Rational Pharmacotherapy in Cardiology

Advanced search


Full Text:


Aim. To study the relationship of arterial stiffness (determined by contour analysis of peripheral pulse wave) with cardiovascular risk factors in women with rheumatoid arthritis (RA). Material and methods. Women with high activity of RA (n=130) were examined. Women without rheumatic diseases (n=25) were included into control group. Assessment of the major traditional risk factors (TRF) of cardiovascular disease (CVD), duplex scanning of the common carotid arteries, transthoracic echocardiography (Echo-CG), and determination of serum inflammation marker levels were performed, in addition to evaluation of clinical symptoms, RA activity and severity. Indicators of digital pulse volume were determined by photoplethysmography. Results. Young and middle aged patients with RA after adjusting for the major TRF of CVD compared with women without RA have higher stiffness index (SI), reflecting increased stiffness of large arteries, and reflection index (RI), that shows raised tone of small arteries. The value SI>9.6 m/s or RI>70% is associated with a higher rate of diastolic dysfunction (DD), and left ventricular hypertrophy (LVH), while the more severe RA [high frequency III/IV radiographic stage, high levels of IgM rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP)] and the history of inefficacy of tumor necrosis factor-α (TNF-α) inhibitors in the absence of significant differences in TRF of CVD. SI and RI values in patients treated with methotrexate were significantly lower than in patients receiving other basic anti-inflammatory drugs or not treated patients. Conclusion. Increased arterial stiffness that is associated with the development of DD and LVH, irreversible joint damages, higher IgM RF and anti-CCP levels may be one of the possible mechanisms of the relationship of RA severity and increased risk of cardiovascular complications. RI determination can be used for screening of LVH in women with RA of high activity.

About the Authors

D. S. Novikova
Research Institute for Rheumatology
Russian Federation

T. V. Popkova
Research Institute for Rheumatology
Russian Federation

A. N. Gerasimov
I.M. Sechenov First Moscow State Medial University
Russian Federation

A. V. Volkov
Research Institute for Rheumatology
Russian Federation

E. L. Nasonov
Research Institute for Rheumatology
Russian Federation


1. Peters M.J., Symmons D.P., McCarey D.W. et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other types of inflammatory arthritis — TASK FORCE «Cardiovascular risk management in RA». Ann Rheum Dis 2010;69:325–31.Poole C.D., Conway P., Currie C.J. An evaluation of the association between C-reactive protein, the change in C-reactive protein over one year, and all-cause mortality in chronic immune-mediated inflammatory disease managed in UK general practice. Rheumatology (Oxford) 2009;48:78–82.

2. Rho Y.H., Chung C.P., Oeser A, et al. Inflammatory mediators and premature coronary atherosclerosis in rheumatoid arthritis. Arthritis Rheum 2009;15;61:1580–5.

3. López-Longo F.J., Oliver-Miñarro D., de la Torre I. et al. Association between anti-cyclic citrullinated peptide antibodies and ischemic heart disease in patients with rheumatoid arthritis. Arthritis Rheum 2009;61:419–24.

4. Novikova D.S., Popkova T.V., Mach E.S., Nasonov E.L. Stiff arteries — an integral indicator of cardiovascular risk in patients with rheumatoid arthritis. Nauchno-Prakticheskaya Revmatologiya 2009; (5):38–48. Russian (Новикова Д.С., Попкова Т.В., Мач Э.С., Насонов Е.Л. Ригидность артерий — интегральный показатель сердечно-сосудистого риска у больных ревматоидным артритом. Научно-Практическая Ревматология 2009; (5):38–48).

5. Millasseau S.C., Kelly R.P., Ritter J.M., Chowienczyk P.J. Determination of age-related increases in large artery stiffness by digital pulse contour analysis. Clin Sci (Lond) 2002;103(4):371–7.

6. Millasseaua S.C., Ritter J.M., Takazawab K., Chowienczyka P.J. Contour analysis of the photoplethysmographic pulse measured at the finger. J Hypertens 2006;24:1449–56.

7. Dawber T.R., Thomas H.E., McNamara P.M. Characteristics of the dicrotic notch of the arterial pulse wave in coronary heart disease. Angiology 1973;24:244–255.

8. Arnett F.C., Edworthy S.M., Bloch D.A. The ARA 1987 revised criteria for classification of rheumatoid arthritis. Arthritis Rheum 1988;31:315–24.

9. Olyunin Yu.A. Assessment activity and the effectiveness of therapy of rheumatoid arthritis. International indices of activity assessment, functional status and quality of life of patients with rheumatic diseases. Moscow: Russian Association of Rheumatology; 2007. Russian (Олюнин Ю.А. Оценка активности и эффективности терапии ревматоидного артрита. Международные индексы оценки активности, функционального статуса и качества жизни больных ревматическими заболеваниями. М.: Ассоциация ревматологов России; 2007).

10. Nasonov E.L., editor. Rheumatology. Clinical recommendations. Moscow: GEOTAR-Media; 2010. Russian (Насонов Е.Л., редактор. Ревматология. Клинические рекомендации. М.: ГЭОТАР-Медиа; 2010).

