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Background: Rheumatoid Arthritis (RA) is a chronic inflammatory autoimmune disease associated with an increased risk of cardiovascular events (1, 2). RA can be compared to type 2 diabetes mellitus as a cardiovascular (CV) risk factor (3). This study investigates the relationship between RA and subclinical atherosclerosis, focusing on Carotid Intima-Media Thickness (CIMT) and carotid stenosis within the Paracelsus 10000 cohort (4) Objectives: Investigating the relationship between Rheumatoid Arthritis (RA) and subclinical atherosclerosis, specifically focusing on Carotid Intima-Media Thickness (CIMT) and carotid stenosis. Analyzing real-world data from the Paracelsus 10000 cohort to assess the association between RA and cardiovascular risk. Methods: Real-world data from the Paracelsus 10000 cohort were analyzed to assess the association between RA and cardiovascular risk. Logistic regression models were employed to evaluate the odds of any carotid stenosis in Common Carotid Artery (CCA) and Internal Carotid Artery (ICA) in RA patients. Stenosis was defined as any classification score above 0 according to the North American Symptomatic Carotid Endarterectomy Trial (NASCET) criteria. Linear regression was used to analyze CIMT, adjusting for traditional cardiovascular risk factors (SCORE2) (5). Additionally, we calculated the relative risk (RR) using Stata's adjrr command. Results: Among 9,831 individuals, RA was associated with a statistically significant increase in CIMT by 0.03 millimeters compared to non-RA individuals (p = 0.004). RA was associated with a significantly higher risk of carotid stenosis (odds ratio OR = 1.43, 95% CI = 1.12 to 1.82, p = 0.004). After adjusting for potential confounders, including SCORE 2, the association remained significant (OR = 1.34, 95% CI = 1.01 - 1.78 p = 0.046). The relative risks (RR) show that RA individuals having a 43% higher risk of carotid stenosis compared to non-RA individuals, which persisted even after adjustment for confounders (RR = 34%). Conclusion: This investigation highlights the role of rheumatoid arthritis (RA) as a potential contributor to subclinical atherosclerosis. While the statistical difference in CIMT is noteworthy, its clinical impact might be limited. The use of real-world data in this study enhances our comprehension of RA's influence on cardiovascular health. The findings highlight the importance of early cardiovascular risk assessment and management in RA patients. Our results suggest that, similar to diabetic patients who undergo routine carotid stenosis screening due to their increased risk, RA patients may also benefit from regular screening for carotid stenosis (6). REFERENCES: 1 Conrad N, Verbeke G, Molenberghs G, Goetschalckx L, Callender T, Cambridge G, et al. Autoimmune diseases and cardiovascular risk: a population-based study on 19 autoimmune diseases and 12 cardiovascular diseases in 22 million individuals in the UK. The Lancet. 2022;400(10354):733-43. 2 Smolen JS, Aletaha D, McInnes IB. Rheumatoid arthritis. Lancet. 2016;388(10055):2023-38. 3 van Halm VP, Peters MJ, Voskuyl AE, Boers M, Lems WF, Visser M, et al. Rheumatoid arthritis versus diabetes as a risk factor for cardiovascular disease: a cross-sectional study, the CARRE Investigation. Ann Rheum Dis. 2009;68(9):1395-400. 4 Frey V, Langthaler P, Raphaelis E, Ring-Dimitriou S, Kedenko L, Aigner E. Paracelsus 10,000: an observational cohort study about the health status of the population of Salzburg, Austria. Rationale, objectives and study design. Paracelsus Proc Exp Med(2023 1: 1–17 1033594/000000600 CrossRefGoogle Scholar. 2023. 5 group Sw, collaboration ECr. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. European Heart Journal. 2021;42(25):2439-54. 6 Johri AM, Nambi V, Naqvi TZ, Feinstein SB, Kim ESH, Park MM, et al. Recommendations for the Assessment of Carotid Arterial Plaque by Ultrasound for the Characterization of Atherosclerosis and Evaluation of Cardiovascular Risk: From the American Society of Echocardiography. J Am Soc Echocardiogr. 2020;33(8):917-33. Acknowledgements: NIL. Disclosure of Interests: None declared.
Ausserwinkler et al. (Sat,) studied this question.