Date Published: January 19, 2017
Publisher: Public Library of Science
Author(s): Piero Ruscitti, Paola Cipriani, Francesco Masedu, Silvio Romano, Onorina Berardicurti, Vasiliki Liakouli, Francesco Carubbi, Paola Di Benedetto, Saverio Alvaro, Maria Penco, Marco Valenti, Roberto Giacomelli, Ying-Mei Feng.
Several studies showed the close relationship between Rheumatoid Arthritis (RA) and cerebro-cardiovascular events (CVEs) and subclinical atherosclerosis. In this study, we investigated the occurrence of CVEs and subclinical atherosclerosis during the course of RA and we evaluated the possible role of both traditional cardiovascular (CV) and disease related risk factors to predict the occurrence of new CVEs and the onset of subclinical atherosclerosis.
We designed a single centre, bias-adjusted, prospective, observational study to investigate, in a homogeneous subset of RA patients, the occurrence of new onset of CVEs and subclinical atherosclerosis. Statistical analyses were performed to evaluate the role of traditional CV and disease-related risk factors to predict the occurrence of new CVEs and subclinical atherosclerosis.
We enrolled 347 RA patients prospectively followed for 12 months. An increased percentage of patients experienced CVEs, developed subclinical atherosclerosis and was affected by systemic arterial hypertension (SAH), type 2 diabetes mellitus and metabolic syndrome (MS), at the end of follow up. Our analysis showed that the insurgence of both SAH and MS, during the follow up, the older age, the CVE familiarity and the lack of clinical response, were associated with a significantly increased risk to experience CVEs and to develop subclinical atherosclerosis.
Our study quantifies the increased expected risk for CVEs in a cohort of RA patients prospectively followed for 1 year. The occurrence of both new CVEs and subclinical atherosclerosis in RA patients may be explained by inflammatory burden as well as traditional CV risk factors.
Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease characterized by progressive joint destruction, associated with extra-articular manifestations, affecting different internal organs . Interestingly, these patients show an increased risk of mortality when compared to general population and recent evidence clearly confirmed that this risk is largely due to cerebro-cardiovascular events (CVEs) [2,3]. In addition, several studies showed the close relationship between RA and specific cardiovascular (CV) events, including myocardial infarction (MI), cerebrovascular accident (CVA) and congestive heart failure (CHF) [4,5].
This study clearly shows that in our RA cohort, prospectively followed for 1 year, at month 12, the percentage of patients with CVEs and/or displaying subclinical atherosclerosis doubles, when compared with the same items at the beginning of the observation. Furthermore, we identified some traditional CV risk factors as well as RA-related factors which are involved in the development of CV complications.
In conclusion, our prospective longitudinal observational study, overcomes some possible limitation, which are correlated with the specific design of clinical trials  and quantifies the increased expected risk for CVEs in a cohort of patients prospectively followed for 1 year. The occurrence of both new CVEs and subclinical atherosclerosis in RA patients may be explained by inflammatory burden as well as traditional CV risk factors. At present, we identified that the failure in suppressing the inflammatory process is the main RA-related variable, influencing the risk to develop new CVEs. As far as the traditional CV risk factors are concerned, we showed that SAH, MS, familiarity for CV diseases and older age are significantly associated with the risk to develop new CVEs. Furthermore, our results strongly suggest the need of optimal control of the disease activity to prevent the insurgence of new CVEs. Future longitudinal analyses, on larger cohorts of patients, with longer follow-up may reinforce these data, and suggest the better therapeutic strategies to prevent the occurrence of CVEs, which are, at present, the main cause of death in these patients.