Subclinical atherosclerosis and cardiovascular risk, insulinresistance, level of adiponectin in rheumatoid arthritis combinated with hypertension
Summary. The study involved 42 patients (38 women, 4 men) aged 45–65 years (median — 54 [51; 60] years) with rheumatoid arthritis (RA) combinated with hypertension (H). All patients were performed clinical examination, ultrasound of the carotid arteries to determine the thickness of intima-media, elastic properties, endothelial dysfunction, lipid spectrum of the blood, level of insulin, adiponectin, daily monitoring of blood pressure were also performed. Atherosclerotic changes identified in 33 (78.6%) patients with RA combinated with H that significantly higher than in the comparison group. Patients of the main group had significantly higher incidence of atherosclerotic plaques — in 23 (54.8%), including unstable structure — in 5 (21.7%) compared to the other group. The presence of atherosclerotic plaques in patients with RA combinated with H was associated with endothelial dysfunction, abnormally carotid elastic properties, age, hyperinsulinemia, high level of adiponectin, duration of glucocorticoid treatment. For adiponectin and HOMA2 AUROC index was 0.787 (95% CI 0,642–0,932; p<0.05) and 0.700 (95% CI 0,536–0,864; p<0.05), respectively, indicating a good quality diagnostic models. In patients with RA combinated with H was significantly more common signs of carotid artery atherosclerotic changes compared with the control groups, which requires more strict control of cardiovascular risk factors. Determining the level of adiponectin and insulin resistance may be additional markers of atherosclerotic changes in these patients.
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