Increased Cardiovascular Events and Subclinical Atherosclerosis in Rheumatoid Arthritis Patients: 1 Year Prospective Single Centre Study

Abstract

Objectives: Several studies showed the close relationship between Rheumatoid Arthritis (RA) and cerebro-cardiovascular events (CVEs) and subclinical atherosclerosis. In this study, we investigated the occurrence of CVEs and subclinical atherosclerosis during the course of RA and we evaluated the possible role of both traditional cardiovascular (CV) and disease related risk factors to predict the occurrence of new CVEs and the onset of subclinical atherosclerosis.

Methods: We designed a single centre, bias-adjusted, prospective, observational study to investigate, in a homogeneous subset of RA patients, the occurrence of new onset of CVEs and subclinical atherosclerosis. Statistical analyses were performed to evaluate the role of traditional CV and disease-related risk factors to predict the occurrence of new CVEs and subclinical atherosclerosis.

Results: We enrolled 347 RA patients prospectively followed for 12 months. An increased percentage of patients experienced CVEs, developed subclinical atherosclerosis and was affected by systemic arterial hypertension (SAH), type 2 diabetes mellitus and metabolic syndrome (MS), at the end of follow up. Our analysis showed that the insurgence of both SAH and MS, during the follow up, the older age, the CVE familiarity and the lack of clinical response, were associated with a significantly increased risk to experience CVEs and to develop subclinical atherosclerosis.

Conclusions: Our study quantifies the increased expected risk for CVEs in a cohort of RA patients prospectively followed for 1 year. The occurrence of both new CVEs and subclinical atherosclerosis in RA patients may be explained by inflammatory burden as well as traditional CV risk factors.

Fig 1. Effectiveness and disease activity evaluation in the enrolled patients.

This Figure shows: A) and B) the progressive reduction of both DAS28 and SDAI values; C) the disease activity at the first observation and after 12 months of follow up, respectively; E) the EULAR response criteria after 12 months of follow up.

Fig 2. Evaluation of pro-inflammatory markers.

This Figure shows: A) and B) the progressive reduction of the serum mean levels of ESR; C) and D) the progressive reduction of the serum mean levels of CRP, during the follow up.

Fig 3. Comparison of lipid profile between time 0 and 12 month.

This Figure shows: A) and B) the mean serum levels of total cholesterol, HDL, LDL triglycerides at the first observation and after 12 months of follow up, respectively.

Fig 4. Traditional CV risk factors, CVEs and subclinical atherosclerosis, comparison between time 0 and 12 month.

This Figure shows: A), B) and C) the increased percentages of patients affected by SAH, MS and T2D (p<0.00001 for each comparison), after 12 months of follow up. D) and E) After 12 months, we observed an increased percentage of patients experienced new CVEs and developed subclinical atherosclerosis, respectively (p<0.00001 for each comparison).