Degree of arterial stiffness is comparable across inflammatory joint disease entities

Figures & data

Table 1. Patient characteristics

	IJD (n = 196)	RA (n = 109)	AS (n = 55)	PsA (n = 32)	p
Age (years)	57.2 ± 11.3	60.0 ± 10.3	51.6 ± 12.1	57.5 ± 9.5	< 0.001
Female	121 (62.1)	80 (73.4)	25 (45.5)	16 (50.0)	0.001
Disease duration (years)	13.0 (5.3–21.0)	13.0 (6.0–20.0)	14.0 (5.0–22.5)	11.0 (3.0–32.0)	0.896
CVD risk factors
Physically inactive	62 (31.6)	37 (33.9)	15 (27.3)	10 (31.3)	0.689
Smoker, current	31 (15.8)	17 (15.6)	9 (16.4)	5 (15.6)	0.994
Smoker, ever	98 (50.0)	56 (51.4)	23 (41.8)	19 (59.4)	0.257
Hypertension	84 (42.9)	47 (43.1)	22 (40.0)	15 (46.9)	0.820
Systolic blood pressure (mmHg)	129.5 ± 16.0	129.7 ± 17.6	129.0 ± 14.7	129.8 ± 12.5	0.961
Diastolic blood pressure (mmHg)	83.1 ± 10.8	82.9 ± 12.0	82.4 ± 10.0	84.9 ± 7.8	0.577
Mean arterial pressure (mmHg)	98.5 ± 11.7	98.4 ± 12.9	97.9 ± 12.9	99.8 ± 8.6	0.758
Total vascular resistance (mmHg/mL)	1.3 (1.2–1.4)	1.3 (1.2–1.4)	1.2 (1.1–1.4)	1.3 (1.1–1.5)	0.580
Cardiac output (L/min)	70.2 (63.8–80.5)	68.8 (60.6–78.4)	76.3 (66.9–86.9)	70.5 (63.5–80.5)	0.002
Heart rate (beats/min)	69.6 ± 12.8	71.2 ± 13.0	66.7 ± 12.4	69.1 ± 11.9	0.109
Diabetes	12 (6.2)	7 (6.5)	3 (5.5)	2 (6.3)	0.974
TC (mmol/L)	5.4 ± 1.1	5.5 ± 1.1	5.4 ± 1.2	5.3 ± 1.0	0.676
HDL-c (mmol/L)	1.6 (1.2–1.9)	1.7 (1.3–2.0)	1.6 (1.2–1.9)	1.4 (1.1–1.7)	0.031
LDL-c (mmol/L)	3.1 ± 1.0	3.1 ± 1.0	3.2 ± 1.1	3.0 ± 0.8	0.772
Triglycerides (mmol/L)	1.2 (0.9–1.7)	1.1 (0.9–1.5)	1.1 (0.8–1.7)	1.6 (1.0–2.3)	0.139
Dyslipidaemia or use of statins	169 (86.2)	97 (89.0)	40 (72.7)	32 (100)	0.001
ESR (mm/h)	11.5 (6.0–18.0)	14.0 (8.0–19.3)	7.0 (5.0–16.0)	9.0 (5.0–18.0)	0.019
CRP	2.0 (1.0–4.0)	2.0 (1.0–4.0)	2.0 (1.0–3.0)	2.0 (1.0–5.0)	0.196
Waist circumference (cm)	94.0 (84.0–103.0)	92.0 (83.0–100.0)	94.0 (85.0–100.0)	105.0 (92.0–114.5)	0.002
BMI (kg/m^2)	25.1 (22.2–29.0)	24.7 (21.8–27.8)	25.6 (22.7–29.4)	27.6 (23.2–32.9)	0.028
Family history of CVD	49 (25.1)	26 (25.0)	9 (16.4)	14 (46.7)	0.013
Patients with asymptomatic carotid plaque(s)	101 (51.8)	62 (56.9)	23 (41.8)	16 (50.0)	0.187
Number of carotid plaques	1.0 (0.0–2.0)	1.0 (0.0–2.0)	0.0 (0.0–1.0)	0.5 (0.0–1.0)	0.057
CVD risk
Established CVD	15 (7.7)	10 (9.2)	2 (3.6)	3 (9.4)	0.418
CVD risk by SCORE	1.5 (1.0–3.0)	2.0 (1.0–4.0)	1.0 (0.0–2.0)	1.0 (1.0–3.0)	0.036
CVD risk ≥ 10, carotid plaque(s), and/or established CVD	105 (53.6)	66 (60.6)	23 (41.8)	16 (50.0)	0.069
Medication
Prednisolone	35 (18.0)	30 (28.8)	3 (5.6)	2 (6.3)	< 0.001
NSAIDs	88 (44.9)	45 (41.3)	29 (52.7)	14 (43.8)	0.476
sDMARDs	101 (51.5)	77 (70.6)	9 (16.4)	15 (46.9)	< 0.001
bDMARDs	74 (37.8)	36 (33.0)	25 (45.5)	13 (40.6)	0.291
Anti-hypertensive therapy	42 (21.4)	22 (20.2)	14 (25.5)	6 (18.8)	0.822
Statins	31 (15.8)	24 (22.0)	4 (7.3)	3 (9.4)	0.028

Data are shown as n (%), mean ± sd, or median (interquartile range).

