Non-invasive assessment of arterial stiffness in patients with rheumatoid arthritis: A systematic review and meta-analysis of literature studies

Abstract

Introduction. Patients with rheumatoid arthritis (RA) have an increased cardiovascular (CV) morbidity and mortality. Pulse-wave velocity (PWV) and augmentation index (AIx) are non-invasive methods to assess arterial stiffness, a marker of CV risk. We performed a meta-analysis evaluating the impact of RA on aortic-PWV, brachial-PWV, brachial–ankle (ba-) PWV, AIx, and AIx normalized to a 75 beats/minute heart rate (AIx@75).

Materials and Methods. Studies evaluating the relationship between RA and aortic-PWV, brachial-PWV, ba-PWV, AIx, and AIx@75 were systematically searched. A total of 25 studies (1,472 RA patients, 1,583 controls) were included.

Results. Compared to controls, RA patients showed a significantly higher aortic-PWV (mean difference 1.32 m/s; 95% CI 0.77, 1.88; P < 0.00001), ba-PWV (MD 198.42 cm/s; 95% CI 45.79, 342.76; P = 0.01), AIx (MD 11.50%; 95% CI 5.15, 17.86; P = 0.0004), and AIx@75 (MD 6.99%; 95% CI 4.92, 9.06; P < 0.00001), with a trend toward a higher brachial-PWV (MD 0.34 m/s; 95% CI –0.03, 0.70; P = 0.07). When analyzing studies on early RA, the difference in aortic-PWV among RA patients and controls was even higher (MD 2.30 m/s; 95% CI 1.15, 3.45; P < 0.0001).

Conclusion. Meta-regression showed that a more severe inflammatory status impacted on aortic-PWV, AIx, and AIx@75. Arterial stiffness, a recognized marker of CV risk, is increased in RA patients. This alteration is associated with the severity of the inflammatory status and is present even in early-stage disease.

Key words::

• Arterial stiffness
• augmentation index
• cardiovascular risk
• pulse-wave velocity
• rheumatoid arthritis

Acknowledgements

The authors want to thank the members of the CaRRDs (Cardiovascular Risk in Rheumatic Diseases) study group: Matteo Nicola Dario Di Minno, Roberta Lupoli, Antonella Scalera, Alessandro Di Minno, Pasquale Ambrosino, Giovanni Tarantino, Giovanni Di Minno (Department of Clinical Medicine and Surgery, Regional Reference Centre for Coagulation Disorders, Federico II University, Naples, Italy); Rosario Peluso, Raffaele Scarpa (Department of Clinical Medicine and Surgery, Rheumatology Research Unit, Psoriatic Arthritis Clinic, Federico II University, Naples, Italy); Paolo Osvaldo Rubba (Department of Clinical Medicine and Surgery, Atherosclerosis Prevention and Vascular Medicine Unit, Federico II University, Naples, Italy); and Salvatore Iervolino (Rheumatology and Rehabilitation Research Unit, ‘Salvatore Maugeri’ Foundation, Scientific Institute of Telese Terme, Benevento, Italy).

Funding: This study has been performed in the frame of the project entitled ‘Biomarkers of Cardiovascular Risk and Disease Activity in Patients with Psoriatic Arthritis: Modifications Induced by Treatment with TNF-alpha Blockers’ (GR-2011-02352752) funded by the Italian Ministry of Health.

Declaration of interest: Matteo Nicola Dario Di Minno has acted as paid lecturer or board member and received grants and honoraria from Bayer, Biotest, Pfizer, and Novo-Nordisk in the last 36 months for researches unrelated to the present study. All the other authors have nothing to declare.

Supplementary material available online

Supplementary Tables I-II and Figures 1–3 to be found online at http://informahealthcare.com/doi/abs/10.3109/07853890.2015.1068950