Subclinical atherosclerotic disease in ankylosing spondylitis and non-radiographic axial spondyloarthritis. A multicenter study on 806 patients

ObjectivesTo compare the atherosclerosis disease burden between ankylosing spondylitis (AS) and non-radiographic (nr) axial spondyloarthritis (axSpA) and establish a model that allows to identify high-cardiovascular (CV) risk in axial spondyloarthritis patients.MethodsCross-sectional study from the AtheSpAin cohort, a Spanish multicenter cohort aimed to study atherosclerosis in axSpA. Carotid ultrasound (US) was performed to determine the carotid intima-media wall thickness (cIMT) and detect the presence of carotid plaques. The European cardiovascular disease risk assessment model, the Systematic COronary Risk Evaluation (SCORE), was also applied.ResultsA set of 639 patients with AS and 167 patients with nr-axSpA without history of CV events were recruited. AS patients were older showing more CV risk factors and higher values of C reactive protein and erythrocyte sedimentation rate (ESR) than those with nr-axSpA. However, no difference in the prevalence of carotid plaques or in the cIMT was found between both groups in the adjusted analysis. The percentage of patients reclassified from the low and moderate CV risk categories to the very high-risk category due to the presence of carotid plaques was comparable in AS and nr-axSpA (10.7% versus 10.1% and 40.5% versus 45.5%, respectively). A model containing age, BASFI and ESR applied to moderate risk axSpA patients identified 41% of these patients as having very high-risk patients with high specificity (88%).ConclusionThe atherosclerosis burden is similar in nr-axSpA and AS. As occurred for AS, more than 40% of axSpA patients included in the category of moderate CV risk according to the SCORE are reclassified into very high risk after carotid US, and a clinically relevant proportion of them can be detected by applying a model containing age, BASFI and ESR.     

A pathobiologic link between risk factors profile and morphological markers of carotid instability

ObjectiveAlthough cardiovascular risk factors have been strongly linked to carotid intimal-media thickness, their association with plaque progression towards instability is poorly understood.We evaluated a large database of endarterectomy specimens removed from symptomatic and asymptomatic patients to determine the correlation between major cardiovascular risk factors and carotid plaque morphology.MethodsIncidence of thrombotic, vulnerable and stable plaques together with the degree of plaque inflammatory infiltration was evaluated in 457 carotid atherosclerotic lesions. Clinical records were reviewed in all cases for risk factors profile.ResultsThrombotic plaques were more frequently observed in patients affected by stroke (66.9%) as compared to TIA (36.1%) and asymptomatic patients (26.8%, p < 0.001). Out of 457 carotid plaques removed during carotid endarterectomy, 181 (39.6%) were represented by thrombotic plaques, 72 (15.8%) by vulnerable plaques (thin cap fibroateroma) and 204 (44.6%) by stable plaques. At the multivariate analysis, a strong association was observed between hypertension, low HDL-cholesterol (HDL-C) and ratio of total to HDL-C >5 with vulnerable and thrombotic carotid plaques. Hypertension (p = 0.001), hypercholesterolemia (p = 0.05) and low HDL-C (p = 0.001) significantly also correlated with the presence of high inflammatory infiltrate of the plaque. When multivariate analysis was restricted to asymptomatic patients, hypertension (p = 0.009, OR 2.29), low HDL-cholesterol (p = 0.01 OR 2.21) and the ratio of total to HDL-C >5 (p = 0.03, OR 2.07) were confirmed to be the risk factors most significantly associated to unstable plaques. The relative risk to carry an unstable plaque for asymptomatic patients with high Framingham Risk Score as compared with those with low risk score was 2.06 (95% C.I., 1.26–3.36).ConclusionsThe present histopathological study identifies risk factors predictive of increased risk of carotid plaque rupture and thrombosis. Asymptomatic patients with high risk factors profile may constitute a specific target to reduce the likelihood of cerebrovascular accidents even in the presence of non-flow-limiting plaque.     

