Introduction: Both Rheumatoid Arthritis (RA) and the Metabolic Syndrome (MetS) have been associated with an increased risk of atherosclerosis. We aimed to assess the progression of carotid intima media thickness (cIMT) in RA patients with MetS and to evaluate prospectively the effect of a treat-to-target treatment versus usual care on cIMT progression.
Methods: We conducted a cohort analysis of the Franciscus Rheumatoid Arthritis and Cardiovascular Intervention Study (FRANCIS) in which RA patients ≤70 year without cardiovascular disease (CVD) or diabetes mellitus were randomized for either treat-to-target intervention or usual care concerning CV risk factors. MetS was scored at baseline.
Results: Three-years follow-up data were available in 212 RA patients of whom 85 (40.1%) had the MetS. Baseline cIMT was significantly higher in patients with MetS compared to those without (0.619 ± 0.112 mm versus 0.557 ± 0.104 mm; p<0.001). After three years, cIMT progression was comparable between patients with and without MetS (0.043 mm ± 0.071 versus 0.043 ± 0.072 mm; p=0.96). Both subjects with and without MetS were well controlled with respect to RA with similar disease activity scores (2.8 ± 1.2 versus 2.4 ± 1.2; p=0.56). In patients with MetS, the presence of plaques significantly increased over three years from 12.9% to 23.5% (p=0.01). The type of intervention had no effect on cIMT progression in patients with MetS. However, in subjects without MetS, treat-to-target resulted in a lower progression of cIMT (0.029 ± 0.064 mm versus 0.058 ± 0.076 mm for usual care; p=0.01).
Conclusion: RA patients with the MetS show an increased CV risk profile based on both a higher prevalence of cardiovascular risk factors and structural vascular changes. This difference remained after three years of follow-up and was independent of treatment. We suggest a more aggressive approach to reduce cardiovascular risk in RA patients with the MetS.