ARTERIAL STIFFNESS IN RHEUMATOID ARTHRITIS PATIENTS AS A POTENTIAL PREDICTOR OF EARLY CARDIOVASCULAR AGEING AND MORBIDITY

Background: Cardiovascular disease (CVD) is one of the most common causes of death in Rheumatoid arthritis patients. Increased arterial stiffness is considered as an independent risk factor of development CVD and a predictor of all-cause morbidity and mortality. Increased arterial stiffness, due to premature vascular ageing, can be observed in patients with chronic inflammatory diseases as well as in RA patients. Objectives: To evaluate arterial stiffness determined as carotid – femoral pulse wave velocity in rheumatoid arthritis patients. The comparison of traditional and nontraditional risk factor of CVD, disease activity and laboratory findings connected with subclinical atherosclerotic changes. Methods: We evaluated data of 50 patients with rheumatoid arthritis (39 females, 11male, mean age 57, mean duration of disease of 13years). The arterial stiffness, measured as carotid – femoral pulse wave velocity (PWV), was established with the SphygmoCor system. This non-invasive technique uses the principle of applanation tonometry. Our control group counted 25 heathy male and females with no history of CVD or autoimmune disease. We evaluated the influence of traditional risk factors for CVD as age, smoking, BMI, lipid profile, diabetes mellitus, history of CV and cerebrovascular morbidity to PWV in RA patients. Non-traditional risk factors contained Adiponectin, Fetuin A, Endothelin-1 and Asymmetric dimethylarginine. To measure disease activity was used DAS 28 and inflammatory parameters as a marker of current disease activity. For chronic changes was used X-ray of small joints. Results were correlated with PWV and statistically evaluated. Results: Mean PWV in Rheumatoid arthritis patients was significantly higher (9.7 m/s) than that in healthy control group (6.7m/s). 49% of RA patients (n= 24) had increased arterial stiffness according to their age. 32% patients (n=16) with PWV over 10m/s that indicates aortal function alteration. We didn´t find correlation between arterial stiffness and traditional and non-traditional CVD risk factors. Increased PWV was not associated with high disease activity. Patients with higher arterial stiffness according to their age had longer RA history, higher level of rheumatoid factor, were more frequently anti-citrullinated protein antibodies (ACPA) negative and were more frequently treated with biological therapy. Conclusion: Rheumatoid arthritis patients are in increased risk of CV disease. PWV is considered as an independent risk factor of CVD. We proved increased arterial stiffness and vascular ageing in comparison to healthy controls. We did not find correlation between increased arterial stiffness and disease activity. All CVD risk factor intervention is necessary to improve the prognosis of patients. Further investigation is needed to establish the role of increased PWV in RA patients. References: [1]Reference Values for Arterial Stiffness’ Collaboration. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: ‘establishing normal and reference values’. Eur Heart J. 2010;31(19):2338–2350. [2]Pasquale Ambrosino, Marco Tasso, Roberta Lupoli, Alessandro Di Minno, Damiano Baldassarre, Elena Tremoli & Matteo Nicola Dario Di Minno. Non-invasive assessment of arterial stiffness in patients with rheumatoid arthritis: A systematic review and meta-analysis of literature studies, Annals of Medicine, 2015; 47:6, 457-467. Acknowledgments: IGA_LF_2019_006, MZ C-RVO (FNOL-00098892, 87-21) Disclosure of Interests: Marketa Schubertova: None declared, Andrea Smržova: None declared, Pavel Horak Speakers bureau: Pfizer, Abbvie, Eli lilly. Novartis, Roche, Sanofi, Martina Skacelova: None declared, Eva Lokocova: None declared, Zuzana Heřmanova: None declared, Frantisek Mrazek: None declared