Association between disease activity, arterial stiffness, and 10-year cardiovascular risk in patients with rheumatoid arthritis: a cross-sectional study

Patients with rheumatoid arthritis (RA) are at increased cardiovascular risk. This study explored the association of RA disease activity with arterial stiffness (AVI) and 10-year atherosclerotic cardiovascular disease (ASCVD) risk. This retrospective cross-sectional study enrolled 1,152 RA patients (484 inactive, 668 active, no prior cardiovascular/cerebrovascular disease) and 235 healthy controls. Clinical characteristics, laboratory parameters, and AVI were compared among groups. Multivariable logistic regression was performed to identify factors independently associated with high AVI. The interaction between disease activity and disease duration on AVI was also assessed using two-way analysis of variance (two-way ANOVA). AVI levels and high AVI prevalence were significantly higher in active RA patients than in inactive RA and controls (p < 0.05). With increasing disease activity, Disease Activity Score 28 based on C-reactive protein (DAS28-CRP), C-reactive protein (CRP), and erythrocyte sedimentation rate increased significantly (all p < 0.001). Multivariable regression showed that systolic blood pressure (OR = 1.025, 95% CI 1.010-1.040), moderate disease activity (OR = 4.932, 95% CI 1.018-23.900), and high disease activity (OR = 6.342, 95% CI 1.239-32.475) were independently associated with high AVI. Two-way ANOVA indicated that disease activity had a significant main effect on AVI (F = 5.343, p < 0.001), whereas disease duration and its interaction with disease activity were not significant. RA disease activity is closely associated with increased arterial stiffness and higher estimated 10-year ASCVD risk. In this cross-sectional cohort, disease activity was more strongly associated with AVI than disease duration.