Background/Purpose:   Measures of arterial health may be useful in assessing the risk of atherosclerotic cardiovascular disease (ASCVD) in patients with rheumatoid arthritis (RA). The objective of this study was to determine if our innovative arterial health testing panel would identify early ASCVD that is not reflected in traditional CV risk scores in patients with RA. The AHA/ACC Pooled Cohort Equation (estimated 10-year CV risk %) is used to classify patients as low/intermediate/high risk. Our study evaluated early CV disease (plaque presence, carotid intima media thickness) using non-invasive arterial health testing in RA patients classified in the low/intermediate CV risk category.

Methods:   50 patients with RA underwent non-invasive arterial health testing (brachial artery reactivity testing, pulse wave velocity, and carotid intima media thickness [CIMT] and plaque presence) and calculation of the estimated 10 year CV risk (%) using the AHA/ACC Pooled Cohort Equation. Comparisons between non-invasive arterial health measures and the low/intermediate/high risk category as identified by the AHA/ACC Pooled Cohort Equation (10-year risk %) were performed using chi-square and rank sum tests. Descriptive statistics were examined to determine whether we could identify early CV disease (plaque presence) in patients typically classified as low or intermediate risk.

Results:   In the 50 patients (mean age: 57.5 years; 76% female, mean RA disease duration: 6.4 years), the AHA/ACC Pooled Cohort Equation (10-year risk %, as measured as low <4%, intermediate 4-7.5%, and high >7.5%) was used to estimate CV risk. Carotid plaques were found in 7 of 21 (33%) patients with low AHA/ACC risk, 11 of 15 (73%) patients with intermediate AHA/ACC risk, and 2 of 8 (25%) patients with high AHA/ACC risk. Plaque in the intermediate AHA/ACC risk group was identified as mild in 9 (82%) and severe in 2 (18%) of the 11 patients with plaques. Brachial artery reactivity testing showed that hyperemic forearm flow was highest in the high risk category (median 712 compared to 510 in intermediate risk and 459 in low risk, p=0.048). No significant differences were identified with measures of arterial stiffness, such as pulse pressure, aortic pulse wave velocity, aortic augmentation index and corrected aortic augmentation index between low, intermediate, and high risk categories. The mean CIMT was highest in the high risk group (median 0.9 compared to 0.8 in intermediate and 0.7 in low risk, p=0.006), and maximal common carotid IMT highest in the high risk group as well (p=0.01).

Conclusion:   Among patients with RA considered to have intermediate CV risk by the AHA/ACC Pooled Cohort Equation (4-7.5% AHA/ACC risk), non-invasive arterial health testing identified a high proportion of patients with both mild and severe carotid plaques. The presence of carotid plaques may identify early ASCVD that is not adequately predicted by standard CV risk scores calculators.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/cardiovascular-risk-assessment-in-persons-with-rheumatoid-arthritis-non-invasive-arterial-health-testing-to-assess-subclinical-risk-of-cardiovascular-disease/