Ankle brachial pressure index in the early identification of cardiovascular disease risk in rheumatoid arthritis

Abstract

AIM Atherosclerosis in the Rheumatoid Arthritis population is under-diagnosed and the relation between Ankle Brachial Pressure Index (ABPI) measurement and cardiovascular disease is under reported. The aim of the study was to determine the relationship between ABPI and cardiovascular disease risk factors in the early identification of vascular disease in Rheumatoid Arthritis (RA) patients. METHODS A prospective observational non-experimental study was conducted on 100 subjects presenting with RA and no history of cardiovascular events. Demographic data and blood results including C-reactive protein, Erythrocyte sedimentation rate, RA factor, Anti-cyclic Citrullinated Peptide Antibodies and cholesterol levels were recorded. A vascular assessment including waveform spectral analysis and ABPI was conducted. ABPI was defined as abnormal if less than 0.9. RESULTS From all cardiovascular disease risk factors measured, this study has identified that high cholesterol levels were related to lower ABPI readings in this cohort (p=0.022). This study also identified gender, analgesics and biologics as other possible risk factors that showed a relationship to the ABPI although not statistically significant. CONCLUSIONS A relationship between ABPI and hypercholesterolaemia was found in RA patients who did not have diabetes, were not taking anti-platelet and anticoagulant treatments, had no history of ulcerations or cardiovascular events. The results showed that RA participants presenting with hypercholesterolaemia demonstrated lower values of ABPI when compared to subjects without hypercholesterolaemia, although almost all of them still fall within the normal range. Health professionals should closely monitor cholesterol levels to avoid possible atherosclerosis in this population.