Risk factors of cardiovascular diseases in rheumatoid arthritis

Cardiovascular complications (CVC) including myocardial infarction (MI), sudden death and stroke (ST) are the main cause of premature mortality in rheumatoid arthritis (RA). Chronic inflammation plays the key role in the development of CVC in RA. Objective. To analyze prevalence of cardiovascular diseases (CVD), significance of traditional risk factors (Rf), DMARDs and RA features in the development of clinical and subclinical signs of atherosclerosis (AT). To compare results with data of QUEST-RA. Material and methods. Traditional Rf and CVD frequency in RA pts were assessed with a questionnaire. Coronary heart disease, MI and ST were diagnosed according to medical documents. Subclinical signs of atherosclerosis were evaluated with carotid artery sonography. Results. Traditional CVD Rf were evaluated in 563 pts (496 female, 93 male) aged 54 (44-54) years with disease duration 72 (24-144) months. Clinical signs of AT were revealed in5,6%, subclinical – in 11% of RA pts. Hyperlipidemia was present in 82%, increase of intima-media thickness – in 51%, family strain of CVD – in 44%, hypertension – in 38% of pts with RA. Traditional Rf, extra-articular features of RA, CVC and early AT signs weremore frequent in men than in women (p<0,005). Thickness of intima-media complex in 11men exceed that in women (p<0,005). RA pts were divided into two groups (I – with CVD and II – without CVD) to assess relationship between traditional Rf and CVC. Frequency of traditional Rf (hypertension and increased intima-media thickness) in group I was higher than in group II. Relative risk of their development was 4,78 and 2,09 respectively (p<0,05). 38% of RA pts had extra-articular features of RA (OR=2,02; p=0,04). Thickness of intima-media complex correlated with duration of treatment with hydroxichloroquine and sulfasalazine (r=0,34; p=0,0002 and r=0,28; p=0,008 respectively). CVC were not associated with administration of other DMARDs.

Reumatoid arthritis, cardiovascular diseases, traditional risk factors, atherosclerosis, inflammation

