Background/Purpose: Cardiovascular (CV) risk assessment is infrequently performed in Familial Mediterranean Fever (FMF), an autoinflammatory disorder with only acute attacks of inflammation. As a surrogate marker of atherosclerosis, carotid intima media thickness (cIMT) is shown to be increased in FMF in previous studies, but the association of cIMT with traditional cardiovascular risk scores is not explored. In this study we aimed to investigate cIMT in FMF and show its relationship to traditional cardiovascular risk scores, disease severity and attack frequency.

Methods: In this cross sectional study, consecutive FMF patients (n=60, M/F: 30/30, mean age= 36.5±9.7 years) were compared to healthy controls (n=60, M/F: 29/31, mean age= 36.8±8.7 years). 10-year CV risk was assesed by 2013 American College of Cardiology/American Heart Association (ACC/AHA) CV risk estimator. FMF severity score-2 (F-SS-2) score was implemented to FMF patients to determine disease severity. Genetic mutations of FMF patients were also recorded.

Results: M694V was positive in 63% of FMF patients, either homozygote, heterozygote or compound heterozygote. 48% of FMF patients had mild, 22% had intermediate and 30% had severe disease according to F-SS-2. Groups were similar in demographic, clinical and biochemical parameters, except for sedimentation rate which was 10±4 mm in control group and 18±11 mm in the FMF group (p< 0.001). ACC/ AHA risk scores were similar in both groups: 2.5±2.9) in FMF patients vs. 2.4±2.1 in controls (p= 0.93). However, median cIMT was significantly higher in the FMF group compared to controls (FMF: 0.59 mm (IQR= 0.17) vs Controls: 0.52 mm (IQR= 0.13), p= 0.002). Patients with severe disease had a higher mean cIMT of 0.62±0.09 mm than those with non-severe disease (0.57±0.09 mm (p= 0.045). In multiple regression analysis for all participants, only age and CRP positivity are significantly associated with CIMT (p< 0.001 and p= 0.001 respectively). In the FMF group, attack frequency while on colchicine treatment (rho= 0.40, p= 0.002) correlated with CIMT, whereas attack frequency before starting colchicine was not associated (r= 0.08, p= 0.53).

Conclusion: cIMT was significantly increased in FMF, but traditional cardiovascular risk scores failed to reflect this change. Attack frequency, which may reflect unsuppressed inflammation, may contribute to the increased cIMT. Therefore, our data suggests that FMF patients, especially those with high attack frequency and severe disease, should be monitored more closely for ischemic CV disease. Further studies are also required to clarify whether better disease control leads to improved cIMT levels.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/disease-severity-and-high-attack-frequency-under-colchicine-treatment-is-associated-with-increased-carotid-intima-media-thickness-in-fmf/