Health related quality of life (HRQoL) in ankylosing spondylitis patients: Relation to clinical features,disease activity and radiographic damage

Aim of the workTo assess health-related quality of life (HRQoL) and associated variables in Egyptian ankylosing spondylitis (AS) patients.Patients and methods50 male patients with AS and 50 age-matched controls were enrolled. Clinical and laboratory data were examined including history for peripheral arthritis. Visual analog scale (VAS), Bath AS disease activity index (BASDAI), AS disease activity score (ASDAS)-C-reactive protein (CRP) and ASDAS-erythrocyte sedimentation rate (ESR), Bath AS functional index (BASFI), Bath AS metrology index (BASMI) and AS quality of life (ASQoL). Spinal radiographs were graded by the modified Stoke AS spinal score (mSASSS).ResultsThe mean age of the patients was 33.1 ± 7.4 years and disease duration of 6.8 ± 3.1 years. The mean ASQoL score in patients was significantly higher (9.4 ± 3.8; 3–15) compared to the control. 26 (52%) patients had peripheral arthritis. Of these, 17 (65.4%) had hip involvement, 6 (23.1%) had knee, 5 (19.2%) had shoulder affection and 3 (11.5%) had ankle joint involvement. Patients with peripheral joint involvement had significantly higher ASQoL score than those without (11.4 ± 3.1 and 7.3 ± 3.4 respectively, p < 0.001). ASQoL significantly correlated with BASMI (p = 0.048), BASFI (p = 0.02), BASDAI (p = 0.01), ASDAS.CRP (p = 0.02) and ASDAS.ESR (p = 0.01). The multiple regression analysis to identify the independent variables associated with the ASQoL showed a significant association with peripheral joint involvement, BASDAI, ASDAS.ESR, ASDAS.CRP and BASFI scores.ConclusionAS is a chronic inflammatory disease that affects HRQoL especially with higher disease activity, functional disability, more peripheral joint involvement and lesser spinal mobility in Egyptian patients.     

Anaemia is associated with higher disease activity in axial spondyloarthritis but is not an independent predictor of spinal radiographic progression: data from the Swiss Clinical Quality Management Registry

Objective

As anaemia represents a biomarker for increased radiographic damage in rheumatoid arthritis, we aimed to investigate whether it independently predicts spinal radiographic progression in axial spondyloarthritis (axSpA).

Methods

AxSpA patients with available haemoglobin levels from the prospective Swiss Clinical Quality Management Registry were included for comparison of patients with and without anaemia. Spinal radiographic progression was assessed according to the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) in patients with ankylosing spondylitis (AS) if ≥ 2 sets of spinal radiographs were available every 2 years. The relationship between anaemia and progression (defined as an increase ≥ 2 mSASSS units in 2 years) was analysed with generalized estimating equation models after adjustment for the Ankylosing Spondylitis Disease Activity Score (ASDAS) and potential confounding, as well as after multiple imputations of missing values.

Results

A total of 212/2522 axSpA patients presented with anaemia (9%). Anaemic patients had higher clinical disease activity, higher acute phase reactants and more severe impairments in physical function, mobility and quality of life. In the subgroup of patients with AS (N = 433), a comparable mSASSS progression was found in anaemic and non-anaemic patients (OR 0.69, 95% CI 0.25 to 1.96, p = 0.49). Age, male sex, baseline radiographic damage and ASDAS were associated with enhanced progression. The results were confirmed in complete case analyses and with progression defined as the formation of ≥ 1 syndesmophyte in 2 years.

Conclusion

Although anaemia was associated with higher disease activity in axSpA, it did not additionally contribute to the prediction of spinal radiographic progression.

Vascular endothelial growth factor and subclinical atherosclerosis by carotid ultrasonography in Egyptian patients with Behçet’s disease

Aim of the workThis study aimed to investigate serum levels of vascular endothelial growth factor (VEGF) and to measure common carotid intima media thickness (cc-IMT) in Egyptian patients with Behçet’s disease (BD) to evaluate their relations to disease activity and different clinical manifestations.Patients and methodsSeventy patients with BD and 70 healthy controls participated in this study. Behçet’s disease patients were subjected to detailed history taking, thorough clinical examination, disease activity assessment using the BD Current Activity Form (BDCAF) and laboratory investigation. Vascular endothelial growth factor levels were measured using ELISA. The carotid arteries were assessed for cc-IMT and plaques with a carotid high-resolution B-mode ultrasound.ResultsThe mean cc-IMT showed a significant difference in BD patients compared to controls (p < 0.011). Three BD patients had plaques (4.3%). There were significant correlations of cc-IMT with disease duration (p < 0.001), systolic blood pressure (BP) (p = 0.029), diastolic BP (p = 0.041), total cholesterol (p < 0.001) and LDL (p < 0.001) and insignificant correlation with BDCAF (p = 0.054). There was a significant elevation of VEGF levels (p < 0.001) in BD patients compared to controls. VEGF levels showed significant correlations with ESR (p = 0.14), CRP (p < 0.001) and BDCAF (P = 0.02), while there was an insignificant correlation with cc-IMT (p = 0.107).ConclusionBD patients have ultrasonographic evidence of subclinical atherosclerosis which was associated with increasing age, longer disease duration, elevated systolic and diastolic BP, total cholesterol and LDL. Elevated VEGF showed statistically significant positive correlations with BDCAF and thus can be used as a marker of disease activity and/or therapeutic targets in BD patients.     

