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

• Published in: Seminars in arthritis and rheumatism Vol. 40; no. 5; pp. 389 - 397
• Main Authors: van Sijl, Alper M., Peters, Mike J., Knol, Dirk K., de Vet, Henrica C., Gonzalez-Gay, Miguel A., Smulders, Yvo M., Dijkmans, Ben A., Nurmohamed, Michael T.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.2011; Elsevier
• Subjects: Arthritis, Rheumatoid - diagnostic imaging; Biological and medical sciences; Cardiovascular Diseases - epidemiology; Carotid Arteries - diagnostic imaging; carotid intima media thickness; Case-Control Studies; Diseases of the osteoarticular system; Humans; Inflammatory joint diseases; Medical sciences; meta-analysis; rheumatoid arthritis; Rheumatology; Risk Factors; Tunica Intima - diagnostic imaging; Tunica Media - diagnostic imaging; Ultrasonography; meta-analysis; rheumatoid arthritis; carotid intima media thickness; Human; Immunopathology; Chronic; Carotid; Rheumatoid arthritis; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; Vascular wall
• ISSN: 0049-0172; 1532-866X; 1532-866X
• DOI: 10.1016/j.semarthrit.2010.06.006

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. 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. 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 (I 2 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). 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.