Subclinical Atherosclerosis in Rheumatoid Arthritis and Systemic Lupus Erythematosus
Section snippets
Cardiovascular morbidity and mortality in the rheumatoid arthritis and systemic lupus erythematosus populations
Studies of populations and cohorts have clearly demonstrated that inflammatory diseases such as RA and SLE are associated with an increased mortality, largely as a consequence of cardiovascular disease. In a population-based cohort study of 606 rheumatoid factor–positive RA patients in Sweden between 1979 and 1994, the age-adjusted standardized mortality ratio for cardiovascular death was 50% higher in RA patients compared with age- and sex-matched controls.6 Similarly, data from the UK General
Carotid ultrasound studies to detect preclinical atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus: Studies measuring intimal-medial thickness
Although it is apparent that RA and SLE may enhance the risk for cardiovascular disease, the prevalence of preclinical atherosclerosis in these patients compared with the general population has been unclear. An approach to assessing the presence and extent of preclinical atherosclerosis is carotid ultrasonography. Because atherosclerosis is a systemic disease, there is strong correlation between coronary atherosclerosis and that in the carotid arteries.24 In the general population, carotid
Accelerated preclinical atherosclerosis in rheumatoid arthritis and systemic lupus erythematosus: Increased presence of carotid plaque
Although carotid IMT strongly predicts cardiovascular events45, 46 and is correlated with the formation of plaque,47, 48, 49 the presence of carotid plaques (which can be measured in a reproducible, noninvasive manner by ultrasonography36, 50, 51, 52) is a more reliable predictor of cardiovascular events than IMT.33, 53, 54 Because of the conflicting data regarding assessment of premature preclinical atherosclerosis in RA and SLE, we chose a direct measure of atherosclerotic plaque rather than
Clinical implications
It is well established that patients with RA and SLE die prematurely relative to the general population and that cardiovascular disease is an important driver of the increased mortality in these populations. Moreover, the increase in cardiovascular events in patients with RA and SLE occurs even in the absence of traditional risk factors for CHD. The higher rates of cardiovascular death in patients with more severe disease, supported by the suggestion in some studies that elevated inflammatory
Author disclosures
The author who contributed to this article have disclosed the following industry relationships:
Jane E. Salmon, MD, serves as a consultant to Genentech, Roche, and Wyeth; and has received an investigator–initiated research grant from Genentech.
Mary J. Roman, MD, has no financial arrangement or affiliation with a corporate organization or a manufacturer of a product discussed in this article.
Acknowledgment
We thank Ali Hassan, PhD, for assistance in drafting the manuscript for this article.
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