Ten-year risk of cardiovascular complications in patients with rheumatoid arthritis

Abstract


Aim. To compare 10-year risk of cardiovascular complications (CVC) assessed by Adult Treatment Panel III (ATP III) and Reynolds Risk Score (RRS); to specify contribution of C-reactive protein (CRP) to development of CVC in patients with rheumatoid arthritis (RA).
Material and methods. The trial included 116 RA patients (100 females and 16 males) and 85 healthy subjects (63 females and 22 males) under 55 years of age free of clinical symptoms of cardiovascular diseases. RA duration and activity were the same in men and women. The patients and controls were matched by age, incidence of standard risk factors (RF). The 10-year risk of CVC development was estimated by two scales - ATP III and RRS. Total cholesterin, HDLP cholesterin were measured with standard enzyme tests, concentration of CRP was assessed by highly sensitive immune nephelometry.
Results. The 10-year risk of CVC was higher in RA patients both by ATP III (1.8 - 1;10%) and RRS (2.6 - 2; 7)% compared to the controls (1 - 1;3)% and (1.2 - 1;4)% (p < 0.05). In male RA patients RRS is higher than in females - 7 (3.5; 12)% and 2 (1;2)%, respectively (p < 0.001). Re-calculation from the scale ATP III to RRS has changed the risk in 17 (17%) females and 7 (44%) males with RA. As a result, the number of RA patients with a low CVC risk decreased, with a moderate risk rose 2 times, with a high risk was the same. RRS dependence on the disease duration, RA activity (DAS28) was not registered. RA patients showed a positive correlation of RRS with thickness of the intima-media complex of the carotid arteries (r = 0.44; p < 0.001).
Conclusion. Introduction of a new prognostic scale RRS allows isolation of groups of patients with moderate and high CVC risk and timely medication of such patients.

About the authors

Elena Vladimirovna Gerasimova

Email: gerasimovaev@list.ru

Tat'yana Valentinovna Popkova

Email: tvpopkova@mail.ru

Diana Sergeevna Novikova

Email: diananovikova75@yandex.ru

Elena Nikolaevna Aleksandrova

Aleksandr Aleksandrovich Novikov

Evgeniy L'vovich Nasonov

Email: sokrat@irramn.ru

E V Gerasimova

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

T V Popkova

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

D S Novikova

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

E N Alexandrova

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

A A Novikov

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

E L Nasonov

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

Research Institute of Rheumatology of the Russian Academy of Medical Sciences, Moscow

