Title: Comparison of Arterial Health in Patients with
Rheumatoid Arthritis to a Population-based Cohort

Background/Purpose: Patients with rheumatoid arthritis
(RA) have increased risk of cardiovascular disease (CVD). Vascular stiffness is
associated with increased cardiovascular risk in the general population. We aim
to characterize the differences in arterial health, including vascular
stiffness and endothelial function between patients with RA and no history of
CVD and a population-based cohort of non-RA patients without a known history of
CVD or RA.  

Methods: A set of arterial health tests were carried
out in patients with RA who were seen in our institution’s Cardio-Rheumatology Clinic
as part of a cardiovascular risk assessment. Assessment included 2-D carotid
artery ultrasound, brachial artery reactivity, and arterial tonometry. Data
from these patients were compared to normative data from the institution’s
cardiovascular healthcare clinic.  Each patient with RA was matched on age and
sex to 10 subjects from the comparison cohort. Diagnosis of RA was made by rheumatologists
according to the 2010 American College of Rheumatology/ European League Against
Rheumatism criteria. Comparisons between cohorts were performed using conditional
logistic regression.

Results:  The study cohort included 28 patients with RA
(mean age: 58.1 [SD:10.4] years; 82% female) compared to 280 controls (mean
age: 58.4 [SD:9.7] years; 82% female). Flow-mediated dilation (FMD) was higher
in the patients with RA (8.7±6.3 vs 6.2±4.9, p=0.014; Table) than controls. Hyperemic
flow was marginally higher in the patients with RA (458±255 vs 403±169, p=0.067).
Among our RA cohort, treatments included methotrexate in 61%, corticosteroids
in 39% and biologics in 54% at the time of arterial health studies.

Conclusion:  

In subjects without a history of CVD, vascular stiffness is
similar in patients with treated RA compared with subjects without RA. 
Patients with RA show a trend toward decreased augmentation pressure,
augmentation index and pulse wave velocity, consistent with increased arterial
stiffness.  Flow-mediated dilation was increased in patients with RA,
suggesting better endothelial function. Hyperemic response was similar in both
cohorts. It is possible that endothelial function in this population is
affected by RA therapies. These measures of arterial stiffness may also have
prognostic values for prediction of risk for CVD and lead to more targeted
prevention strategies to reduce this risk in this population that is already at
higher risk for CVD.

Table