Department of Rheumatology, Jan van Breemen Research Institute - Reade, The Netherlands.
J Rheumatol. 2012 Dec;39(12):2261-6. doi: 10.3899/jrheum.120617. Epub 2012 Oct 1.
Rheumatoid arthritis (RA) is associated with an increased cardiovascular (CV) risk, but mechanisms behind this increased risk have not been fully elucidated. Carotid arterial remodeling is the change of structural properties in response to hemodynamic or metabolic factors aimed at keeping wall stress within certain limits. This process might become maladaptive when stress on the arterial wall increases beyond these limits. We investigated whether maladaptive carotid arterial remodeling is present in RA compared with control subjects.
The 2 cohorts were 96 patients with RA and 274 healthy subjects, who were investigated cross-sectionally. Carotid intima-media thickness (cIMT) and interadventitial diameter (IAD) were assessed by B-mode carotid ultrasonography. Lumen diameter (LD), circumferential wall stress (CWS), and circumferential wall tension (CWT) were calculated. Linear regression analyses were used to investigate the association between presence of RA and carotid arterial remodeling.
Compared with healthy subjects, RA was associated with a 0.40 mm (9.3%) greater LD, 0.41 mm (7.8%) greater IAD, 10% higher CWS, and 8% higher CWT. The groups had comparable cIMT. Associations remained similar after exclusion of patients with prior CV disease and after adjustment for demographic factors and CV risk factors.
RA is associated with maladaptive outward carotid arterial remodeling. These results are relevant because maladaptive outward remodeling is associated with plaque instability and rupture. These results indicate an alternative pathway, beyond the traditional CV risk factors, in RA that amplifies the CV risk.
类风湿关节炎（RA）与心血管（CV）风险增加相关，但这种风险增加的机制尚未完全阐明。颈动脉重塑是结构特性对血流动力学或代谢因素变化的反应，旨在将壁应力保持在一定范围内。当动脉壁上的压力超过这些限制时，这个过程可能变得不适应。我们研究了与对照组相比，RA 中是否存在适应性不良的颈动脉重塑。
这两个队列包括 96 例 RA 患者和 274 例健康受试者，他们进行了横断面研究。通过 B 型颈动脉超声评估颈动脉内膜-中层厚度（cIMT）和内中膜直径（IAD）。计算管腔直径（LD）、周向壁应力（CWS）和周向壁张力（CWT）。线性回归分析用于研究 RA 与颈动脉重塑之间的关系。
与健康受试者相比，RA 患者的 LD 增加了 0.40mm（9.3%），IAD 增加了 0.41mm（7.8%），CWS 增加了 10%，CWT 增加了 8%。两组的 cIMT 相当。排除有 CV 病史的患者后，以及在调整人口统计学因素和 CV 危险因素后，这些关联仍然相似。
RA 与适应性不良的颈动脉向外重塑有关。这些结果很重要，因为适应性不良的向外重塑与斑块不稳定和破裂有关。这些结果表明，在 RA 中，除了传统的 CV 危险因素外，还有一种放大 CV 风险的替代途径。
