The role of inflammation and cardiovascular disease risk on microvascular and macrovascular endothelial function in patients with rheumatoid arthritis: a cross-sectional and longitudinal study Reportar como inadecuado




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Arthritis Research and Therapy

, 14:R117

First Online: 17 May 2012Received: 09 January 2012Revised: 03 April 2012Accepted: 17 May 2012

Abstract

IntroductionRheumatoid arthritis RA is associated with an increased risk for cardiovascular disease CVD, and it has been postulated that RA disease-related inflammation contributes to endothelial dysfunction. The aim of the present work was to examine predictors RA-related and CVD risk factors and anti-tumor necrosis factor-alpha anti-TNF-α treatment effects on endothelial function in different vascular beds.

MethodsMicrovascular endothelial function laser Doppler imaging with iontophoresis of acetylcholine and sodium-nitroprusside, and macrovascular endothelial function flow-mediated dilatation and glyceryl-trinitrate-mediated dilatation were analyzed in parallel with disease activity. Individual CVD risk factors and global CVD risk were assessed cross-sectionally in 99 unselected RA patients and longitudinally baseline, 2 weeks, and 3 months in 23 RA patients commencing anti-TNF-α therapy.

ResultsIn this cross-sectional study, regression analyses revealed that markers of RA disease-related inflammation were not associated with microvascular or macrovascular endothelium-dependent function P > 0.05; global CVD risk inversely correlated with microvascular endothelium-dependent function P < 0.01 and with macrovascular endothelium-independent function P < 0.01. In the longitudinal study, only microvascular endothelium-dependent function showed an improvement after 2 weeks of anti-TNF-α treatment when compared with baseline 437% ± 247% versus 319% ± 217%; P = 0.001, but no association was evident between change in endothelial function and change in inflammatory markers.

ConclusionsClassical CVD risk may influence endothelial function more than disease-related markers of inflammation in RA. Classical CVD risk factors and anti-TNF-α medication have different effects on microvascular and macrovascular endothelial function, suggesting that combined CVD-prevention approaches may be necessary. Prospective studies examining whether assessments of vascular function are predictive of long-term CV outcomes in RA are required.

AbbreviationsAchacetylcholine

anti-TNF-αanti-tumor necrosis factor-alpha

BMIbody mass index

CRPC-reactive protein

CVDcardiovascular disease

CVcoefficient of variation

cGMPcyclic guanosine monophosphate

DAS28disease activity score in 28 joints

DBPdiastolic blood pressure

EDendothelial dysfunction

ESRerythrocyte sedimentation rate

FMDflow-mediated dilatation

FRSFramingham Risk Score

GTNglyceryl trinitrate-mediated dilatation

HAQHealth Assessment Questionnaire

HDLhigh-density lipoprotein cholesterol

HOMAhomeostasis model assessment

IPAQInternational Physical Activity Questionnaire

LDIlaser Doppler imaging

LDLlow-density lipoprotein cholesterol

NOnitric oxide

NSAIDnonsteroidal antiinflammatory drug

QUICKIQuantitative Insulin Sensitivity Check Index

RArheumatoid arthritis

SCORESystematic Coronary Risk Evaluation

SBPsystolic blood pressure

TCtotal cholesterol

TGtriglyceride.

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Autor: Aamer Sandoo - George D Kitas - Douglas Carroll - Jet JCS Veldhuijzen van Zanten

Fuente: https://link.springer.com/







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