Clinical significance of aortic stiffness, carotid intima-media thickness and serum osteoprotegerin level in rheumatoid arthritis patients

Aim of the work: Cardiovascular diseases represent a major source of morbidity and mortality for patients with rheumatoid arthritis (RA). The increase in aortic stiffness, carotid intima-media thickness (CIMT) and serum osteoprotegerin (OPG) have been shown to be independent risk factors for cardiovascular events. This work aimed to investigate the clinical significance of these parameters in RA patients. Patients and methods: 60 RA patients and 30 control with no primary cardiovascular risk factors were included. Disease activity score (DAS28) was assessed in patients. Aortic stiffness was evaluated by transthoracic echocardiography and CIMT evaluated by Doppler ultrasonography. OPG was determined by ELISA. Results: The 60 RA patients had a mean age of 40.8 ± 8.3 years, disease duration of 6.9 ± 4.9 years and were 46 females and 14 males. In RA patients, serum OPG and CIMT (thickest and mean) were significantly higher than the control (60.5 ± 32.4 pg/ml vs 29.4 ± 16.7 pg/ml, p < 0.001; 0.73 ± 0.18 mm vs 0.63 ± 0.13 mm, p < 0.001; 0.61 ± 0.1 mm vs 0, 56 ± 0.1 mm, p = 0.007, respectively). The aortic stiffness tended to be higher in patients (6.9 ± 4.8 vs 5.2 ± 2.5, p = 0.114) and in males (9.7 ± 7.4) vs females (5.7 ± 3.4, p = 0.013). OPG levels were significantly higher in those with erosions (n = 41) (68.6 ± 34.5 pg/ml vs 49.1 ± 22 pg/ml p = 0.038) and in those seropositive (n = 54) (65.4 ± 32.2 pg/ml vs 36 ± 18.3 pg/ml p = 0.012). In patients, CIMT (thickest and mean) correlated significantly with the aortic stiffness (p = 0.02 and p = 0.04 respectively). Conclusion: RA is an independent risk factor associated with cardiovascular events. For determining this risk, measuring the serum OPG, CIMT and aortic stiffness may be a useful guide. Keywords: Aortic stiffness, Atherosclerosis, Carotid intima-media thickness, Osteoprotegerin, Rheumatoid arthritis, DAS2