. Cardiovascular risk factors and disease characteristics are consistently associated with arterial function in rheumatoid arthritis [published online June 1, 2017]. J Rheumatol. doi:10.3899/jrheum.170029