EditorialEndothelial Dysfunction, Carotid Intima-Media Thickness, and Accelerated Atherosclerosis in Rheumatoid Arthritis
Section snippets
Endothelial Dysfunction in Rheumatoid Arthritis
Vascular endothelial injury is the primary event in atherosclerosis (11). It has been associated with endothelial dysfunction (12), which is the most important step in early atherogenesis and also contributes to the development of clinical features in the later stages of vascular disease including progression of atherosclerotic plaque (13, 14).
The endothelium modulates vascular tone by releasing a number of vasoactive substances including nitric oxide in response to mechanical stress (15).
Carotid IMT Another Surrogate Marker of Atherosclerosis in RA
Carotid IMT of the common carotid artery, determined by high-resolution B-mode ultrasonography, is a useful noninvasive anatomic structural measure of subclinical CV disease. It constitutes an excellent surrogate marker of macrovascular atherosclerotic disease. This is the most popular technique used to study the early structural changes in the arterial wall.
Case-control studies have shown that increased common carotid artery IMT determined by this technique is a good indicator of generalized
HLA-DRB1 Shared Epitope Alleles as Predictors of Atherosclerosis in RA
Complex interactions between environmental and genetic determinants in both the host immune system and the vasculature may operate to modifying the vascular risk in RA.
Genes within the major histocompatibility complex, in particular, HLA-DRB1 alleles encoding a common sequence of amino acids corresponding to residues 67 to 74 within the HLA-DRβ1 chain, called shared epitope alleles, are associated with increased susceptibility to RA (41). Shared epitope alleles have also been associated with an
How Can We Determine the CV Risk of a Patient with RA?
Since FMD constitutes a physiologic assessment of endothelial dysfunction and carotid IMT is an anatomic structural measure of subclinical atherosclerosis, it is logical to think that FMD may be more useful than carotid IMT in early stages of the disease. In contrast, carotid IMT might be considered in the assessment of CV risk of patients with longstanding RA.
However, a recent study on 40 patients presenting with definite RA within 12 months of symptom onset showed that RA patients exhibited
Acknowledgment
These studies by Dr. Gonzalez-Gay's group are supported by a grant from Fondo de Investigaciones Sanitarias PI06-0024 (Spain).
References (46)
- et al.
Rheumatoid arthritis: a disease associated with accelerated atherogenesis
Semin Arthritis Rheum
(2005) - et al.
Non-invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis
Lancet
(1992) - et al.
HLA-DRB1 status affects endothelial function in treated patients with rheumatoid arthritis
Am J Med
(2003) - et al.
Common carotid intima-media thickness as an indicator of atherosclerosis at other sites of the carotid arteryThe Rotterdam Study
Ann Epidemiol
(1996) - et al.
Reproducibility of extracranial carotid atherosclerotic lesions assessed by B-mode ultrasound: the Atherosclerosis Risk in Communities Study
Ultrasound Med Biol
(1996) - et al.
Measurement of the ultrasonic intima-media complex thickness in normal subjects
J Vasc Surg
(1993) - et al.
Carotid and femoral ultrasound morphology screening and cardiovascular events in low risk subjects: a 10-year follow-up study (the CAFES-CAVE study(1))
Atherosclerosis
(2001) - et al.
Duplex study of the carotid and femoral arteries of patients with rheumatoid arthritis: a controlled study
Semin Arthritis Rheum
(2005) - et al.
Acceleration of atherosclerosis during the course of rheumatoid arthritis
Atherosclerosis
(2007) - et al.
Influence of human leukocyte antigen-DRB1 on the susceptibility and severity of rheumatoid arthritis
Semin Arthritis Rheum
(2002)
Endothelial dysfunction in rheumatoid arthritis: influence of HLA-DRB1 alleles
Autoimmun Rev
Cardiovascular admissions and mortality in an inception cohort of patients with rheumatoid arthritis with onset in the 1980s and 1990s
Ann Rheum Dis
Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis
Circulation
Accelerated atherosclerosis in autoimmune rheumatic diseases
Circulation
High incidence of cardiovascular events in rheumatoid arthritis cohort not explained by traditional cardiac risk factors
Arthritis Rheum
Traditional and nontraditional cardiovascular risk factors are associated with atherosclerosis in rheumatoid arthritis
J Rheumatol
HLA-DRB1 and persistent chronic inflammation contribute to cardiovascular events and cardiovascular mortality in patients with rheumatoid arthritis
Arthritis Rheum
Association between carotid atherosclerosis and markers of inflammation in rheumatoid arthritis patients and healthy subjects
Arthritis Rheum
High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis
J Rheumatol
Risk factors associated with different stages of atherosclerosis in colombian patients with rheumatoid arthritis
Semin Arthritis Rheum
Atherosclerosis—an inflammatory disease
N Engl J Med
Endothelial function: a barometer for cardiovascular risk?
Circulation
Endothelial cell dysfunction in systemic vasculitis: new developments and therapeutic prospects
Curr Opin Rheumatol
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