Subclinical atherosclerosis of the carotid arteries in patients with rheumatoid arthritis with low cardiovascular risk

Abstract

Aim. To evaluate the detection rate of subclinical carotid atherosclerosis in rheumatoid arthritis (RA) patients with low cardiovascular risk (CVR). Materials and methods. The study included 182 RA patients with low CVR (mSCORE1%) and no established cardiovascular diseases and a control group comprising 100 people. Atherosclerotic lesion of the carotid arteries was assessed using Doppler ultrasound of the carotid arteries and was determined by the detection of atherosclerotic plaque (ASP) the local increase in the thickness of the intima-media complex (IMT) 1.5 mm. Results. Carotid ASP were observed more frequently in RA patients with low CVR than in the control group (17% versus 8%; p=0.02). The frequency of ASP in RA patients with low CVR did not depend on the diseases stage or activity and ongoing therapy. In RA, the detection of subclinical atherosclerosis was associated with traditional risk factors: carotid ASP were detected 4 times more often in men than in women (48% versus 12%, p0.01); carotid IMT correlated with age (R=0.46), body mass index (R=0.17), LDL-C level (R=0.20), systolic blood pressure (R=0.17); p0.05 in all cases. According to a multivariate model, in RA, the risk of developing ASP increased in the presence of dyslipidemia (odds ratio OR 2.97; 95% confidence interval CI 1.366.49; p=0.006) and arterial hypertension (OR 2.16; 95% CI 1.034.54; p=0.04). In RA patients with carotid ASP, sCD40L level was associated with carotid IMT (R=0.32; p=0.04) and cholesterol concentration (R=0.39; p=0.01). Conclusion. Subclinical atherosclerotic lesions of the carotid arteries were observed in 24% of RA patients with low cardiovascular risk and were detected almost 2 times more often than in the control group. In RA patients with low CVR, the risk of developing carotid ASP increased by 23 times with concomitant hypertension and dyslipidemia. The carotid IMT was associated with traditional risk factors age, gender, lipid levels and blood pressure indicators, in cases of detection of ASP with an immunoinflammatory marker sCD40L.