Subclinical Atherosclerosis in Rheumatoid Arthritis in India

SUNDEEP GROVER, RAMANAND PRASAD SINHA, UTTAM SINGH, SATYENDRA TEWARI, AMITA AGGARWAL, and RAMNATH MISRA

ABSTRACT.

Objective. Patients with rheumatoid arthritis (RA) have high cardiovascular morbidity and mortality as compared to the general population. Indians are also at increased risk of developing early and severe atherosclerotic coronary artery disease. Carotid intima-media thickness as measured by ultrasound is a validated surrogate marker of atherosclerosis. We studied the prevalence of subclinical atherosclerosis in Indian patients with RA.

Methods. Common carotid IMT (CCA IMT) was measured at the level of carotid bifurcation along with fasting lipid profile in 57 RA patients and 45 age and sex matched controls. Values of mean CCA IMT above mean + 2 SD of the control group were defined as abnormal IMT. Variables of disease activity and severity were measured in RA patients. Patients and controls with known traditional cardiovascular risk factors were excluded from the study. Student t test and chi-square test for proportion were used for statistical analysis. A logistic regression analysis was done to find out independent predictors of abnormal IMT.

Results. Nineteen RA patients (33.3%) and 2 controls (4.44%) had abnormal IMT values. RA patients had significantly increased mean CCA IMT (0.558 ± 0.137 mm) as compared to controls (0.416 ± 0.002 mm; p < 0.0001). Age ≥ 42 years, duration of disease ≥ 6 years, and tender joint count ≥ 5 predicted increased risk of having abnormal CCA IMT in a logistic regression analysis.

Conclusion. One-third of Indian RA patients had subclinical atherosclerosis. Age and tender joint count were independent predictors of abnormal CCA IMT. (J Rheumatol 2006;33:244-7)

Key Indexing Terms:

ASIANS
INFLAMMATORY ARTHRITIS
CAROTID INTIMA-MEDIA THICKNESS

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From the Departments of Immunology and Cardiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.

S. Grover, MD (Medicine), Senior Resident in Clinical Immunology, Department of Immunology; R.P. Sinha, MD (Medicine), Senior Resident in Cardiology, Department of Cardiology; U. Singh, PhD (Statistics), Assistant Professor of Biostatistics, Department of Biostatistics; S. Tewari, MD (Medicine), DM (Cardiology), Associate Professor of Cardiology, Department of Cardiology; A. Aggarwal, MD (Medicine), DM (Clinical Immunology), Associate Professor of Clinical Immunology; R. Misra, MD (Medicine), Professor of Clinical Immunology, Department of Immunology.

Address reprint requests to Prof. R. Misra, Department of Immunology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, 226014, India. E-mail: rnmisra@sgpgi.ac.in

Accepted for publication August 28, 2005.

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