Background: Individuals with rheumatoid arthritis (RA) are at an elevated risk for cardiovascular disease, frequently presenting as accelerated vascular aging. Traditional clinical markers may inadequately reflect the initial phases of this process. While carotid intima-media thickness (CIMT) is a common indicator of structural deterioration, it may not accurately reflect the early mechanical and functional changes in the artery wall. To close this diagnostic gap and improve cardiovascular prevention, we used a multimodal vascular ultrasonography framework that included structural (CIMT), mechanical (Shear Wave Elastography/SWE), and functional (Wall Shear Stress/mWSS) parameters to provide a comprehensive assessment of subclinical arterial alterations in RA patients.

Objectives: To identify independent determinants of vascular alterations in RA patients using a multimodal vascular investigation, specifically evaluating structural modifications (CIMT), arterial stiffness (SWE), and endothelial-blood flow interactions (WSS).

Methods: A cross-sectional study was performed including 60 RA patients from an Indonesia-based tertiary referral hospital Ngoerah Hospital Bali Indonesia. High-resolution ultrasonography was used to measure vascular parameters such Mean CIMT, Mean SWE, and Mean WSS. All participants underwent standardized carotid ultrasound examination performed by two experienced operators blinded to clinical data. We used bivariate (Spearman’s/Pearson) and multivariate linear regression analyses to find independent predictors among demographic, clinical, and laboratory data.

Results: Our study included 60 patients with RA, predominantly female (86.7%), with a median age of 42.50 years and a median RA duration of 4.0 years. We found mean DAS-28 of 2.87 ± 1.02 and a mean LDL-cholesterol level of 148.17 mg/dL. Multivariate analysis indicated that LDL-cholesterol served as significant independent predictor for both structural alterations (mCIMT: B=0.002, p=0.007) and arterial stiffness (mSWE: B=0.084, p=0.025). Moreover, ESR was identified as a significant independent predictor for mCIMT (p=0.032) and mSWE (p=0.040), underscoring the enduring effects of chronic inflammation. Functional flow interactions (mWSS) exhibited a negative correlation with systolic blood pressure in bivariate analysis (r = -0.351, p = 0.014) but did not provide independent predictions in the multivariate model (p > 0.05).

Conclusions: Premature vascular aging in RA is driven by a synergistic double-hit of systemic inflammation and dyslipidemia. While mWSS captures early functional flow dysfunction, CIMT and SWE provide definitive evidence of irreversible structural and mechanical remodeling. Comprehensive CV risk management in RA must aggressively target both ESR and LDL-cholesterol levels.

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Acknowledgments: NIL.

Disclosure of Interests: None declared.