Carotid intima-media thickness in middle-aged adults with and without rheumatoid arthritis: a case-cohort analysis

Abstract Background Rheumatoid Arthritis (RA) is a chronic autoimmune disease characterised by systemic inflammation and a possible increased risk of subclinical atherosclerosis. Carotid intima-media thickness (cIMT) is an early marker of atherosclerotic disease and can be performed noninvasively using ultrasound imaging. cIMT is a well-established marker of subclinical atherosclerosis and an independent predictor of cardiovascular events. Purpose The aim of this study was to evaluate the cross-sectional and prospective associations of cIMT, including its 8-year incidence, in individuals with and without RA, free of prior cardiovascular conditions at baseline, using data from a large multicentre cohort study. Methods A case-cohort study was conducted with 161 participants with RA and 977 controls without RA, selected from a randomly assigned subcohort at baseline from a prospective cohort study of adults aged 35–74 years. This analysis included baseline (2008–2010) and 8-year follow-up data (2016–2018). RA diagnosis was based on physician confirmation, use of disease-modifying antirheumatic drugs, or positive serological biomarkers. cIMT was measured by ultrasonography at baseline and follow-up. Associations between RA and cIMT prevalence and incidence were assessed using linear and logistic regression models, adjusted for sociodemographic and cardiovascular risk factors. P-value 0.05 was considered statistically significant. Results The mean ± SD age of participants was 51.0 ± 8.4 years, with 58.3% being women. Participants with RA were significantly older (53.1 ± 8.7 vs 50.6 ± 8.3 years) and more likely to be female (79.5% vs 54.8%). The incidence of cIMT ≥75th percentile over the 8-year follow-up was significantly higher in the RA group. In the unadjusted model, RA was associated with a significantly higher Odds Ratio (OR) of cIMT ≥75th percentile (OR: 2.58, 95% Confidence Interval (95% CI): 1.01–6.60, p = 0.04), although this association lost significance after adjusting for sociodemographic and cardiovascular risk factors (OR: 2.43, 95% CI: 0.94–6.27, p = 0.06; OR: 2.46, 95% CI: 0.95–6.38, p = 0.06). No significant associations were found in linear or logistic regression analyses for the association of RA with cIMT prevalence (Table 1). Conclusion RA was associated with a higher incidence of cIMT ≥75th percentile over the 8-year follow-up, suggesting increased subclinical atherosclerosis. However, this association lost significance after adjusting for confounders, and no significant association was found for the prevalence of cIMT.