Rheumatoid Arthritis, Artery Risk Tied

People with rheumatoid arthritis may be more likely to have neck arteries narrowed by plaque, a new study shows.

The study focuses on the carotid arteries, which run up through the neck, bringing blood to the brain.

Using ultrasound imaging, the researchers viewed the carotid arteries of 98 people with rheumatoid arthritis (RA) and 98 people without it. The two groups were matched for age, sex, and ethnicity.

Rheumatoid arthritis patients were three times as likely to have plaque-narrowed carotid arteries as those without it, the study shows.

Compared with the general public, people with RA die prematurely, mainly from heart disease, write Mary Roman, MD, and colleagues in the Annals of Internal Medicine.

Roman works in the cardiology division at Cornell University’s Weill Medical College.

Plaque and Rheumatoid Arthritis

The researchers noted participants’ risk factors for heart disease, including high blood pressure, family history of heart disease, and diabetes.

The group without RA included more smokers and people with high blood pressure. Even so, the RA group had triple the odds of having plaque-narrowed arteries.

Among the RA patients, 44 percent had plaque-narrowed carotid arteries. So did 15% of the comparison group without RA.

Participants without RA who had high blood pressure stopped taking their blood pressure medication for three weeks before their carotid arteries were studied. Blood pressure medicine wasn’t interrupted for anyone with RA.

About the RA Patients

The rheumatoid arthritis patients were 20-83 years old (average age: 35). On average, they had been diagnosed with RA 12 years before the study.

Compared with people without RA, plaque-narrowed arteries were more common in RA patients of all age groups, “particularly among the younger patients,” the researchers write.

However, not all RA patients had plaque-narrowed carotid arteries. The artery problem was more often seen in patients taking TNF therapy, biologic drugs that target an inflammatory protein called tumor necrosis factor (TNF).

Roman’s team doesn’t blame anti-TNF drugs for that pattern. Instead, the researchers say patients taking TNF therapy may have more severe rheumatoid arthritis, which could affect risk of artery disease.

Inflammation’s Role?

Possibly, inflammation related to RA is also tied to risk of atherosclerosis (plaque-hardened blood vessels), the researchers write, noting that they haven’t proven that theory.

They call for “aggressive control” of rheumatoid arthritis -- along with curbing other risk factors for heart disease -- “because chronic inflammation is probably a driving force for premature atherosclerosis.”

Since participants’ arteries were only checked once, the study doesn’t show how artery disease progressed over time. Future studies should probe how rheumatoid arthritis speeds up atherosclerosis and how to stop that process, write Roman and colleagues.

By Miranda Hitti, reviewed by Louise Chang, MD

SOURCES: Roman, M. Annals of Internal Medicine, Feb. 21, 2006; vol 144: pp 249-256. News release, American College of Physicians.