Angiotensin-Receptor Blockade Improves Inflammation and Endothelial Dysfunction in Ankylosing Spondylitis: ARB-AS Study

Cardiovascular (CV) disease is the leading cause of premature death in ankylosing spondylitis (AS). Atherosclerosis and AS share similar pathogenic mechanisms. The proven benefits of angiotensin-receptor blockers (ARBs) in atherosclerotic cardiovascular disease and their role in immune mediation provide strong rationale to investigate its impact with olmesartan on inflammation and endothelial dysfunction in AS. To investigate the effect of olmesartan on inflammation and endothelial dysfunction in AS. 40 AS patients were randomized to receive 24 weeks of treatment with olmesartan (10 mg/day, n  = 20) and placebo ( n  = 20) as an adjunct to existing stable antirheumatic drugs. Markers of endothelial function included the following: flow-mediated dilation (FMD) assessed by AngioDefender, endothelial progenitor cells (EPCs) estimated by flow cytometry, nitrite (nitric oxide surrogate), intracellular adhesion molecule-1 (ICAM-1) and vascular cell adhesion molecule-1 (VCAM-1) and inflammatory measures including Bath ankylosing spondylitis disease activity index (BASDAI), ankylosing spondylitis disease activity score (ASDAS) and bath ankylosing spondylitis functional index (BASFI); erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP); proinflammatory cytokines (interleukin-1 [IL-1], IL-6, tumor necrosis factor-α [TNF-α]) and marker of oxidative stress– thiobarbituric acid reactive substances (TBARS) estimated at baseline and after treatment. Health assessment questionnaire disability index (HAQDI), 36-item short form survey (SF-36), and systematic coronary risk evaluation (SCORE) were estimated using standard tools. FMD improved significantly in the olmesartan group (5.83 ± 0.31% to 7.68 ± 0.27%, p  ≤  0.05) as compared with placebo (5.89 ± 0.35% to 6.04 ± 0.32%, p  = 0.33). EPC population, nitrite, VCAM-1, and TBARS levels improved significantly in olmesartan group as compared with placebo ( p ≤ 0.05). Olmesartan significantly decreased ASDAS, BASDAI, BASFI, ESR, CRP, IL-6, TNF-α, and SCORE as compared with placebo. HAQDI and SF-36 (PH) scores improved significantly in olmesartan group as compared with placebo. Olmesartan reduces inflammatory disease activity, improves quality of life (QOL), and decreases CV risk demonstrating the immunomodulatory, vasculoprotective, and cardioprotective potential of this drug in AS.     

Evaluation of quality of life in patients with axial spondyloarthritis and its association with disease activity,functionality, mobility,and structural damage

To evaluate quality of life (QoL) in patients with axial spondyloarthritis (axSpA) and its association with disease activity, functionality, structural damage, and spinal mobility, using patient-reported outcomes. This was an observational, cross-sectional, and single-center study in which 100 consecutive patients with axSpA were included. We obtained from all patients’ sociodemographic data and values related to disease activity, functionality, structural damage, mobility, and quality of life. The Ankylosing Spondylitis Quality of Life Questionnaire (ASQoL) was considered as the primary outcome. Pearson r statistic, Student’s T test, and univariate and multivariate linear regressions were performed to relate ASQoL with the studied covariates. Mean ASQoL score in all patients was 4.02?±?2.81, with statistically significant differences between male and female (3.61?±?2.80 vs. 4.83?±?2.70). Patients with high disease activity (measured by the ASAS-endorsed Disease Activity Score, ASDAS >?2.1) showed higher mean score in ASQoL than those with low disease activity (ASDAS ≤?2.1) (3.21?±?0.74 vs. 1.43?±?0.43, p?<?0.001). ASQoL presented a significant linear correlation with BASDAI, BASFI, and ASDAS (r?>?0.60). However, disease duration was not significantly correlated with ASQoL. Finally, the 68.9% of the ASQoL variability (R²?=?0.689) was determined by BASDAI, BASFI, and mSASSS, presenting mSASSS a negative regression coefficient (??0.035). In our study, the impairment of QoL was mainly associated with disease activity (BASDAI) and worsening of functionality (BASFI). However, there is an inverse relationship between the worsening of QoL and structural damage. In addition, disease duration does not seem to influence the patient’s welfare.     

