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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2009;29:1702.)
© 2009 American Heart Association, Inc.

Clinical and Population Studies

Atherosclerosis in Rheumatoid Arthritis Versus Diabetes

A Comparative Study

Kimon S. Stamatelopoulos; George D. Kitas; Christos M. Papamichael; Elda Chryssohoou; Katerina Kyrkou; George Georgiopoulos; Athanassios Protogerou; Vasileios F. Panoulas; Aamer Sandoo; Nikolaos Tentolouris; Myron Mavrikakis; Petros P. Sfikakis

From the Vascular Laboratory, Department of Clinical Therapeutics (K.S.S., C.M.P., E.C., K.K., G.G., A.P., M.M.), Alexandra Hospital, Greece; the Dudley Group of Hospitals NHS Foundation Trust, Dudley, and Arthritis Research Campaign Epidemiology Unit (G.D.K., V.F.P., A.S.), University of Manchester, UK; and the First Department of Propaedeutic and Internal Medicine (N.T., P.P.S.), Laikon Hospital, Athens University Medical School, Greece.

Correspondence to Kimon Stamatelopoulos, MD, "Alexandra" Hospital, 80, Vassilissis Sofias Ave, Athens GR, PO box 11528. E-mail stamatelopoulosk{at}yahoo.gr

Objective— The extent to which atherosclerosis is accelerated in chronic inflammatory diseases is not established. We compared preclinical atherosclerosis in rheumatoid arthritis with diabetes mellitus, a known coronary heart disease equivalent.

Methods and Results— Endothelial function, arterial stiffness, carotid intima-media thickness, and analysis of atheromatous plaques were examined in 84 rheumatoid arthritis patients without cardiovascular disease versus healthy controls matched for age, sex, and traditional cardiovascular disease risk factors, as well as in 48 diabetes patients matched for age, sex, and disease duration with 48 rheumatoid arthritis patients. Rheumatoid arthritis duration associated with arterial stiffening, whereas disease activity associated with carotid plaque vulnerability. All markers of preclinical atherosclerosis were significantly worse in rheumatoid arthritis compared to controls, whereas they did not differ in comparison to diabetes despite a worse cardiovascular risk factor profile in diabetics. Both diseases were associated independently with increased intima-media thickness; rheumatoid arthritis, but not diabetes, was independently associated with endothelial dysfunction.

Conclusions— Preclinical atherosclerosis appears to be of equal frequency and severity in rheumatoid arthritis and diabetes of similar duration with differential impact of traditional risk factors and systemic inflammation. Cardiovascular disease risk factors in rheumatoid arthritis may need to be targeted as aggressively as in diabetes.

In this cross-sectional case–control study, preclinical atherosclerosis appears to be of comparable frequency and severity in rheumatoid arthritis and diabetes, a known coronary heart disease equivalent, with differential impact of traditional risk factors and systemic inflammation. These results may have clinical implications on cardiovascular disease prevention strategies in rheumatoid arthritis.

Key Words: preclinical atherosclerosis • rheumatoid arthritis • diabetes mellitus • inflammation