Cimt in Individuals with Rheumatoid Arthritis Compared to Individuals with Type2 Diabetes

Helen Pahau Sr.^1,2, Leanne Short³, Brian Haluskas⁴, Vibeke Videm⁵ and Ranjeny Thomas⁶, ¹Diamantina Institute, The University of Queensland, Woolloongabba, Australia, ²Diamantina Institute, University of Queensland Diamantina Institute, Brisbane, Australia, ³Cardiovascular Imaging Research Centre, University of Queensland, Woolloongabba, Australia, ⁴Cardiovascular Imaging Research Centre, the University of Queensland, Woolloongabba, Australia, ⁵Department of Laboratory Medicine, Children's and Women's Health, Norwegian University of Science and Technology, and Department of Immunology and Transfusion Medicine, Trondheim University Hospital,, Trondheim, Norway, ⁶University of Queensland Diamantina Institute, Brisbane, Australia

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Cardiovascular disease, Diabetes, intima medial thickness, rheumatoid arthritis (RA) and ultrasound

Session Information

Title: Imaging of Rheumatic Diseases: Ultrasound

Session Type: Abstract Submissions (ACR)

Background/Purpose

It is well known that patients with RA or Type 2 diabetes (T2DM) have increased risk of atherosclerosis and CVD. Carotid ultrasound measurement of the intima media thickness is the most commonly used method to validate progression of atherosclerosis. We aim to investigate the characteristics of cardiovascular risk and progression of carotid intima media thickness in individuals with Rheumatoid Arthritis compared to individuals with type2 diabetes.

Methods

Participants with T2DM were recruited from hospital clinics and the community in the same geographic area as RA participants. The participants with T2DM participated in a randomised trial of exercise intervention for 4 weeks and patients with previous CV events were excluded in that study. All participants were subjected to B-Mode ultrasonography of the common carotid artery to measure Carotid intima media thickness, and to undertake a physical assessment, routine laboratory investigations and history of CV risk profile. Average CIMT were measured on individuals with RA and individuals with Type2 diabetes at two time points, separated by a mean of 4.8 and 2.4 years respectively, using carotid duplex scanning and automated software.

Results

The study comprised 290 individuals: 78 with RA and 212 with T2DM. The RA patients were significantly older and had a higher proportion of smokers and previous CV events. The T2DM had higher BMI, diastolic blood pressure (BP) and triglycerides, lower HDL cholesterol and higher statin use.

At baseline, CIMT measurements were similar in the RA and T2DM cohorts at baseline (0.88mm (0.19) vs. 0.86 (0.21) p=0.80). Despite a shorter follow-up, 91 % of the T2DM cohort had CIMT at follow-up compared to 54 % of the RA cohort (p<0.0005). In a regression model for yearly rate of CIMT change, the only significant variables were diabetes (p<0.0005) and ever use of statins (p=0.01). Baseline CIMT was not significantly associated with the yearly rate of CIMT change. In a supplementary adjusted logistic regression analysis where the outcome was CIMT progression compared to unchanged or reduced CIMT, the OR for progression in T2DM compared to RA was 11.4 (5.2-25.0). In the RA cohort, DMARD use at baseline was associated with significantly lower CIMT values at follow-up (p=0.04).

Conclusion Diabetes patients have a much higher risk of CIMT progression than RA patients when adjusting for relevant risk factors and baseline CIMT.

Disclosure:

H. Pahau Sr.,
None;

L. Short,
None;

B. Haluskas,
None;

V. Videm,
None;

R. Thomas,
None.

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