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Background: Cardiovascular disease (CVD) is the primary cause of mortality in women in developed countries. CVD risk rises with age, yet for women there is a rapid increase that occurs after the onset of menopause (1). There has been found that there is four to five times atherosclerosis compared to premenopausal women. Adding to traditional CVD risk, rheumatoid arthritis (RA) patients have an increased CVD morbimortality because of the inflammatory disorder (2). To detect the burden of CVD, carotid ultrasound has been promoted to identify preclinical atherosclerosis.
Objectives: To determine the prevalence of carotid atherosclerosis and carotid intima-media thickness (cIMT) in postmenopausal patients with RA and compare them to matched controls.
Methods: Observational, cross-sectional study. RA patients aged 40-75 years that fulfilled 2010 ACR/EULAR criteria with post-menopause and matched controls (without RA) were included. Patients with history of previous atherosclerotic CVD, women who undergone menopause due to hysterectomy or cessation of periods other than by a natural cause, women on hormone replacement therapy and having irregular menses were excluded. Clinical history and carotid ultrasound were performed. Increased cIMT defined as ≥0.9 mm was measured using the two inner layers of the common carotid artery and carotid plaque as a focal narrowing ≥0.5 mm of the surrounding lumen. Descriptive analysis was done with frequencies (%), median (q25-q75). Comparisons with Chi-square and Mann Whitney-U test. Binary regression analysis was used to test association an increased cIMT with cardiovascular risk factors and RA diagnosis.
Results: A total of 139 women with established post-menopause were included. Baseline characteristics (
Baseline characteristics
| RA
| Control
| p | |
|---|---|---|---|
| Age, median (q25-q75) | 55.04 ± 5.381 | 56 6 ±.481 | NS |
| Disease duration, year, median (q25-q75) | 10.32 (4.5-15.3) | ||
| Body mass index, median (q25-q75) | 28.19 (25.36-31.84) | 28.55 (26.57-31.18) | NS |
| Diabetes Mellitus, n (%) | 8 (11.6) | 14 (20) | NS |
| Hypertension, n (%) | 19 (27.5) | 26 (37.1) | NS |
| Dyslipidemia, n (%) | 23 (32.9) | 21 (30.4) | NS |
| Active smoking, n (%) | 14 (20.3) | 5 (7.1) | NS |
Carotid ultrasound findings
| RA
| Controls
| p | |
|---|---|---|---|
| Any plaque, n (%) | 24 (34.3) | 17 (24.6) | NS |
| Right CP, n (%) | 19 (27.9) | 8 (11.6) | 0.01 |
| Left CP, n (%) | 17 (25) | 13 (18.8) | NS |
| Any cIMT ≥0.9 mm, n (%) | 38 (54.3) | 19 (27.5) | 0.001 |
| Right carotid cIMT ≥0.9 mm, n (%) | 25 (35.7) | 10 (14.7 | <0.001 |
| Left carotid cIMT ≥0.9 mm, n (%) | 31 (44.3) | 15 (21.7) | <0.001 |
| CP characteristics: | |||
| Homogeneous n (%) | 2 (2.8) | 3 (4.3) | NS |
| Heterogeneous, n (%) | 20 (28.6) | 16 (23.2) | NS |
CP: carotid plaque
Conclusion: Despite the increase in cardiovascular risk in postmenopausal women compared to the general population, women with RA have a higher risk compared to healthy women. Carrying out cardiovascular prevention and management in patients with RA is essential, especially in those who are in a stage of post-menopause.
REFERENCES:
[1]Karvinen, S. et al (2019). Menopausal Status and Physical Activity Are Independently Associated with Cardiovascular Risk Factors of Healthy Women, Endocrinol, 10, 589.
[2]Schott, L., et al (2009). Do carotid artery diameters manifest early evidence of atherosclerosis in women with rheumatoid arthritis? JWomensHealth, 18, 21-29.
Disclosure of Interests: None declared