Short term effect of non-steroidal anti-inflammatory drugs on clinical and magnetic resonance imaging of the sacroiliac joints progression in axial spondyloarthritis patients

Aim of the workTo evaluate the short term effect of maximally tolerated dose of non-steroidal anti-inflammatory drugs (NSAIDs) on disease activity and radiographic progression of axial spondyloarthritis (axSpA) patients.Patients and methodsA six-week prospective study on thirty patients with active axSpA. All patients were assessed at baseline visit, a follow-up visit after 2 weeks, and 6 weeks of treatment with a maximally tolerated dose of NSAID. Disease activity was assessed by determining Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Ankylosing Spondylitis Disease Activity Score (ASDAS), and functional assessment by using Bath Ankylosing Spondylitis Functional Index (BASFI). Spinal mobility was assessed by the mean improvement in Bath Ankylosing Spondylitis Metrology Index (BASMI). Magnetic Resonance Imaging (MRI) of sacroiliac joints (SIJs) was taken at baseline and at the end of the study and was evaluated according to Berlin scoring method.ResultsImprovement in laboratory activity markers and all disease activity scores has been observed at week 6 of maximally tolerated dose of NSAIDs which were significant (p < 0.001). Additionally, ASDAS clinically important improvement was achieved in 63.3% of patients, and BASDAI50 was achieved in 30% and 56.7% of patients at week 2 and week 6, respectively. Furthermore, Berlin score showed an improvement by 14.2% with a reduction in bone marrow edema signal intensity of SIJs in 40% of patients.ConclusionIn Egyptian cohort of patients with axSpA, intake of maximally tolerated dose of NSAID could improve the health-related quality of life, disease activity scores, and sacroiliac joint inflammation on MRI.     

Plasma creatinine levels,estimated glomerular filtration rate and carotid intima media thickness in middle-aged women: A population based cohort study

Background and aimThe relationships between high Creatinine (Cr) levels or low estimated Glomerular Filtration Rate (eGFR) and common carotid Intima Media thickness (IMT) have been evaluated in a population-based cohort study in women, aged 30–69 (Progetto ATENA).Methods and resultsSerum Cr and eGFR were measured in 310 women, as a part of 5.062. In this group carotid ultrasound examination (B-Mode imaging) was performed and mean max IMT was calculated. Women were classified by Cr levels >1 mg/dL or eGFR < 56 ml/min.Women with Cr > 1 mg/dL (90th percentile of creatinine distribution) or eGFR less than 56 ml/min (5th percentile of eGFR distribution) had relatively more carotid plaques as compared to the rest of the cohort.Multivariate logistic analysis, after adjustment for age, demonstrated a significant association between Cr (>1 mg/dL) and IMT (≥1.2 mm): OR 4.12 (C.I 1.22–13.86), p = 0.022; or eGFR (<56 ml/min) and IMT (≥1.2 mm): OR 4.31 (C.I 1.27–14.66), p = 0.019.ConclusionsThese findings on an independent relationship between Cr and common carotid plaques in this population of middle aged women, independently of age, suggest the value of screening for early carotid disease in asymptomatic middle aged-women with mild renal insufficiency, in order to predict those at relatively higher risk for future cardiovascular events.     

Atherogenic index of plasma and its association with cardiovascular disease risk factors among postmenopausal rural women of Bangladesh

ObjectivesThere is absolute lacking of evidences on atherogenic index of plasma (AIP) and its association with cardiovascular disease (CVD) risk factors among postmenopausal women of Bangladesh. This prompted us to investigate this association between AIP and CVD risk factors among postmenopausal women in a rural setting.MethodsThis cross-sectional study recruited 265 postmenopausal women aged 40–70 years who visited a primary health-care center of Bangladesh. We used modified STEP-wise approach for the Surveillance of Noncommunicable diseases risk factors questionnaire of the World Health Organization to collect data on sociodemographic and behavioral risk factors. Physical measurements were carried out following the method described in the ‘noncommunicable disease risk factors survey Bangladesh 2010’. AIP was determined by the logarithmic transformation of triglyceride to high-density lipoprotein ratio, and association with CVD risk factors were examined by multiple linear regression analysis.ResultsOverall 35.5% respondents had a high risk level of AIP with a mean of 0.16 ± 0.25. After adjusting the confounders, CVD risk factors including duration of menopause (β = 0.606, p = 0.043), waist–hip ratio (β = 0.165, p = 0.003), 2-h plasma glucose (β = 0.118, p = 0.04), total cholesterol (β = 1.082, p < 0.001), low-density lipoprotein cholesterol (β = −1.044, p < 0.001), and metabolic equivalent of tasks (β = −0.171, p = 0.003) showed a significant association with AIP.ConclusionHigh AIP and its significant association with CVD risk factors demand proper lifestyle intervention for postmenopausal women of Bangladesh.     

