Increased arterial stiffness and cardiovascular risk have been observed in inflammatory diseases. Polymyalgia rheumatica (PMR) is a disease which affects primarily the elderly and exhibits evidence of a systemic inflammatory response, but little is known about aortic involvement in PMR. We investigated whether aortic stiffness is increased in PMR and whether it improves after steroid treatment.

Thirty-nine PMR patients (age 72±8 years, men 45%, blood pressure 134/75±16/9 mmHg) and 39 age-, sex- and blood pressure-matched control subjects underwent aortic pulse wave velocity (PWV) determination (applanation tonometry, Sphygmocor). Aortic augmentation as a measure of the impact of the reflection wave on central hemodynamics was also measured, and corrected for heart rate. Twenty-nine of the PMR patients were reexamined after 4-week treatment with prednisone (starting dose, 12.5–50 mg/day).

Aortic PWV was significantly higher in PMR patients than in control subjects (12.4±4 vs 10.2±2 m/s, p<0.01). Treatment was followed by a reduction in heart rate (from 78±12 to 70±10 bpm, p<0.001), and no significant change in BP (from 134/75±16/8 to 134/75±15/9 mmHg, both p=n.s.). As shown in the Figure, aortic PWV decreased significantly after steroid treatment (from 11.8±4 to 10.5±3 m/s, p=0.015), and the difference was independent from blood pressure and heart rate changes. Treatment was also associated with a significant reduction in aortic augmentation. Augmentation index corrected for a heart rate of 75 bpm decreased from 0.34±0.07 to 0.29±0.08 (p<0.01).

Conclusions: Polymyalgia rheumatica is associated with increased aortic stiffness, which may improve upon reduction of systemic inflammation determined by treatment with corticosteroids.