Cardiovascular disease risk in inflammatory rheumatic disease: focus on early markers

Inflammatory rheumatic diseases like rheumatoid arthritis (RA) are associated with an increased incidence of cardiovascular disease. This increase cannot be solely explained by traditional risk factors, including hypertension, diabetes mellitus, smoking, hypercholesterolemia, positive family history for premature cardiovascular disease and obesity. Atherosclerosis, the main underlying cause of cardiovascular disease, is regarded as an inflammatory disease that develops over years. Several previous studies have shown that cardiovascular events can occur at a higher than expected rate shortly after the first symptoms of RA.
The overall aim of the research in this thesis was to assess potential early markers for atherosclerosis in RA patients and to assess whether individuals at risk of RA are more prone to develop cardiovascular disease as is the case for patients with fully developed RA.
We measured several serological biomarkers together with other measures such as intima media thickness (IMT), pulse-wave analysis (PWA) and skin autofluorescence ( a non-invasive marker for accumulation of Advanced Glycation End products) as markers for atherosclerosis and inflammation, as early markers for atherosclerosis.
This thesis supports the view that there are indications for presence of early atherosclerosis at group level in RA risk individuals and RA patients and therefore awareness may give an opportunity for prevention of clinical manifest cardiovascular disease in daily clinical practice.
For the future, it would be interesting to know to which extent individual biomarkers, or a simple multi biomarker set can improve risk classification and can be a base for targeted treatment.