References

  1. Демина А. Б. Ревматические болезни: анализ летальных исходов: Дис. ... канд. мед. наук. М.; 2005.
  2. Avina-Zubieta J., Choi H., Sadatsafavi M. et al. Risk of cardiovascular mortality in patients with rheumatoid arthritis: a meta-analysis of observational studies. Arthr. and Rheum. 2008; 59 (12): 1690-1697.
  3. Sokka Т., Abelson В., Pincus T. Mortality in rheumatoid arthritis: 2008 update. Clin. Exp. Rheumatol. 2008 (5, Suppl. 51): S35-S61.
  4. Meune C., Touze E., Trinquart L. et al. Trends in cardiovascular mortality in patients with rheumatoid arthritis over 50 years: systematic review and meta-analysis of cohort studies. Rheumatology (Oxford) 2009; 48 (10): 1309-1313.
  5. Douglas K., Adrain V., Treharne G. et al. Exsess recurrent cardiac events in rheumatoid arthritis with acute coronary syndrome. Ann. Rheum. Dis. 2005 1 (3): 348-353.
  6. Sódergren A., Stegmayr В., Lundberg A. et al. Increased incidence of and impaired prognosis after acute myocardial infarction among patients with seropositive rheumatoid arthritis. Ann. Rheum. Dis. 2007; 66: 263-266.
  7. Aubry M., Klemers M., Reinalda M. et al. Differences in atherosclerotic coronary heart disease between subjects with and without rheumatoid arthritis. J. Rheumatol. 2007; 34: 937-942.
  8. Попкова Т. В., Хелковская А. Н., Мач Э. С. и др. Сердечно-сосудистые заболевания при ревматоидном артрите. Тер. арх. 2007; 5: 9-14.
  9. Wang Т., Larson M., Levy D. et al. C-reactive protein is associated with subclinical epicardial coronary calcification in men and women: the Framingham Heart Study. Circulation 2002; 106 (10): 1189-1191.
  10. Ridker P. M. Clinical application of C-reactive protein for cardiovascular disease and prevention. Girculation 2003; 107: 363-369.
  11. Buckley D., Fu R., Freeman M. et al. C-reactive protein as a risk factor for coronary heart disease: a systematic review and meta-analyses for the U. S. Preventive Services Task Force. Ann. Intern. Med. 2009; 151 (7): 483-495.
  12. Ridker P., Buring J., Rifai N. et al. Development and validation of improved algorithms for assessment of Global Cardiovascular Risk in women. The Reynolds Risk Score. J. A. M. A. 2007; 297 (6): 611-619.
  13. Chung C. P., Oeser A., Raggi P. et al. Lipoprotein subclasses determined by nuclear magnetic resonance spectroscopy and coronary atherosclerosis in patients with rheumatoid arthritis. J. Rheumatol. 2010; 37 (8): 1633-1638.
  14. Ridker P., Paynter N., Rifai N. et al. C-reactive protein and history improve global cardiovascular risk prediction: the Reynolds Risk Score for men. Circulation 2008; 118: 2243-2251.
  15. Baka Z., Buzás E., Nagy G. Rheumatoid arthritis and smoking: putting the pieces together. Arthr. Res. Ther. 2009; 11 (4): 238.
  16. Scott D., Wolfe F., Huizinga T. Rheumatoid arthritis. Lancet 2010; 376 (9746): 1094-1108.
  17. Arnson Y., Shoenfeld Y., Amital H. Effects of tobacco smoke on immunity, inflammation and autoimmunity. J. Autoimmun. 2010; 34 (3): J258-J265.
  18. Boyer J., Gourraud P., Cantagrel A. et al. Traditional cardiovascular risk factors in rheumatoid arthritis: A meta-analysis. Jt Bone Spine 2010; Sep 16. 2010; 16: 105-109.
  19. Asia Pacific Cohort Studies Collaboration. A Comparison of Lipid Variables as Predictors of Cardiovascular Disease in the Asia Pacific Region. Ann. Epidemiol. 2005; 15: 405-413.
  20. Bittner V., Johnson В., Zineh I. et al. The triglyceride/high-density lipoprotein cholesterol ratio predicts all-cause mortality in women with suspected myocardial ischemia: a report from the Women's Ischemia Syndrome Evaluation (WISE). Am. Heart J. 2009; 157 (3): 548-555.
  21. Myasoedova E., Crowson C., Kremers H. et al. Total cholesterol and LDL levels decrease before rheumatoid arthritis. Ann. Rheum. Dis. 2010; 69 (7): 1310-1314.
  22. Lloyd-Jones D., Nam В., D'Agostino R. et al. Parental cardiovascular disease as a risk factor for cardiovascular disease in middle-aged adalts: a prospective study of parents and offspring. J. A. M. A. 2004; 291: 2204-2211.
  23. Hippisley-Cox J., Coupland C., Vinogradova Y. et al. Derivation and validation of QRISK, a new cardiovascular disease risk score for the United Kingdom: prospective open cohort study. Br. Med. J. 2007; 335: 136.
  24. Woodward M., Brindle P., Tunstall-Pedoe H. Adding social deprivation and family history to cardiovascular risk assessment: the ASSING core from the Scottish Heart Health Extended cohort. Heart 2007; 93: 172-176.
