Subclinical atherosclerosis in patients with rheumatoid arthritis

Pasquale Ambrosino; Roberta Lupoli; Alessandro Di Minno; Marco Tasso; Rosario Peluso; Matteo Nicola Dario Di Minno

doi:10.1160/TH14-11-0921

Thrombosis and Haemostasis, Table of Contents

Thromb Haemost 2015; 113(05): 916-930
DOI: 10.1160/TH14-11-0921

Review Article

Schattauer GmbH

Subclinical atherosclerosis in patients with rheumatoid arthritis

A meta-analysis of literature studies

Pasquale Ambrosino

¹Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

,

Roberta Lupoli

¹Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

,

Alessandro Di Minno

¹Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

,

Marco Tasso

¹Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

,

Rosario Peluso

¹Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

,

Matteo Nicola Dario Di Minno

¹Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy

²Unit of Cell and Molecular Biology in Cardiovascular Diseases, Centro Cardiologico Monzino, IRCCS, Milan, Italy

› Author Affiliations

Abstract

Summary

We performed a systematic review with meta-analysis and meta-regression of literature studies evaluating the impact of rheumatoid arthritis (RA) on common carotid artery intima-media thickness (CCAIMT) and on the prevalence of carotid plaques. Studies evaluating the relationship between RA and markers of cardiovascular (CV) risk (CCA-IMT and prevalence of carotid plaques) were systematically searched in the PubMed, Web of Science, Scopus and EMBASE databases. A total of 59 studies (4,317 RA patients and 3,606 controls) were included in the final analysis, 51 studies with data on CCA-IMT (52 data-sets on 3,600 RA patients and 3,020 controls) and 35 studies reporting on the prevalence of carotid plaques (2,859 RA patients and 2,303 controls). As compared to controls, RA patients showed a higher CCA-IMT (mean difference [MD]: 0.10 mm; 95 % confidence interval [CI]: 0.07, 0.12; p < 0.00001), and an increased prevalence of carotid plaques (odds ratio [OR]: 3.61; 95 %CI: 2.65, 4.93; p< 0.00001). Interestingly, when analysing studies on early RA, the difference in CCAIMT among RA patients and controls was even higher (MD: 0.21 mm; 95 %CI: 0.06, 0.35; p=0.006), and difference in the prevalence of carotid plaques was entirely confirmed (OR: 3.57; 95 %CI: 1.69, 7.51; p=0.0008). Meta-regression models showed that male gender and a more severe inflammatory status [as expressed by disease activity score in 28 joints (DAS28), C-reactive protein (CRP) levels, and erythrocyte sedimentation rate (ESR)] significantly impacted on CCA-IMT. In conclusion, RA appears significantly associated with subclinical atherosclerosis and CV risk. These findings can be useful to plan adequate prevention strategies and therapeutic approaches.

Keywords

Rheumatoid arthritis - cardiovascular risk - intima-media thickness - carotid plaques

Full Text

References

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