11. De Backer G., Ambrosioni E., Borch-Johnsen K. et al. Third Joint Force of European and other Societies on Cardiovascular Disease and Prevention in Clinical Practice. European guidelines on cardiovascular disease and prevention in clinical practice. Atherosclerosis 2003;171:145–55.

12. Haward G., Sharrett A.R., Heiss G. et al. Carotid artery intima-media thickness distribution in general populations as evaluated by B-mode ultrasound. Stroke 1993;24:1297–1304.

13. National guidelines for diagnosis and treatment of hypertension (4th revision). Sistemye Gipertenzii 2010; (3):5–26. Russian (Национальные рекомендации по диагностике и лечению артериальной гипертонии (четвертый пересмотр). Системные гипертензии 2010; (3): 5–26).

14. National guidelines for diagnosis and treatment of chronic heart failure. Serdechnaya Nedostatochnost' 2010;11(1): 1–45. Russian (Национальные рекомендации по диагностике и лечению хронической сердечной недостаточности. Сердечная недостаточность 2010;11(1): 1–45).

15. Gerasimov A.N., Shpitonkov M.I. Comparative analysis of the autocorrelation function and the scope for some epidemiological problems. Trudy Instituta Sistemnogo Analiza RAN 2008;32(1): 290–4. Russian (Герасимов А.Н., Шпитонков М.И. Сравнительный анализ автокорреляционной функции и размаха для некоторых эпидемиологических задач. Труды Института Системного анализа РАН 2008;32(1): 290–4.

16. Guidelines for immunologic laboratory testing in the rheumatic diseases: an introduction. American college of rheumatology ad hoc committee on immunologic testing guidelines. Arthritis Rheum 2002;47:429–33.

17. Laurent S., Cockcroft J., Van Bortel L. et al. Expert consensus document on arterial stiffness: methodological issues and clinical applications European Heart Journal 2006;27:2588–605.

18. Gunarathne A., Patel J.V., Hughes E.A., Lip G.Y. Measurement of stiffness index by digital volume pulse analysis technique: clinical utility in cardiovascular disease risk stratification. Am J Hypertens 2008;21(8):866–72.

19. McEniery C.M., Yasmin, Hall I.R., Quasem A. et al. Normal vascular aging: differential effect on wave reflection and aortic pulse wave velocity: the Anglo-Cardiff Collaborative Trial (ACCT) JACC 2005;46:1753–60.

20. Ryabikov A.N., Malyutina S.K., Ivanov S.V. Vascular stiffness and pulse wave reflection: the relationship with the established and discussed the determinants of cardiovascular disease. In: New evaluation of arterial stiffness — early marker of cardiovascular disease. Symp. XIV Russian National Congress "Man and medicine." Moscow. April 19, 2007 Moscow: Russkiy vrach; 2007: 15–30. Russian (Рябиков А.Н., Малютина С.К., Иванов С.В. Жесткость сосудистой стенки и отражение пульсовой волны: связь с установленными и обсуждаемыми детерминантами сердечно-сосудистых заболеваний. В: Новые возможности оценки артериальной ригидности — раннего маркера развития сердечно-сосудистых заболеваний. Материалы симпозиума. XIV Российский национальный конгресс «Человек и лекарство». Москва. 19 апреля 2007 г. Москва: Русский врач; 2007: 15–30).

21. Park S., Lakatta E.G. Role of inflammation in the pathogenesis of arterial stiffness. Yonsei Med J 2012;53(2):258–61.

22. Potter C., Hyrich K.L., Tracey A. et al. Association of rheumatoid factor and anti-cyclic citrullinated peptide positivity, but not carriage of shared epitope or PTPN22 susceptibility variants, with anti-tumour necrosis factor response in rheumatoid arthritis. Ann Rheum Dis 2009;68(1):69–74.

23. Gerli R., BartoloniBocci E., Sherer Y. et al. Association of anti-cyclic citrullinated peptide antibodies with subclinical atherosclerosis in patients with rheumatoid arthritis. Ann. Rheum Dis 2008;67:724–725.

24. Giles J.T., Malayeri A.A., Fernandes V. et al. Left ventricular structure and function in patients with rheumatoid arthritis, as assessed by cardiac magnetic resonance imaging. Arthr Rheum 2010;62(4):940–51.

25. Van Popele N.M., Grobbee D.E., Bots M. et al. Association between arterial stiffness and atherosclerosis. Stroke 2001;32:454–60.

26. Chen J.Y., Tsai W.C., Lin C.C. et al. Stiffness index derived from digital volume pulse as a marker of target organ damage in untreated hypertension. Blood Press 2005;14(4):233–7.

For citation:

Novikova D.S., Popkova T.V., Gerasimov A.N., Volkov A.V., Nasonov E.L. THE RELATIONSHIP OF CARDIOVASCULAR RISK FACTORS AND ARTERIAL WALL STIFFNESS IN WOMEN WITH A HIGH ACTIVITY OF RHEUMATOID ARTHRITIS. Rational Pharmacotherapy in Cardiology. 2012;8(6):756-765. (In Russ.)

Views: 477

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 License.

ISSN 1819-6446 (Print)
ISSN 2225-3653 (Online)