Dickkopf-1 in ankylosing spondylitis: Relation to spinal dysmobility and radiographic findings

Back groundDickkopf-1 (DKK-1) is an inhibitory molecule that regulates Wnt pathway, which is critically important in osteoblastic new bone formation, therefore it may play a role in the process of new bone formation in Ankylosing Spondylitis (AS).Aim of the workTo measure serum level of DKK-1 in AS patients and study the relation between these levels with disease activity, spinal dysmobility and radiographic findings.Patients and methodsThirty AS patients as well as 20 healthy subjects as a control group were included in this study. DKK-1 serum levels were measured using ELISA technique, disease activity was assessed using Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) score, radiographic assessment by Bath Ankylosing Spondylitis Radiology Index-spine (BASRI-s) and modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS).ResultsDKK-1 was not correlated to ESR, CRP or BASDAI (p > 0.05) and was negatively correlated to BASRI-s and mSASSS (p < 0.001), though DKK-1 serum level was unexpectedly higher in patients versus control (p < 0.001). On comparing HLA-B27 positive and HLA-B27 negative patients, there were a significant increase in BASRI-s and mSASSS and decrease in DKK-1 level in those with positive HLA-B27 (p < 0.05). On comparing patients received anti TNF therapy and those not received anti TNF therapy, there was no significant difference in DKK-1 level (p > 0.05).ConclusionOur finding suggests dysfunction of DKK-1 in patient with AS.     

Gender-related differences in axial spondyloarthritis (axSpA) patients

Aim of the workTo explore the gender-related differences in axial spondyloarthritis (axSpA) patients.Patients and methodsSeventy-six male and 38 female patients with axSpA were assessed regarding disease characteristics and treatment. Disease activity, functional and radiologic severity index were measured using the Bath ankylosing spondylitis disease activity index (BASDAI), Bath ankylosing spondylitis functional index (BASFI), Bath ankylosing spondylitis radiology index (BASRI-s) respectively, and enthesitis was assessed using Maastricht Ankylosing Spondylitis Enthesitis Score (MASES).ResultsThe mean age of the patients was 37.8 ± 10 years with a male: female ratio (2:1). Females had more delay in diagnosis (9.2 ± 3.9 years vs males 6.7 ± 3.4 years; p < 0.001) and they had enthesitis, peripheral arthritis, widespread pain and fibromyalgia as initial presentations more often than males. The mean BASDAI and BASFI was higher in females (6.3 ± 1.3 vs 5.2 ± 1.4; p < 0.001 and 6.1 ± 1.4 vs 5.3 ± 1.3; p = 0.003 respectively). Enthesitis increased in females (n = 18, 47% vs n = 12, 15.8%; p < 0.001) with higher MASES than men (3.7 ± 4 vs 1.8 ± 2; p < 0.001).Peripheral arthritis was markedly higher in females (n = 15, 39.5%vs n = 16, 21.1%; p = 0.03).Females more frequently used methotrexate and sulphasalazine (p = 0.003). BASRI-s and sacroiliitis grading were higher in males (7.2 ± 1.9 vs 4.6 ± 1.9; p < 0.001 and 3 ± 0.6 vs 2 ± 0.3; p < 0.001 respectively) with cervical syndesmophyte predominance in females (p = 0.005).ConclusionThe clinical and initial presentations differ between the two genders and the disease activity, functional limitation, and enthesitis score are higher in females. While radiologic severity is worse in men, there is predominant cervical spine involvement in women.     

Interrelationships between body mass to waist circumference ratio,body mass index,and total body muscularity in older women

