An exploratory cross-sectional study of subclinical vascular damage in patients with polymyalgia rheumatica

Abstract

The aim of the study was to investigate the presence of subclinical vascular damage in polymyalgia rheumatica (PMR). We enrolled PMR patients having major cardiovascular risk factors (MCVRF) and, as controls, patients with MCVRF. All underwent: color Doppler ultrasound to evaluate the common carotid intima-media thickness (IMT), the anterior-posterior abdominal aortic diameter (APAD), and the prevalence of carotid artery stenosis; the cardio-ankle vascular index (CAVI) to measure arterial stiffness together with the ankle-brachial index (ABI) to investigate the presence of lower-extremity peripheral arterial disease. Finally, we measured the serum levels of adipocytokines implicated in vascular dysfunction. As a result, 48 PMR and 56 MCVRF patients were included. An increase of IMT (1.07/0.8-1.2 vs 0.8/0.8-1.05; p = 0.0001), CAVI (8.7/7.8-9.3 vs 7.6/6.9-7.8; p < 0.0001) and APAD values (21.15/18.1-25.6 vs 18/16-22; p = 0.0013) was found in PMR patients with respect to controls. No differences were reported in the prevalence of carotid artery stenosis or ABI values between the two groups. A significant correlation between IMT and CAVI in PMR and MCVRF subjects (r² = 0.845 and r² = 0.556, respectively; p < 0.01) was found. Leptin levels (pg/mL; median/25th-75th percentile) were higher in PMR than in MCVRF subjects (145.1/67-398.6 vs 59.5/39.3-194.3; p = 0.04). Serum levels of adiponectin (ng/mL) were higher in PMR patients (15.9/10.65-24.1 vs 6.1/2.8-22.7; p = 0.01), while no difference in serum levels of resistin (ng/mL) was found between PMR and MCVRF subjects (0.37/0.16-0.66 vs 0.26/0.14-1.24). Our study shows an increased subclinical vascular damage in PMR patients compared to those with MCVRF, paving the way for further studies aimed at planning primary cardiovascular prevention in this population.

Figure 1

IMT values (right/left side mean values) in patients with PMR (n = 48) and MCVRF controls (n = 56). Data are shown as Tukey boxplots; lines represent the median level with 25th–75th percentile. IMT intima-media thickness, PMR polymyalgia rheumatica, MCVRF major cardiovascular risk factors.

Figure 2

CAVI values (right/left side mean values) in patients with PMR (n = 48) and MCVRF controls (n = 56). Data are shown as Tukey boxplots; lines represent the median level with 25th–75th percentile; data not included between the whiskers are plotted as outliers with dots. CAVI cardio-ankle vascular index, PMR polymyalgia rheumatica, MCVRF major cardiovascular risk factors.

Figure 3

APAD values in patients with PMR (n = 48) and MCVRF controls (n = 56). Data are shown as Tukey boxplots; lines represent the median level with 25th–75th percentile. APAD anterior–posterior abdominal aortic diameter, PMR polymyalgia rheumatica, MCVRF major cardiovascular risk factors.

Figure 4

Correlation between IMT and CAVI values (right/left side mean values). (a) Patients with polymyalgia rheumatica (n = 48) ($r^2$= 0.845; p < 0.01). (b) Major cardiovascular risk factors controls (n = 56) ($r^2$= 0.556; p < 0.01). CAVI cardio-ankle vascular index, IMT intima-media thickness.

Figure 5

Comparison of adipokines serum levels in patients with PMR (n = 40) and MCVRF controls (n = 18). (a) Serum leptin levels. (b) Serum adiponectin levels. Data are shown as Tukey boxplots; lines represent the median level with 25th–75th percentile; data not included between the whiskers are plotted as outliers with dots. PMR polymyalgia rheumatica, MCVRF major cardiovascular risk factors.