Background/Purpose:

Carotid intima media (cIMT) measurement is a validated surrogate measure of cardiovascular (CV) disease. Our aim was to evaluate baseline and follow-up cIMTs in a cohort of northern Alberta inflammatory arthritis (IA) biologic patients to determine if CIMT correlates with traditional CV factors, arthritis activity measures or risk scores.

Methods:

CIMT’s were performed on 83 IA patients at the Mazankowski Heart Institute as part of their evaluation in the “Cardiovascular Risk Reduction Clinic for Inflammatory Rheumatic Diseases” (CRRC). Univariate and multivariate logistic regression analyses evaluated associations between CV and IA risk factors and the composite outcomes (cIMT > 0.9 mm, presence of plaque or both). Change in cIMT or new plaques were evaluated with repeat cIMT at > 1 year in 13 patients.

Results:

CIMTs were performed on 83 IA patients, mean age 60 (SD 12) years, female:male = 58:28. Baseline characteristics included: disease duration 18 (SD 13) years, ESR 16 (SD 16) mm/hr, CRP 6 (SD 8) mg/L, 48 RF/anti-CCP + patients, DAS28 2.92 (SD 1.46). All patients had been on at least one biologic and 59 with past prednisone. Traditional CV risk factors included: 13 current smokers, 6 diabetics, 33 patients with systolic hypertension, 31 patients with dyslipidemia (mean values (mmol/L): total cholesterol 4.80 (SD 1.01), LDL 2.69 (SD 0.78), HDL 1.50 (SD 0.49), total cholesterol/HDL 3.38 (SD 0.91), triglycerides 1.41 (SD 0.76) mmol/L. Twenty-nine patients had family history of premature CVD, 14 patients with personal history of CVD, mean Framingham 12.5% (SD 8.1), mean Framingham with EULAR adjustment 22.0% (SD 13.4). Mean cIMT was 0.69 (SD 0.15) and 15 patients had one or more plaques. Age > 65 years old was associated with worse cIMT (> 0.9 mm) at baseline (OR 4.58 (95% CI 1.26-16.57). No significant change in cIMT or new plaque formation was seen in 13 patients with repeat cIMT at 1 year or longer. The composite score of cIMT > 0.9 & presence of plaque was associated with moderate Framingham risk score (with EULAR adjustment) (OR 18 (95% CI 1.65-196.35).

Conclusion:

Stability of cIMT over time is demonstrated, suggesting possible modification of the increased cardiovascular risk in this small sample of IA patients on biologics. Associations of cIMT with the EULAR-adjusted Framingham risk score requires further study.