Background: Rheumatoid arthritis (RA) is an independent risk factor for cardiovascular disease (CVD); RA patients demonstrate advanced pre-clinical carotid atherosclerosis compared to controls.

Objectives: To assess: the rate of progression of subclinical atherosclerotic plaque formation in RA patients and the factors leading to progression; whether the rate of progression in these patients is faster than in non-RA subjects carefully-matched for traditional CV risk factors. Methods: Carotid plaques were assessed by ultrasonography at baseline and follow-up end, separated by an average of 3.6±0.2 years, in 64 non-diabetic RA patients (53♀, aged 59.2±12 years) without concomitant CVD (RA disease duration 7.8±6.2 years). ‘Healthy’ controls matched 1:1 both at baseline and follow-up end for all traditional CVD risk factors with 35 RA patients were also studied.

Results: New plaques formed in 30% of patients who were significantly older, heavier tobacco user and had higher average systolic blood pressure compared to the rest RA population. Lipids, obesity, inflammatory markers and other RA related parameters were comparable between the 2 subgroups. In multivariate analysis: age and smoking predicted new plaque formation of all classical CVD factors (model 1); longer duration of corticosteroid use (low-dose) and shorter duration of biologic agent use (of all RA related parameters/drugs -model 2). In a final model: age, smoking and corticosteroid use predicted new plaque formation. Being in clinical remission on average during 62% of follow-up time, RA patients displayed similar rate of progression atherosclerotic plaque formation to the matched controls.

Conclusions: Formation of new atherosclerotic plaques in patients with well-controlled RA depends mainly on traditional cardiovascular risk factors and corticosteroid use.