PurposeTo examine the relationships between body mass to waist circumference (BM:W) ratio or body mass index (BMI) and muscularity, 140 overweight (BMI ≥ 25 kg/m² and <30 kg/m²), 265 normal weight (BMI > 18.5 kg/m² and <25 kg/m²) and 26 underweight (BMI ≤ 18.5 kg/m²) Japanese women aged 60–80 years volunteered (overall 431 women).MethodsMuscle thickness was measured by ultrasound at six sites on the anterior and posterior aspects of the body. Total muscle mass (TMM) was estimated from an ultrasound-derived prediction equation. BMI and BM:W ratio were calculated using anthropometrical variables.ResultsWhen the overall sample was used, BMI was positively correlated with the TMM (r = 0.573, p < 0.001) and TMM index (r = 0.659, p < 0.001). BM:W ratio was also positively correlated with the TMM (r = 0.566, p < 0.001) and TMM index (r = 0.400, p < 0.001). In normal weight women, BMI was positively correlated with the TMM (r = 0.460, p < 0.001) and TMM index (r = 0.496, p < 0.001). Similarly, BM:W ratio was positively correlated with the TMM (r = 0.514, p < 0.001) and TMM index (r = 0.318, p < 0.001). In overweight and underweight women, TMM was significantly and positively correlated with BM:W ratio (r = 0.442 and r = 0.715, respectively; p < 0.001), but not BMI (r = 0.077 and r = 0.315). TMM index was also positively correlated with BM:W ratio in both overweight (r = 0.184, p < 0.05) and underweight (r = 0.500, p < 0.01) women. BMI was positively correlated with TMM index (r = 0.230, p < 0.01) and inversely correlated to the percentage of TMM in body mass (r = −0.262, p < 0.01) in overweight women.ConclusionThese results suggest that, compared to BMI, BM:W ratio may provide a simple and potential index for assessing muscularity in Japanese older underweight women. However, in normal and overweight women, BMI and BM:W ratio are both preferred in assessing muscularity.     

Gender-specific differences in carotid intima-media thickness and its progression over three years: A multicenter European study

Background and aimsThis multicentre European study evaluated, in a young-to-middle-aged healthy population without carotid atherosclerosis, the gender-related differences in carotid intima-media thickness (IMT) and its short-term (3-year) progression, and whether these differences are related to different vascular ageing rate, cardiovascular risk profile or different susceptibility to family predisposition to cardiovascular diseases (CVD).Methods and results366 men and 422 women (age between 30 and 60 years) underwent B-mode carotid ultrasound at baseline and after 3-year follow-up period. IMT in 3 carotid segments was higher in men than in women (p < 0.0001 for all segments). When evaluated according to age decade, differences between men and women disappeared in the 6th decade, as in this decade a 3-year IMT progression rate accelerated in women (p < 0.05 as compared to the 4th and 5th age decade). Age was a major determinant of baseline all-segment IMT in women; in men all-segment IMT was influenced by age and LDL-cholesterol. IMT progression did not correlate with established cardiovascular risk factors, their short-term changes or family predisposition to CVD. Yet, a 3-year IMT progression in common carotid artery (CCA) was higher in men (p = 0.01) and women (p < 0.01) in whom relative Framingham risk increased during the corresponding period.ConclusionThis study provides reference values on IMT and its short-term progression in healthy young-to-middle-aged population, and demonstrates gender-related differences in the susceptibility of carotid wall to ageing and LDL-cholesterol. Increase in Framingham risk accelerated a short-term CCA IMT progression rate in both genders, whereas family predisposition to CVD did not influence carotid IMT.     

Increased subclinical atherosclerosis in patients with chronic plaque psoriasis

Background: Psoriasis is an immune-mediated inflammatory skin condition of unknown aetiology which usually requires life-long treatment. It is regarded a systemic inflammatory disease with a possible increased risk of cardiovascular disease. The aim of this study was to assess carotid intima-media thickness (IMT), plaque prevalence and carotid stenosis as surrogate measures for cardiovascular disease in psoriasis patients and healthy controls. Methods: Sixty-two patients with psoriasis and thirty-one healthy controls were included in the study. All were examined by Colour duplex ultrasound of the carotid arteries to compare carotid IMT values, carotid plaques and carotid stenosis in the two groups. Adjustments were made for traditional cardiovascular risk factors. Results: Patients with psoriasis had increased carotid IMT values compared to the controls: mean ± SD 0.71 ± 0.17 mm vs. 0.59 ± 0.08 mm; p = 0.001. When adjusted for known atherosclerotic risk factors this difference remained significant (p = 0.04). Carotid plaques were also more common (p = 0.03) in patients with psoriasis 13 (21%) compared to controls 1 (3%). There was no difference with regard to the number of carotid stenoses in patients and controls. Conclusion: The results of this study support previous evidence which suggests that psoriasis is associated with an increased risk for atherosclerosis and subsequent cardiovascular disease.     

