Correlation Between Inflammatory Risk Factors And Cardiovascular Disease For Patients With Rheumatoid Arthritis

Background The high incidence of cardiovascular events in rheumatoid arthritis(RA) has been paid more and more attention in recent years, which plays 42% of the dead cause of rheumatoid arthritis(RA),but traditional cardiovascular's risk factors (such as hypertension, hyperlipemia, diabetes,smoking and so on)can not completely explain the high case of the RA patients, it is thought that chronic inflammation may plays significant role in it,but we can't find any report in domestic about the occurrence of cardiovascular disease of patients with rheumatoid arthritis and the role of inflammatory factors in rheumatoid arthritis patients with atherosclerosis.Objective TO explore the occurrence of premature atherosclerosis and heart disease in patients with rheumatoid arthritis by neck vascular ultrasound and echocardiography, compare the disparities between them and healthy people(age and gender matching); To detect the serum macrophage migration inhibitory fact(MIF) ,interleukin-17(IL-17), interleukin-23(IL-23) level and clinical indicators in rheumatoid arthritis patients ,analysis the association between them and the role of them in rheumatoid arthritis patients with atherosclerosis.Methods 69 RA patients were collected in the Rheumatology and Immune Department of the First Affiliated Hospital of Anhui Medical University during September in the year of 2009 to May in the year of 2010,traditional cardiovascular's risk factors (such as hypertension, hyperlipemia, diabetes,smoking and so on)also have been excluded among them. General information and disease-related variables such as ESR,CRP,RF,anti-CCP in RA patients were investigated ;76 healthy controls were included in this study (age and gender matching). Neck vascular ultrasound was conducted to detect carotid artery plaques and to measure maximum intima media thickness (M-IMT) of carotid artery;the cardiac function parameters such as IVS were determined by echocardiography. Total of Subjects were divided into atherosclerosis group(AS group) ,without atherosclerosis group(NAS group) and normal control group(NC group) according to neck vascular ultrasound, MIF and IL-17,IL-23 level were determined by ELISA assay.Results1. The abnormal rate of echocardiography in RA patients was 78.26%(54/69 cases),they were left ventricular diastolic dysfunction 30 cases,valvular regurgitation 22 cases,the calcification of aortic valve with a small amount of reflux 6 cases,arrhythmia 4 cases;while in NC group the abnormal rate of echocardiography was 26.32%(20/76 cases),there were significant differences between them(X~2=39.05, p<0.01). However, differences of the abnormal rate of electrocardiogram between RA and NC group had no statistical significance(13.04% vs 9.21%, p>0.05).2. Compared with NC group, the right ventricular internal diameter(RV) ( 21.69±3.32 vs 20.47±3.69, p<0.05) and interventricular septal thickness(IVS)(9.45±1.13 vs 8.91±1.55, p<0.05) were higher, the posterior wall of left ventricle(LVPW) (9.05±0.94 vs 8.32±1.39, p<0.01) were significantly higher,ejection fraction(EF) (65.63±4.04 vs 68.95±7.33, p<0.01)and V_E/V_A of mitralis (1.03±0.32 vs 1.35±0.45, p<0.01)were significantly reduce in RA group. 3. EF value was negative correlated with ESR(r=-0.290, p=0.023) and RF(r=-0.335, p=0.01); V_E/V_A value was negative correlated with the course of disease(r=-0.312, p=0.017) and anti-CCP(r=-0.334, p=0.041) in RA group.4. According to neck vascular ultrasound the occurrence of arteriosclerosis in RA group was 52.17%(36/69 cases), including carotid premature atherosclerosis 19 cases (M-IMT≥0.85mm), carotid atherosclerotic plaque formation 17 cases(M-IMT>1.3mm); the occurrence of arteriosclerosis in NC group was 15.79%(12/76 cases), there were significant differences between them(X~2=21.62, p<0.01).5. Compared with NC group, M-IMT value were significantly higher in RA group (0.95±0.17 vs 0.85±0.15, p<0.01),and show positive correlation with age(r=0.568, p=0.000) and RF ( r=0.264, p=0.045); M-IMT value in gentle activity group,medium activity group and severe activity group of RA patients were 0.80±0.22,0.92±0.11,1.04±0.13mm. Analysis of variance show that there were significant differences between them( F=11.247, p=0.000).6. Serum MIF level in AS group(n=30)was significantly higher than that in NAS group(n=30) and NC group(n=64) (15.25±1.72 vs 13.82±2.19 vs 8.01±2.87, p<0.05),and there were significant correlations between the serum MIF level,carotid intima-media thickness(IMT) (r=0.271, p=0.036), the size of atherosclerotic plaques(r=0.291, p=0.024), the serum level of IL-17(r=0.328, p=0.007) and IL-23(r=0.316, p=0.010).7. Compared with NAS group, serum IL-17 and IL-23 level were not increased obviously in AS group (2.83±2.03 vs 2.52±1.28,448.74±173.66 vs 380.07±136.95, p>0.05). However, both are higher than those in NC group( p<0.05).8. Serum MIF level,CRP level and DAS28 score in RA patients were risk factors for atherosclerosis according to Logistic-Regression Analysis.Conclusion1. Compared with the subset of healthy controls, there were high incidence of premature atherosclerosis and cardiovascular disease in RA patients.2. Serum MIF level in RA patients with AS group was significantly higher than that in NAS group and NC group, and it might be related with the serum level of IL-17 and IL-23.3. Serum MIF level,CRP level and DAS28 score in RA patients may be risk factors for atherosclerosis according to Logistic-Regression Analysis.4. Inflammatory factors and autoantibodies may play an important role in rheumatoid arthritis with cardiovascular disease.