Data were compared by analysis of variance.

IJD, inflammatory joint disease; RA, rheumatoid arthritis; AS, ankylosing spondylitis; PsA, psoriatic arthritis; CVD, cardiovascular disease; TC, total cholesterol; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; BMI, body mass index; SCORE, Systematic COronary Risk Evaluation; NSAID, non-steroidal anti-inflammatory drug; sDMARD, synthetic disease-modifying anti-rheumatic drug; bDMARD, biological disease-modifying anti-rheumatic drug.

Figure 1. Differences in arterial stiffness, assessed by mean aortic pulse wave velocity (aPWV) and median augmentation index (AIx@75), across the inflammatory joint disease (IJD) entities: rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA). • Unadjusted data; ○ adjusted data. Error bars represent the standard error. *Significant difference (p < 0.05) from RA. aPWV adjusted for age and heart rate; AIx@75 adjusted only for age.

Table 2. Comparison of traditional cardiovascular disease (CVD) risk factors, haemodynamic factors, and medication use between patients with high and low aortic pulse wave velocity (aPWV)

		aPWV ≥ 10 (n = 36)	aPWV < 10 (n = 160)	p
Diagnosis	RA	27 (75.0)	82 (51.3)	0.022
	AS	4 (11.1)	51 (32.5)
	PsA	5 (13.9)	27 (16.9)
Age (years)		70.7 ± 5.5	54.2 ± 9.9	< 0.001
Female		27 (75.0)	94 (58.8)	0.070
Disease duration (years)		14 (8–26)	12 (5–21)	0.501
Physically inactive		13 (36.1)	49 (30.6)	0.540
Current smoker or smoked in the past		27 (75.0)	102 (63.8)	0.214
Hypertension		25 (69.4)	59 (36.9)	< 0.001
Systolic blood pressure (mmHg)		140.8 ± 16.0	127.0 ± 15.0	< 0.001
Diastolic blood pressure (mmHg)		85.1 ± 11.8	82.6 ± 10.6	0.215
Mean arterial pressure (mmHg)		103.4 ± 12.3	97.1 ± 11.3	0.004
Total vascular resistance (mmHg/mL)		1.2 (1.1–1.3)	1.3 (1.2–1.4)	0.069
Cardiac output (L/min)		70.4 (63.5–78.7)	70.2 (63.8–81.5)	0.605
Heart rate (beats/min)		77 ± 13	68 ± 12	< 0.001
Diabetes mellitus		3 (8.3)	9 (5.6)	0.553
TC (mmol/L)		5.4 ± 1.2	5.5 ± 1.1	0.877
HDL-c (mmol/L)		1.8 (1.4–2.2)	1.5 (1.2–1.9)	0.028
LDL-c (mmol/L)		2.9 ± 1.1	3.2 ± 1.0	0.148
Triglycerides (mmol/L)		1.1 (0.8–1.6)	1.2 (0.9–1.8)	0.606
Dyslipidaemia or use of statins		30 (85.7)	139 (92.1)	0.241
ESR (mm/h)		13.5 (7.8–20.3)	10.0 (5.0–17.0)	0.149
CRP (mg/L)		2.0 (1.0–5.3)	2.0 (1.0–4.0)	0.246
Waist circumference (cm)		91.0 (81.5–104.0)	94.0 (84.0–103.0)	0.693
BMI (kg/m^2)		24.6 (22.2–29.2)	25.5 (22.2–29.0)	0.531
Family history of CVD		10 (29.4)	39 (25.7)	0.653
Patients with asymptomatic carotid plaque(s)		27 (75.0)	74 (46.3)	0.002
Number of carotid plaques		2.00 (0.25–3.00)	0.00 (0.00–1.00)	0.001
Patients with established CVD		8 (22.2)	7 (4.4)	< 0.001
Prednisolone		12 (33.3)	23 (14.6)	0.008
NSAIDs		24 (70.6)	78 (49.4)	0.034
sDMARDs		20 (55.6)	81 (51.3)	0.299
bDMARDs		11 (30.6)	63 (39.9)	0.642
Anti-hypertensive therapy		15 (41.7)	69 (43.1)	0.873
Statins		14 (38.9)	17 (10.6)	< 0.001

Data are shown as n (%), mean ± sd, or median (interquartile range).

