Rheumatoid arthritis
Carotid Intima Media Thickness in Rheumatoid Arthritis as Compared to Control Subjects: A Meta-Analysis

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Objectives

Rheumatoid arthritis (RA) is associated with increased risk of cardiovascular disease. Carotid intima media thickness (cIMT) is frequently used to identify populations at elevated cardiovascular risk. A systematic literature search and meta-analysis were performed to evaluate cIMT difference between RA and controls.

Methods

The literature was screened to identify all available studies comparing cIMT in RA patients and controls. Random effects meta-analysis was performed to estimate the overall mean cIMT difference between both groups. Meta-regression was performed to assess the influence of age and the degree of comparability regarding established cardiovascular risk factors on cIMT difference. Potential publication bias was examined by a funnel plot and Egger test.

Results

From 22 studies, cIMT data were available from 1384 RA patients and 1147 controls. In 17 of the studies, RA patients had a statistically significantly greater cIMT. The overall mean cIMT difference was 0.09 mm (95%CI: 0.07-0.11 mm). Heterogeneity was observed (I2 72.5%, P < 0.001). A likely source of heterogeneity was the difference in cardiovascular risk factors between RA patients and controls at baseline, but not age. The funnel plot did not show a skewed or asymmetrical shape, which was supported by the Egger's test (P = 0.87).

Conclusions

Our observations support the current evidence base for an increased cardiovascular burden in RA and support the use of cIMT in observational studies in RA patients. The next step is to determine its utility as a surrogate cardiovascular risk marker in RA in prospective studies.

Section snippets

Search and Review Strategy

A systematic search of the literature published between January 1966 and December 2008 was conducted in MEDLINE and EMBASE to identify all articles using cIMT as a surrogate measure of CV risk in RA patients compared with control subjects. Search terms were used in every possible spelling, as synonyms, acronyms, key- or text words, and these groups were combined with an ā€˜ANDā€™ operator. The following key words were used in all fields: ā€œarthritis, rheumatoidā€ AND ā€œcarotid atherosclerosisā€ OR

Results

The search resulted in 53 potential articles of interest, of which 22 were included (Fig. 1). In all studies, RA patients were recruited from hospital-outpatient clinics and fulfilled the American College of Rheumatology criteria (20). Table 1 summarizes the clinical characteristics and the degree of comparability with regard to other CV risk factors of each study. Only 4 of 22 studies (17%) included 100 or more RA patients and most studies investigated middle-aged female RA patients. Overall,

Discussion

The key finding of this meta-analysis is a statistically significantly greater cIMT in RA patients compared with control subjects, supporting epidemiological evidence for an increased CV burden in these patients. In fact, of all 22 studies identified, only 1 study reported a smaller cIMT in RA patients. In this particular study, RA patients were compared with controls obtained from a hypertension cohort (29). In accordance with this, we observed that the cIMT difference was significantly higher

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    Disclosures: Professor Dijkmans received educational grants from Wyeth, Abbot, and Pfizer. The other authors have no conflicts of interest to disclose.

    1

    These authors contributed equally on this article.

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