1. <div><p>Рациональная фармакотерапия ревматических заболеваний: Руководство для практикующих врачей под ред. Насоновой В.А., Насонова Е.Л. М, Изд-во «Литтерра», 2003</p><p>Kaplan M.J. Cardiovascular disease in rheumatoid arthritis. Curr. Opin. Rheumatol., 2006, 18, 289-97</p><p>Pincus T., Sokka T., Wolfe F. Premature mortality in patients with rheumatoid arthritis: evolving concepts. Arthritis Rheum., 2001, 44, 1234-36</p><p>Kitas G.D., Erb N. Tackling ischemic heart disease in rheumatoid arthritis. Rheumatology, 2003, 42, 607-13</p><p>Boers M., Dijkmans B., Gabriel S., et al. Making an impact on mortality in rheumatoid arthritis. Targeting cardiovascular comorbidity. Arthritis Rheum., 2004, 50, 1734-39</p><p>Hall F.C, Dalbeth N. Disease modification and cardiovascular risk reduction: two sides of the same coin? Rheumatology, 2005, 2-10</p><p>Насонов Е.Л. Проблема атеротромбоза в ревматологии. Вестник РАМН, 2003,7,6-10</p><p>Teir J, Koduri G, Meadows A. et al. Letter to the editor (other). An audit of recording cardiovascular risk factors in patients with rheumatoid arthritis and systemic lupus erythematosus in centres in East Anglia and the South East. Rheumatology, 2008, 1-3</p><p>Giles J, Post W, Blumenthal R. et al. Therapy insight: managing cardiovascular risk in patients with rheumatoid artritis. Nature Сlin. Pract. Rheumatol., 2006, 2, 6, 320-9</p><p>Van Doornum S., McColl G., Wicks I.P. Accelerated atherosclerosis. An extraarticular feature of rheuma- toid arthritis. Arthritis Rheum., 2002, 46, 862-75</p><p>Насонов Е.Л. Иммунологические маркеры атеросклероза. В кн.; Антифосфолипидный синдром. М., Из-во «Литтера», 2004, 278-98</p><p>Gonzalez-Gay M.A, Gonzalez-Juanatey C, Martin J. Rheumatoid arthritis: a disease associated with accel- erated atherogenesis. Sem. Arhritis Rheum., 2005, 35, 8-17</p><p>Naranjo A., Sokka T., Descalzo M.A. et al. Cardiovascular disease in patients with rheumatoid arthritis: results from the QUEST-RA study. Arthritis Res. Ther., 2008, 10, R30</p><p>Arnett F.C., Edworthy S.M., Bloch D.A. et al. The American Rheumatism Association 1987 revised cri- teria for the classification of rheumatoid arthritis. Arthritis Rheum., 1988, 3, 315-24</p><p>Ревматология 2005. Клинические рекомендации Ассоциации ревматологов России под ред. Насонова Е.Л. М.: ГЭОТАР-Медиа; 2005, 25-71</p><p>Haward G., Sharrett A.R., Heiss G. et al. Carotid artery intima-media thickness distribution in general populations as evaluated by B-mode ultrasound. ARIC Investigators. Stroke., 1993, 24, 1297-304</p><p>Iannuzzi A., Michele M.D., Panico S. et al. Radical- trapping activity, blood pressure, and carotid enlarge- ment in women. Hypertension, 2003, 41, 289-96</p><p>Friedwald W.T., Levy R.J., Fredrickson D.S. Estimation of the calculation of LDL cholesterol in plasma without use of the preparative ultracentrifuge. Clin. Chem., 1972, 18, 499-502</p><p>Solomon D.H., Curhan G.C., Rimm E.B., Cannuscio C.C., Karlson E.M. Cardiovascular risk factors in women with and without rheumatoid arthritis. Arthritis Rheum., 2004, 50, 3444-9</p><p>Del Rincon I., Williams K., Stern M.P. et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthritis Rheum., 2001, 44, 2737-45</p><p>Dessein P.H., Joffe B.I., Veller M.G. et al. Traditional and nontraditional cardiovascular risk factors are associated with atherosclerosis in rheumatoid arthritis. J. Rheumatol., 2005, 32, 435-42</p><p>Goodson N. Coronary artery disease and rheumatoid arthritis. Curr. Opin. Rheumatol., 2002, 14, 115-20</p><p>Solomon D.H., Karlson E.W., Rimm E.B. et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation, 2003, 107, 1303-7</p><p>Turesson C., Jarenros A., Jacobsson L. Increased incidence of cardiovascular disease in patients with rheumatoid arthritis: results from a community based study. Ann. Rheum. Dis., 2004, 63, 952-55</p><p>Wolfe F., Freundlich B., Straus W.L. Increased in cardiovascular and cerebrovascular disease preva- lence in rheumatoid arthritis. J. Rheumatol., 2003, 30, 36-40</p><p>Tunstall-Pedoe H., Kuulasmaa K., Mähönen M. et al. Contribution of trends in survival and coronary-event rates to changes in coronary heart disease mortality: 10-year results from 37 WHO MONICA project popu- lations. Monitoring trends and determinants in cardio- vascular disease. Lancet, 1999, 353, 1547-57</p><p>Sokka T., Toloza S., Cutolo M. et al. Women, men, and rheumatoid arthritis: analyses of disease activity, disease characteristics, and treatments in the QUESTRA study. Arthritis Res. Ther., 2009, 11, R7</p><p>Попкова Т.В., Хелковская А.Н., Мач Э.С. и соавт. Сердечно-сосудистые заболевания при ревмато- идном артрите. Тер. архив 2007, 5, 9-14</p><p>Roman M.J., Moeller E., Davis A. et al. Preclinical carotid atherosclerosis in patients with rheumatoid arthritis. Ann. Intern. Med., 2006, 144, 249-56</p><p>Ревматология: Национальное руководство. Под ред. Насонова Е.Л, Насоновой В.А. М., Гэотар- Медиа, 2008, 647-60</p><p>Gazi I.F, Boumpas D.T, Mikhailidis D. et al. Clustering of cardiovascular risk factors in rheumatoid arthritis: the rationale for using statins. Clin. Exp. Rheumatol., 2007, 25,102-11</p><p>Del Rincon I, Williams K, Stern M. et al. High incidence of cardiovascular events in a rheumatoid arthri- tis cohort not explained by traditional cardiac risk factors. Arthritis Rheum., 2001, 44, 2737-45</p><p>Попкова Т.В, Новикова Д.С, Новиков А.А. и соавт. Роль нарушений в системе транспорта холестерина крови в развитии атеросклероза при ревматоидном артрите. Научно-практ. ревма- тол., 2007, 5, 4-10</p><p>Gonzalez-Gay M.A, Gonzalez-Juanatey C, Martin J. Rheumatoid arthritis: a disease associated with accel- erated atherogenesis. Semin. Arhritis Rheum., 2005, 35, 8-17</p><p>Papadopoulos N.G, Alamanos Y, Voulgari P.V. et al. Does cigarette smoking influence disease expression, activity and severity in early rheumatoid arthritis patients? Clin. Exp. Rheumatol., 2005, 23, 861-66</p><p>Solomon D, Curhan G, Rimm E. et al. Cardiovascular risk factors in women with and without rheumatoid arthritis. Arthritis Rheum., 2004, 50, 344-49</p><p>Sattar N., McCrey D.W., Capell H. et al. Explaning how “high-grade” systemic inflammation acceler- ated vascular risk in rheumatoid arthritis. Circulation, 2003, 108, 2957-63</p><p>van Halm V.P., Nurmohamed M.T., Twisk JWR. et al. Disease-modifying antirheumatic drugs are associ- ated with a reduced risk for cardiovascular disease in patients with rheumatoid arthritis: a case control study. Arhritis Res. Ther., 2006, 8, R 151</p><p>Choi H.K., Hernan M.A., Seeger J.D. et al. Methotrexate and mortality in patients with rheuma- toid arthritis: a prospective study. Lancet, 2002, 359, 1173–77</p><p>Jacobsson L.T., Turesson C., Gulfe A. et al. Treatment with tumor necrosis factor blockers is associated with a lower incidence of first cardiovascular events in patients with rheumatoid arthritis. J. Rheumatol., 2005, 32, 1213 –18</p><p>Suissa S., Bernatsky S., Hudson M. Antirheumatic drug use and the risk of acute myocardial infarction. Arthritis Rheum., 2006, 55, 531-6</p><p>Georgiadis A.N., Papavasiliou E.C., Lourida E.S. et al. Atherogenic lipid profile is a feature characteris- tic of patients with early rheumatoid arthritis: effect of early treatment – a prospective, controlled study. Arthritis Res. Ther., 2006, 8, R 82</p></div><br />