RA, rheumatoid arthritis; AS, ankylosing spondylitis; PsA, psoriatic arthritis; TC, total cholesterol; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; BMI, body mass index; NSAID, non-steroidal anti-inflammatory drug; sDMARD, synthetic disease-modifying anti-rheumatic drug; bDMARD, biological disease-modifying anti-rheumatic drug.

Table 3. Associations between arterial stiffness and cardiovascular disease (CVD) risk factors, haemodynamic factors, and medication use

	Univariate analysis		Multivariate analysis
	OR (95% CI)	p	OR (95% CI)	p
Age (years)	1.40 (1.25–1.58)	< 0.001	1.44 (1.26–1.65)	< 0.001
Gender (0 = female, 1 = male)	0.48 (0.21–1.08)	0.074	0.43 (0.10–1.89)	0.262
ln Disease duration (years)	1.15 (0.75–1.77)	0.528
Physically inactive	1.27 (0.59-2.71)	0.539
Current smoker or smoked in the past	1.68 (0.74–3.81)	0.217
Hypertension	3.89 (1.79–8.47)	0.001	–	–
Systolic blood pressure (mmHg)	1.07 (1.03–1.09)	< 0.001	–	–
Diastolic blood pressure (mmHg)	1.02 (0.99–1.06)	0.215	–	–
Mean arterial pressure (mmHg)	1.05 (1.01–1.08)	0.006	–	–
ln Total vascular resistance (mmHg/mL)	0.13 (0.01–2.28)	0.162
ln Cardiac output (L/min)	0.60 (0.07–5.01)	0.633
Heart rate (beats/min)	1.06 (1.03–1.09)	< 0.001	1.07 (1.02–1.12)	0.008
Diabetes mellitus	1.51 (0.39–5.86)	0.556
TC (mmol/L)	0.97 (0.70–1.36)	0.876
ln HDL-c (mmol/L)	3.47 (0.91–13.23)	0.068	0.45 (0.04–4.97)	0.513
LDL-c (mmol/L)	0.75 (0.50–1.11)	0.148
ln Triglycerides (mmol/L)	0.74 (0.24–2.26)	0.594
Dyslipidaemia or use of statins	0.52 (0.17–1.58)	0.248
ln ESR (mm/h)	1.41 (0.88–2.27)	0.159
ln CRP (mg/L)	1.18 (0.83–1.69)	0.356
ln Waist circumference (cm)	0.58 (0.03–11.12)	0.717
BMI (kg/m^2)	0.49 (0.06–3.76)	0.494
Family history of CVD	1.21 (0.53–2.75)	0.654
Asymptomatic carotid plaque(s)	3.49 (1.54–7.88)	0.003	–	–
ln Number of carotid plaques	2.33 (0.98–5.58)	0.057	–	–
Established CVD	6.25 (2.10–18.60)	0.001	–	–
Prednisolone	0.79 (0.30–2.05)	0.625
NSAIDs	0.43 (0.19–0.95)	0.037	–	–
sDMARDs	1.19 (0.57–2.46)	0.642
bDMARDs	0.66 (0.31–1.44)	0.301
Antihypertensive therapy	0.94 (0.45–1.96)	0.870
Statins	5.35 (2.32–12.37)	< 0.001	–	–

Blood pressure, presence/number of carotid plaques, established CVD, and medications were excluded from the final model as the cause–effect relationship with aPWV has not yet been fully clarified. In addition, blood pressure, presence/number of carotid plaques, and established CVD are correlated with age.

OR, odds ratio; CI, confidence interval; ln, natural logarithm; TC, total cholesterol; HDL-c, high-density lipoprotein cholesterol; LDL-c, low-density lipoprotein cholesterol; ESR, erythrocyte sedimentation rate; CRP, C-reactive protein; BMI, body mass index; SCORE, Systematic COronary Risk Evaluation; NSAID, non-steroidal anti-inflammatory drug; sDMARD, synthetic disease-modifying anti-rheumatic drug; bDMARD, biological disease-modifying anti-rheumatic drug.

Figure 2. Relationship between cardiovascular disease (CVD) risk estimation by the Systematic COronary Risk Evaluation (SCORE) algorithm and arterial stiffness, expressed as aortic pulse wave velocity (aPWV) and augmentation index (AIx@75). y(PWV) = 7.52 + 0.32x; r² (PWV) = 0.49. y(AIx@75) = 24.57 + 0.26x; r² (AIx@75) = 0.0038. Solid black line: regression line of aPWV; dashed black line: confidence interval of regression line of aPWV; solid grey line: regression line of AIx@75; dashed grey line: confidence interval of regression line of AIx@75.