Cardiovascular risk in patients with rheumatoid arthritis


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Abstract

Aim. Cardiovascular risk determination in patients with rheumatoid arthritis (RA) on the basis of standard and new risk factors (RF).
Material and methods. Incidence of standard cardiovascular RF was studied in 312 RA patients and 57 healthy controls. Overall coronary risk (OCR) and cardiovascular death risk (SCORE scale), coronary heart disease risk (Framingem scale) were analysed. In addition, such RF as severity of systemic inflammation, some hemostatic indices, arterial wall stiffness were assessed.
Results. Arterial hypertension (AH) occurred in 63.5% and hypercholesterinemia in 57.7% patients. AH in RA males is detected significantly more often than in population while blood lipid composition is satisfactory because of high HDLP cholesterol. The Framingem index in RA patients is lower than in the controls (7.7 ± 5.4 and 9.4 ± 9.3%), mean SCORE was 2.16 ± 2.9% (17.3% patients had high SCORE), a high OCR was registered in 25.7%. High level of C-reactive protein, platelets (320 Ѕ 109/l), hyperfibrinogenemia were found in 70.2, 31.1% and 55.9% patients, respectively. RA is accompanied with high activity of Willebrand factor, a low level of antithrombin III, suppression of fibrinolysis in blood plasm (p < 0.05). This reflects high thrombogenic blood potential, high risk of thrombosis and related complications of coronary heart disease. Aortic pulse wave velocity over 12 m/s was recorded significantly more frequently in RA than in control patients (p < 0.001), RA females had high arterial rigidity both in the periphery and aorta.
Conclusion. Cardiovascular risk indices based on standard RF cannot assess the risk in RA patients. Additional factors should be taken into consideration: severity of inflammation, hemostasis, arterial stiffness.

