Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis and Low Cardiovascular Risk: The Role of von Willebrand Factor Activity

<div><p>Background</p><p>To evaluate association between von Willebrand factor (vWF) activity, inflammation markers, disease activity, and subclinical atherosclerosis in patients with rheumatoid arthritis (RA) and low cardiovascular risk.</p><p>Methods</p><p>Above mentioned parameters were determined in blood samples of 74 non-diabetic, normotensive, female subjects, with no dyslipidemia(42 patients, 32 matched healthy controls, age 45.3±10.0 vs. 45.2±9.8 years). Intima-media thickness (IMT) was measured bilaterally, at common carotid, bifurcation, and internal carotid arteries. Subclinical atherosclerosis was defined as IMT>IMT_mean+2SD in controlsat each carotid level and atherosclerotic plaque as IMT>1.5 mm. Majority of RA patients were on methotrexate (83.3%), none on steroids >10 mg/day or biologic drugs. All findings were analysed in the entire study population and in RA group separately.</p><p>Results</p><p>RA patients with subclinical atherosclerosis had higher vWF activity than those without (133.5±69.3% vs. 95.3±36.8%, p<0.05). Predictive value of vWF activity for subclinical atherosclerosis was confirmed by logistic regression. vWF activity correlated significantly with erythrocyte sedimentation rate, fibrinogen, modified disease activity scores (mDAS28–ESR, mDAS28–CRP), modified Health Assessment Questionnaire (p<0.01 for all), duration of smoking, number of cigarettes/day, rheumatoid factor concentration (p<0.05 for all), and anti-CCP antibodies (p<0.01). In the entire study population, vWF activity was higher in participants with subclinical atherosclerosis (130±68% vs. 97±38%, p<0.05) or atherosclerotic plaques (123±57% vs. 99±45%, p<0.05) than in those without. Duration of smoking was significantly associated with vWF activity (β 0.026, p = 0.039).</p><p>Conclusions</p><p>We demonstrated association of vWF activity and subclinical atherosclerosis in low-risk RA patients as well as its correlation with inflammation markers, all parameters of disease activity, and seropositivity. Therefore, vWF might be a valuable marker of early atherosclerosis in RA patients.</p></div

Correlation of haemostatic factors with clinical, laboratory features, and treatment in patients with rheumatoid arthritis.

<p>All values are Spearman's correlation coefficients.</p><p>*p<0.05;</p><p>** p<0.01;</p><p>*** p<0.001</p><p>vWF—von Willebrand factor, PAI—plasminogen activator inhibitor.</p><p>Correlation of haemostatic factors with clinical, laboratory features, and treatment in patients with rheumatoid arthritis.</p

Univariate and multivariate logistic regression analysis of association between traditional or RA related cardiovascular risk factors with the presence of subclinical atherosclerosis (mean IMT+2SD of the controls) or atherosclerotic plaque (IMT>1.5 mm) in the entire study group and patients with rheumatoid arthritis.

<p>β—regression coefficient in the univariate analysis, NA—not applicable, vWF—Von Willebrand factor, RF—rheumatoid factor.</p><p>^a Also significant in multiple regression analysis, which included parameters showing significant difference in the univariate analysis (p<0.01 for all, except for smoking habits and subclinical atherosclerosis, where p<0.05)</p><p>Univariate and multivariate logistic regression analysis of association between traditional or RA related cardiovascular risk factors with the presence of subclinical atherosclerosis (mean IMT+2SD of the controls) or atherosclerotic plaque (IMT>1.5 mm) in the entire study group and patients with rheumatoid arthritis.</p