Are Brachiocephalic Atherosclerotic Plaques to be considered as Predictors of Myocardial Infarction in Rheumatoid Arthritis Patients

Introduction: Carotid ultrasound based on assessment of intima media thickness (IMT) and presence of plaques has been considered to be a cheap and efficient way to measure clinical atherosclerosis. Both carotid IMT and carotid plaques have been proved to be good predictors of CV (cardiovascular) events of rheumatic patients, offering additional value to the traditional risk scores in the prediction of CVD (cardiovascular disease). The objective of the study was to determine whether atherosclerotic brachiocephalic plaques, traditional CV risk factors as well as RA (rheumatoid arthritis) disease activity have an effect on the risk of myocardial infarction in RA patients with comparable disease duration. Methods: A case control study was performed within the prospective cohort of 92 RA patients, out of them were female 81%, aged 40-84. In cases there were 20 patients who had developed their first myocardial infarction (MI) after the diagnosis of RA. The case and control groups were matched by sex and disease duration. RA activity and severity were determined by DAS28 scores and HAQ questionnaires, ultrasonography of synovitis. Information about traditional (BMI, smoking history, diabetes mellitus, primary arterial hypertension) and disease-specific risk factors was thoroughly gathered. AIP (atherogenic index of plasma (log10 TG/HDLC) was calculated. Brachiocephalic artery hemodynamic parameters, IMT and plaques were assessed using the high resolution B mode and Doppler–mode ultrasound. Results: Patients with MI (myocardial infarction) were older in comparison to control RA patients, mostly females (85%). The case and control groups were matched by disease duration and gender. One of the classic risk factors for 95% of patients with MI had been suffering from arterial hypertension (HTN). The odds ratio for MI patients with HTN was 12 (95% CI 1.5 to 95.4). Seropositivity, erosions and synovitis of small joints, joint replacement surgery was similar for case and control groups. Seropositivity was found in 95% of the case group. Despite that, RF (rheumatoid factor) was more presented in case group. High RA disease activity (DAS 28 above 5.1) was observed among 55% of patients with MI (p=0.007). The odds ratio for MI patients with a high disease activity (DAS 28>5.1) was 3.95 (95% CI 1.40 to 11.13). About 50% of cases were smokers. Smoking status, BMI, diabetes, atherogenix index did not differ between cases and controls. IMT (intima media thickness) dx et sin were age dependent, correlated with hemodinamicaly non-significant atherosclerotic plaques. Furthermore, atherosclerotic lesions were not more pronounced in RA patients with versus without CVD. Non-hemodinamicaly significant atherosclerotic plaques and IMT sin were associated with hypertensive disease. Conclusion: In our case-control study, MI was observed in older individuals RF positive, being positively associated with systolic arterial hypertension. Increased risk to MI was found in patients with high disease activity evaluated as DAS 28 above 5.1.