References

  1. Maradit-Kremers H., Nicola P. J., Crowson C. S. et al. Cardiovascular death in rheumatoid arthritis: A population - based study. Arthr. and Rheum. 2005; 52: 722-732.
  2. Reilly P. A., Cosh J. A., Maddison P. J. et al. Mortality and survival in rheumatoid arthritis: 25 year prospective study of 100 patients. Ann. Rheum. Dis. 1990; 49: 363-369.
  3. Gonzalez-Gay M. A., Gonzalez-Juanatey C., Martin X. Rheumatoid arthritis: The disease associated with accelerated atherogenesis. Semin. Arthr. Rheum. 2005; 35: 8-17.
  4. Erb N. X., Banks M. J., Rowe I. F. et al. Unavoidable and modifiable risk factors for ischaemic heart disease (IHD) in rheumatoid arthritis (RA). EULAR J. 2001; 60: 118.
  5. Adamson J., Ebrahim S., Dieppe P., Hunt K. Prevalence and risk factors for joint pain among men and women in the West of Scotland Twently-07 study. Ann. Rheum. Dis. 2006; 65: 520-524.
  6. Antivalle M., Mutti A., Randisi G. et al. Prevalence of metabolic syndrome, risk factor clustering, inflammatory markers, and cardiovascular morbidity in rheumatoid arthritis and spondyloarthritis. Ann. Rheum. Dis. 2006; 65 (suppl. II): 160.
  7. del Rincon I. D., Williams K., Stern M. P. et al. High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors. Arthr. and Rheum. 2001; 44 (12): 2737-2745.
  8. Ardent N. K., Edwards C. J. et al. The increased risk of myocardial infarction in patients with rheumatoid arthritis is greatest in young women and is not due to traditional risk factors. Rheumatology (Oxford) 2006; 45 (suppl. 1): il.
  9. Wallberg-Jonsson S., Ohman M. X., Dahlqvist S. R. Cardiovascular morbidity and mortality in patients with seropositive rheumatoid arthritis in Northern. J. Rheumatol. 1997; 24 (4): 445-451.
  10. Retterstol L., Eikvar M., Bohn L. et al. C-reactive protein predicts death in patients with previous premature myocardial infarction-a 10 year follow-up study. Atherosclerosis 2002; 160 (2): 433-440.
  11. McEntegart A., Roubenoff R., Selhub J. et al. Association between plasma homocysteine concentrations and extracranial carotid-artery stenosis. N. Engl. J. Med. 1995; 332 (4): 286-291.
  12. McEntegart A., Capell H. A., Creran D. et al. Cardiovascular risk factors, including thrombotic variables, in a population with rheumatoid arthritis. Rheumatology (Oxford) 2001; 40 (6): 640-644.
  13. Arnett D. K., Evans G. W., Riley W. A. Arterial stiffness: a new cardiovascular risk factor? Am. J. Epidemiol. 1994; 140: 669-682.
  14. Meaume S., Rudnichi A., Lynch A. et al. Aortic pulse wave velocity: an independent marker of cardiovascular risk. J. Hypertens. 2001; 19: 871-877.
  15. Laurent S., Boutouyrie P., Asmar R. et al. Aortic stiffness as an independent predictor of all-cause mortality in hypertensive patients. Hypertension 2001; 37: 1236-1241.
  16. Nьrnberger J., Keflioglu-Scheibera A., Opazo Saezb A. M. et al. Augmentation index is associated with cardiovascular risk. J. Hypertens 2002; 20: 2407-2414.
  17. Wong M., Toh L., Wilson A. et al. Reduced vascular compliance in patients with rheumatoid arthritis. EULAR J. 2002; 61: 75.
  18. Klocke R., Cockcroft J. R., Taylor G. J. et al. Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis. Ann. Rheum. Dis. 2003; 62 (5): 414-418.
  19. Arnett F. C., Edworthy S. M., Bloch D. A. et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthr. and Rheum; 1988; 31: 315-324.
  20. Thompson G. R. Handbook of hyperlipidemia. London 1990.
  21. Климов А. Н., Никульчива Н. Г. Липиды, липопротеиды и атеросклероз. СПб.: Питер Пресс; 1995.
  22. Wilson P. W., D'Agostino R. B., Levy D. et al. Predictor of coronary heart disease using risk factor categories. Circulation 1998; 97: 1837-1847.
  23. Перова Н. В. Суммарный риск ишемической болезни сердца и показания к лечению гиперхолестеринемии. (Применение Европейских рекомендаций 1994 г. к российским условиям). Кардиология 1996; 3: 47-53.
  24. Краткие Российские рекомендации "Диагностика и коррекция нарушений липидного обмена с целью профилактики и лечения атеросклероза" Разработаны группой экспертов секции атеросклероза ВНОК. М.; 2005. 11.
  25. Blacher J., Safar M. E. Clinical Trials in Russia, 2001; 1: 13-15.
  26. Klocke R., Cockcroft J. R., Taylor G. J. et al. Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis. Ann. Rheum. Dis. 2003; 62 (5): 414-418.
  27. Van Doornum S., McColl G., Jenkins A. et al. Screening for atherosclerosis in patients with rheumatoid arthritis: comparison of two in vivo tests of vascular function. Arthr. and Rheum. 2003; 48: 72-80.
  28. Зверева К. В., Грунина Е. А., Надирова Н. Н. Особенности артериальной гипертензии при ревматоидном артрите. Тер. арх. 1997; 5: 26-27.
  29. Насонова В. А., Саморядова О. С., Масенко В. П. и др. Эффективность капотена при лечении ревматоидного артрита с артериальной гипертензией: анализ гипотензивного и противовоспалительного действия. Тер. арх. 1992; 8: 68-73.
  30. Van Halm V. P., Voskuyl A. E., Lems W. F. et al. Risk factors for cardiovascular disease in patients with rheumatoid arthritis. EULAR J. 2002; 61: 75.
  31. Carmona L., Balsa A., Gonzales I. et al. Prevalence of specific comorbid conditionis in a nation-wied cohort of rheumatoid arthritis patients. EULAR J. 2001; 60: 148.
  32. Vaz Patto J., Figueirinhas J., Lima Faleiro L. et al. Risk factors: atherosclerosis in rheumatoid arthritis. EULAR J. 2002; 61: 376.
  33. Мазуров В. И., Столов С. В., Якушева В. А. и др. Кардиоваскулярные проблемы в ревматологии. Науч.-практ. ревматол. 2006; 4: 28-34.
  34. Boers M., Nurmohamed M. T., Lard L. R. et al. Low cholesterol and very low HDL-cholesterol in early active rheumatoid arthritis. EULAR J. 2002; 61: 85-86.
  35. Santos M. J., Cordeiro A., Godinho A. et al. Increased prevalence of heart valve disease in RA. EULAR J. 2002; 61: 365.

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