Accelerated atherosclerosis in premenopausal women with rheumatoid arthritis – A 15-year follow-up study

Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increased mortality and morbidity due to the higher risks for cardiovascular disease. Traditional risk factors are insufficient to predict accelerated atherosclerosis in RA patients. The aim of this long-term prospective study was to investigate the relationships of asymptomatic atherosclerosis with traditional risk factors as well as inflammatory markers in patients with RA and matched healthy controls. Laboratory test results, concentrations of inflammatory mediators, matrix metalloproteases (MMP) and inflammation markers in a total of 70 (60 at follow-up) premenopausal healthy women with RA and 40 (34 at follow-up) matched controls were compared. B-mode ultrasound was applied for imaging of the carotid arteries for detection of asymptomatic atherosclerosis. Correlations with different factors were evaluated. The expression levels of intercellular adhesion molecules, vascular cell adhesion molecules (VCAMs), interleukin 6, tumour necrosis factor alpha and MMP-3 were significantly higher in the patient group during the follow-up period. The extent of plaque formation was greater in the patient group as compared to that in the control group (42.4% vs. 12.9%, respectively, p = 0.005), as was the cIMT (p = 0.001). By bivariate regression analysis, only VCAM expression was predictive of plaque formation (r = 0. 341, p = 0.016), but not for cIMT (r = −0.130, p = 0.327) in premenopausal female patients with RA at 15 years. These findings indicate that asymptomatic atherosclerosis is accelerated in premenopausal women with RA. During follow-up, there was an association between inflammation and accelerated atherosclerosis. Furthermore, VCAM was significantly correlated with plaque formation in RA patients.