Bone mineral density in ankylosing spondylitis: Relation to disease activity,functional capacity,spinal mobility and radiological damage

Aim of the workTo assess the bone mineral density (BMD) in Ankylosing Spondylitis (AS) patients and to investigate its relation to disease activity, functional capacity, spinal mobility and radiological damage.Patients and methodsThirty male AS patients (mean age 27.9 ± 6.2 and disease duration 4.2 ± 3.6 years) and thirty age-matched healthy controls were studied. Patients were assessed using the Bath Ankylosing Spondylitis Disease Activity Index (BASDAI), the Bath Ankylosing Spondylitis Functional Index (BASFI), the Bath Ankylosing Spondylitis Metrology Index (BASMI) and the modified Stoke Ankylosing Spondylitis Spinal Score (mSASSS) to quantify radiological damage. BMD of the lumbar spine and femoral neck were assessed by Dual Energy X ray Absorptiometry (DEXA).ResultsPatients had a lower BMD of the lumbar spine (1.13 ± 0.14 versus 1.22 ± 0.09 g/cm², p = 0.007) and femoral neck (0.89 ± 0.1 versus 1.05 ± 0.13 g/cm², p = 0.001) than controls. BMD of the lumbar spine was negatively correlated with the erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), BASDAI, BASFI, BASMI and mSASSS (r = -0.6,-0.4, −0.5, −0.4, −0.5, −0.6; p = 0.001, 0.003, 0.01, 0.01, 0.004, 0.001, respectively) while BMD of the femoral neck was correlated negatively with the ESR,CRP, mSASSS (r = -0.5,-0.4,-0.5, p = 0.001, 0.004, 0.01) and positively with the modified Schöber test (r = 0.41, p = 0.02). On multiple regression analysis, the modified Schöber test, ESR and CRP were independent predictors of the BMD of the femoral neck (β = 0.45,-1.12, 0.58; p = 0.048, 0.02, 0.03, respectively).ConclusionBMD is reduced in AS patients and correlates with disease activity, functional capacity, spinal mobility and radiological damage.     

Association of asymptomatic hyperuricemia and endothelial dysfunction in psoriatic arthritis

IntroductionCardiovascular disease is an increasingly recognized contributor to excess morbidity and mortality in psoriatic arthritis (PsA). Traditional cardiovascular risk factors do not adequately account for the extent of cardiovascular disease in PsA.Aim of the workTo examine the prevalence of subclinical atherosclerosis in patients with PsA to emphasize the potential role of serum uric acid on endothelial dysfunction, as an early predictor for atherosclerosis in PsA patients.Patients and methodsThis study included 60 PsA patients as well as 60 age and sex matched healthy controls. Assay of serum uric acid, interleukin-6 (IL-6) and soluble intercellular adhesion molecule-1 (sICAM-1) was done for all patients and controls. Patients were subjected to psoriasis area severity index (PASI) and assessment of disease activity. Patients and controls underwent brachial flow-mediated dilatation (FMD) assessment by color duplex sonography to determine endothelial dysfunction as well as extracranial carotid arteries assessment by high-resolution B-mode ultrasound to measure the common carotid intima-media thickness (CIMT) and the detection of atheromatous plaques.ResultsPsA patients have a high significant difference in CIMT, FMD of the brachial artery and mean levels of serum uric acid compared to healthy controls (p < 0.001). PsA patients with hyperuricemia have a high significant difference in CIMT and FMD of the brachial artery than those with normal serum uric acid. Serum uric acid levels showed a high significant positive correlation with each of CIMT, disease duration, markers of inflammation (ESR, CRP, IL-6, sICAM-1), disease activity score in 28 joints (DAS 28) and PASI (r = 0.71, 0.893, 0.956, 0.858, 0.853, 0.877, 0.907, 0.847, respectively, as p < 0.001). A high significant negative correlation was found between serum uric acid levels and FMD of the brachial artery as r = ?0.634, p < 0.001.ConclusionPatients with PsA have a high prevalence of subclinical atherosclerosis dependent on serum uric acid, suggesting that chronic systemic inflammation and endothelial dysfunction appear to be the link between asymptomatic hyperuricemia and atherosclerosis. Therefore, proper control of serum uric acid may play a preventive role in the development of atherosclerosis in PsA patients.     