  25. Dessein P., Joffe В., Veller M. et al. Traditional and nontraditional cardiovascular risk factors are associated with atherosclerosis in rheumatoid arthritis. J. Rheumatol. 2005; 32: 435- 442.
  26. Насонов Е. Л., Панюгова Е. В., Александрова Е. Н. С-реактивный белок - маркер воспаления при атеросклерозе (новые данные). Кардиология 2002; 7: 53-62.
  27. Singh P., Hoffmann M., Wolk R. et al. Leptin induces C-reactive protein expression in vascular endothelian cells. Arterioscler. Thromb. Vasc. Biol. 2007; 27: 32-37.
  28. Montecucco F., Mach F. Common inflammatory mediators orchestrate pathophysiological processes in rheumatoid arthritis and atherosclerosis. J. Rheumatol. 2009; 48: 11-22.
  29. Koenig W., Lówel H., Baumert J. et al. C-Reactive protein modulates risk prediction based on the Framingham Score: implications for future risk assessment: results from a large cohort study in Southern Germany. Circulation 2004; 23: 1349- 1353.
  30. Gonzalez-Gay M., Conzalez-Juanatey C., Pineiro A. et al. High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis. J. Rheumatol, 2005; 32: 1219-1223.
  31. Goodson N., Symmons D., Scott D. et al. Baseeline levels of C-reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyarthritis: a ten-year followup study of a primary care-based inception cohort. Arthr. and Rheum. 2005; 52: 2293-2299.
  32. Попкова Т. В., Новикова Д. С., Насонов Е. Л. Атеротромбоз при аутоиммунных заболеваниях: современное состояние проблемы. Consilium Medicum 2008; 10 (11): 128-135.
  33. Del Rincon I., Williams K., Stern M. et al. Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects. Arthr. and Rheum. 2003; 48: 1833-1840.
  34. Vaudo G., Marchesi S., Gerli R. et al. Endothelial dysfunction in young patients with rheumatoid arthritis and low disease activity. Ann. Rheum. Dis. 2004; 63: 31-35.
  35. Pahor A., Hojs R., Gorenjak M. et al. Accelerated atherosclerosis in pre-menopausal female patients with rheumatoid arthritis. Rheumatol. Int. 2006; 27: 119-123.
  36. Aletaha D., Nell V., Stamm T. et al. Acute phase reactants add little to composit disease activity indices for rheumatoid arthritis: validation of a clinical activity score. Arthr. Res. Ther. 2005; 7: 796-806.
  37. Graf J., Scherzer R., Grunfeld C. et al. Levels of C-reactive protein associated with high and very high cardiovascular risk are prevalent in patients with rheumatoid arthritis. PLoS One 2009; 4 (7): 6242.
  38. Goodson N., Symmons D., Scott D. et al. Baseline levels of C-reactive protein and prediction of death from cardiovascular disease in patients with inflammatory polyarthritis: a ten-year followup study of a primary care-based inception cohort. Arthr. and Rheum. 2005; 52 (8): 2293-2299.
  39. Lee Y., Choi S., Ji J. et al. Lipoprotein (a) and lipids in relation to inflammatory in rheumatoid arthritis. Clin. Rheumatol. 2000; 19: 324-325.
  40. Попкова Т. В., Новикова Д. С., Новиков А. А. и др. Роль нарушений в системе транспорта холестерина крови в развитии атеросклероза при ревматоидном артрите. Науч.-практ. ревматол. 2007; 5: 4-10.
  41. Peters M., van Halm V., Nurmohamed M. et al. Relations between autoantibodies against oxidized low-density lipoprotein, inflammation, subclinical atherosclerosis, and cardiovascular disease in rheumatoid arthritis. J. Rheumatol. 2008; 35: 1495- 1499.
  42. Chung C., Oeser A., Raggi P. et al. Lipoprotein subclasses determined by nuclear magnetic resonance spectroscopy and coronary atherosclerosis in patients with rheumatoid arthritis. J. Rheumatol. 2010; 37 (8): 1633-1638.
  43. Aho K., Solonen J., Puska P. Autoantibodies predicting death due to cardiovascular disease. Cardiology 1982; 69: 125-129.
  44. Heliovaara M., Aho K., Knekt P. et al. Rheumatoid factor, chronic arthritis and mortality. Ann. Rheum. Dis. 1995; 54: 811-814.
  45. Liang K., Gabriel S. Autoantibodies: innocent bystander or key player in immunosenescence and atherosclerosis? J. Rheumatol. 2007; 34: 1203-1207.

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Copyright (c) 2020 Gerasimova E.V., Popkova T.V., Novikova D.S., Aleksandrova E.N., Novikov A.A., Nasonov E.L., Gerasimova E.V., Popkova T.V., Novikova D.S., Alexandrova E.N., Novikov A.A., Nasonov E.L.

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