Carotid artery plaque in women with rheumatoid arthritis and low estimated cardiovascular disease risk: a cross-sectional study

被引:29
作者
Corrales, Alfonso [1 ]
Dessein, Patrick H. [2 ,6 ]
Tsang, Linda [2 ]
Pina, Trinitario [1 ]
Blanco, Ricardo [1 ]
Gonzalez-Juanatey, Carlos [3 ]
Llorca, Javier [4 ,5 ]
Gonzalez-Gay, Miguel A. [1 ,2 ]
机构
[1] IDIVAL, Epidemiol Genet & Atherosclerosis Res Grp Syst In, Div Rheumatol, Santander 39011, Spain
[2] Univ Witwatersrand, Sch Physiol, Fac Hlth Sci, Cardiovasc Pathophysiol & Genom Res Unit, ZA-2193 Johannesburg, South Africa
[3] Hosp Lucus Augusti, Div Cardiol, Lugo 27003, Spain
[4] Univ Cantabria, Sch Med, Dept Epidemiol & Computat Biol, Santander 39011, Spain
[5] IDIVAL, CIBER Epidemiol & Salud Publ CIBERESP, Santander 39011, Spain
[6] Univ Witwatersrand, Sch Physiol, ZA-2193 Johannesburg, South Africa
基金
英国医学研究理事会; 新加坡国家研究基金会;
关键词
SUBFRACTIONS HDL2; ATHEROSCLEROSIS; MANAGEMENT; EVENTS; SCORE; STRATIFICATION; CLASSIFICATION; ULTRASOUND; FRAMINGHAM; CRITERIA;
D O I
10.1186/s13075-015-0576-7
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction: We previously reported that most patients with rheumatoid arthritis (RA) and moderate cardiovascular disease (CVD) risk according to the Systematic COronary Evaluation score (SCORE) experience carotid artery plaque. In this study, we aimed to identify patient characteristics that can potentially predict carotid plaque presence in women with RA and a concurrent low CVD risk according to the SCORE. Methods: A cohort of 144 women with an evaluated low risk of CVD (SCORE value of zero) was assembled amongst 550 consecutive patients with RA that underwent CVD risk factor recording and carotid artery ultrasound. Participants had no established CVD, moderate or severe chronic kidney disease, or diabetes. We assessed carotid plaque(s) presence and its associated patient characteristics. Results: Carotid artery plaque was present in 35 (24.3%) of women with RA. Age, the number of synthetic disease-modifying agents (DMARDs) and total cholesterol concentrations were independently associated with plaque in multivariable stepwise backward regression analysis (odds ratio (95% confidence interval) = 1.15 (1.07 to 1.24), P < 0.0001, 1.51 (1.05 to 2.17), P = 0.03 and 1.66 (1.00 to 2.73) P = 0.04), respectively). The area under the curve (AUC) of the receiver operating curve (ROC) for the association with plaque was 0.807 (P < 0.0001), 0.679 (P = 0.001) and 0.599 (P = 0.08) for age, total cholesterol concentrations and number of synthetic DMARDs used, respectively. The optimal cutoff value in predicting plaque presence for age was 49.5 years with a sensitivity and specificity of 74% and 75%, respectively, and for total cholesterol concentration, it was 5.4 mmol/l with a sensitivity and specificity of 63% and 70%, respectively. The plaque prevalence was 37.5% in patients (n = 80; 55.6%) with age > 49.5 years or/and total cholesterol concentration of > 5.4 mmol/l, respectively, compared to only 7.8% in those (n = 64; 44.4%) with age = 49.5 years or/and total cholesterol concentration of = 5.4 mmol/l, respectively. Conclusions: Approximately one-third of women with RA who experience a low SCORE value and are aged > 49.5 years or/and have a total cholesterol concentration of > 5.4 mmol/l, experience high-risk atherosclerosis, which requires intensive CVD risk management.
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页数:8
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