Arterial stiffness,carotid atherosclerosis and left ventricular diastolic dysfunction in postmenopausal women

BackgroundPostmenopausal women have an increased cardiovascular morbidity that may be due to the increase in classical cardiovascular risk factors and also to the arterial structure and function alterations. The aim of our study was to evaluate the association of aortic pulse wave velocity (PWV), and carotid intima–media thickness (IMT), with left ventricular diastolic dysfunction (LVDD) in postmenopausal women.Patients and methodsIn 96 women without overt cardiovascular disease (age 62 ± 7.7 years), and with normal left ventricular systolic function, aortic PWV was assessed by using an oscillometric device, intima–media thickness was measured by B-mode ultrasonography and the parameters of left ventricular diastolic function were evaluated by a transthoracic echocardiographic study.ResultsLVDD, defined as an E/A ratio ≤ 1 was found in 50 patients (52%). All of them had mild LVDD. In these patients we found significant increase in age (p < 0.001), aortic PWV (p < 0.001), carotid IMT (p = 0.002) and plaque score (p = 0.004) when compared with patients without LVDD. In a logistic regression analyzed, after adjusting for age, only aortic PWV was a significant predictor of LVDD (2.15, 95% CI 1.39–3.31, p = 0.0006).ConclusionsThis study among postmenopausal women provides evidence that increased arterial stiffness as measured by aortic PWV and not carotid IMT may be a marker or a risk factor for LVDD, independent of other classical risk factors.     

Women show worse control of type 2 diabetes and cardiovascular disease risk factors than men: Results from the MIND.IT Study Group of the Italian Society of Diabetology

Background and aimsThe study explores the degree of control of hyperglycaemia and cardiovascular (CV) disease risk factors in men and women with type 2 diabetes and the impact thereon of obesity, central adiposity, age and use of medications.Methods and resultsA cross-sectional survey was conducted at 10 hospital-based outpatients diabetes clinics. 1297 men and 1168 women with no previous CV events were studied. Women were slightly (only one year) older and more obese than men: average BMI was respectively 30.7 ± 5.7 vs 28.6 ± 4.1 kg/m² (p < 0.001), and prevalence of abdominal obesity was 86% vs 44% (p < 0.001). Women smoked less, but had higher HbA1c, LDL cholesterol, non-HDL cholesterol, systolic blood pressure and serum fibrinogen than men. Accordingly optimal targets for HbA1c (<7%), LDL cholesterol (<100 mg/dL), HDL cholesterol (>40 for men, >50 for women, mg/dL), and systolic blood pressure (<130 mmHg) were less frequently achieved by women than men (respectively 33.8% vs 40.2%; 14.6% vs 19.2%; 34.1% vs 44.5%; 68.8% vs 72%; p < 0.05 for all). Findings were confirmed after stratification for waist circumference (< or ≥ 88 cm for women; < or ≥ 102 cm for men), BMI (< or ≥ 25 kg/m²) or age (< or ≥ 65 years). As for treatment, women were more likely than men to take insulin, alone or in combination with oral hypoglycaemic drugs, to be under anti-hypertensive treatment, whereas the use of lipid lowering drugs was similar in men and women.ConclusionsControl of hyperglycaemia and major CVD risk factors is less satisfactory in women than men. The gender disparities are not fully explained by the higher prevalence of total and central obesity in women; or by a less intensive medical management in women.     

Insulin resistance as a risk factor for subclinical atherosclerosis in rheumatoid arthritis

BackgroundInsulin resistance (IR) is strongly associated with systemic inflammation. Insulin resistance is known to be increased in patients with rheumatoid arthritis (RA) and has been shown to be a risk factor for both clinical cardiovascular disease and subclinical atherosclerosis.Aim of the workTo study the relationship between insulin resistance, disease activity and subclinical atherosclerosis in RA patients.Patients and methodsForty RA patients and twenty age and sex matched healthy individuals as controls were included. Patients with diabetes mellitus, obesity and hypertension were excluded. Fasting plasma sugar and serum insulin were done, RA disease activity was assessed using the disease activity score (DAS28) and IR was evaluated by the homeostasis model assessment (HOMA2). Carotid artery intima media thickness (IMT) was evaluated using ultrasound.ResultsRA patients had significantly higher erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) positivity, fasting plasma sugar and fasting serum insulin, HOMA2-IR levels than the controls. IR was present in 33 (82.5%) RA patients while it was present in only one (10%) of the controls (p = 0.001). RA patients with IR had significantly longer disease duration (p = 0.003), higher disease activity (p = 0.000), greater carotid IMT (p = 0.000), and more carotid plaques (p = 0.043) than those without insulin resistance. RA patients with increased IMT had significantly longer disease duration (p = 0.002), higher DAS28 score (p = 0.000) and higher HOMA2-IR (p = 0.000) than those with normal IMT.ConclusionsIn RA patients, IR significantly correlated with both disease activity and disease duration. Our study pointed out a significant association between IR and subclinical atherosclerosis in RA.