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Objectives Women with a previous hypertensive disorder of pregnancy (HDP: gestational hypertension and preeclampsia) have increased long-term cardiovascular disease risk. Recent meta-analyses show adverse levels of non-invasive functional and structural cardiovascular risk markers such as pulse wave velocity (PWV), heart-rate adjusted augmentation index (AIx75), carotid intima-media thickness (CIMT), and reactive hyperemia index (RHI) after HDPs, and suggest using these for cardiovascular risk stratification. However, it is not known if a previous HDP predict levels of these markers beyond classical cardiovascular risk factors. Study design and main outcome measures. We assessed PWV, AIx75, CIMT, RHI, classical cardiovascular risk factors, and pregnancy characteristics in 221 women 1 year postpartum (controls: 95, previous HDP: 126). Uni- and multi- variate regression analysis were conducted to assess associations between previous HDP and PWV, AIx75, CIMT or RHI. We adjusted for classical cardiovascular risk factors and pregnancy characteristics. A p-level Results PWV was associated with previous HDP on univariate analysis. This effect was confounded by blood pressure and not significant after adjustment. We found no significant associations between AIx75, RHI, CIMT, and a previous HDP, neither before nor after adjustments. Conclusions Associations between a previous HDP and PWV, AIx75, CIMT, or RHI 1 year postpartum can largely be explained by adverse levels of classical cardiovascular risk markers in women with a previous HDP. Women with previous HDP should receive primary prevention of cardiovascular disease, but PWV, AIx75, CIMT or RHI are unlikely to aid in cardiovascular risk stratification 1 year postpartum.

Objectives To examine all-cause and cardiovascular disease (CVD) mortality in consecutive cohorts of patients with incident RA, compared with population comparators. Methods The Oslo RA register inclusion criteria were diagnosis of RA (1987 ACR criteria) and residency in Oslo. Patients with disease onset 1994–2008 and 10 matched comparators for each case were linked to the Norwegian Cause of Death Registry. Hazard ratios for all-cause and CVD mortality were calculated for 5, 10, 15 and 20 years of observation using stratified cox-regression models. Mortality trends were estimated by multivariate cox-regression. Results 443, 479 and 469 cases with disease incidence in the periods 94–98, 99–03 and 04–08 were matched to 4430, 4790 and 4690 comparators, respectively. For cases diagnosed between 1994 and 2003, the all-cause mortality of cases diverged significantly from comparators after 10 years of disease duration [hazard ratio (95% CI) 94–98 cohort 1.42 (1.15–1.75): 99–03 cohort 1.37 (1.08–1.73)]. CVD related mortality was significantly increased after 5 years for the 94–98 cohort [hazard ratio (95% CI) 1.86 (1.16–2.98) and after 10 years for the 99–03 cohort 1.80 (1.20–2.70)]. Increased mortality was not observed in the 04–08 cohort where cases had significantly lower 10-year all-cause and CVD mortality compared with earlier cohorts. Conclusion All-cause and CVD mortality were significantly increased in RA patients diagnosed from 1994 to 2003, compared with matched comparators, but not in patients diagnosed after 2004. This may indicate that modern treatment strategies have a positive impact on mortality in patients with RA.

OBJECTIVE In observational studies, low vitamin D levels are associated with type 2 diabetes (T2D), impaired glucose metabolism, insulin sensitivity, and insulin secretion. We evaluated the efficacy of vitamin D supplementation on insulin sensitivity and insulin secretion in subjects with T2D and low vitamin D (25-hydroxyvitamin D [25(OH)D] RESEARCH DESIGN AND METHODS Sixty-two men and women with T2D and vitamin D deficiency participated in a 6-month randomized, double-blind, placebo-controlled trial. Participants received a single dose of 400,000 IU oral vitamin D3 or placebo, and the vitamin D group received an additional 200,000 IU D3 if serum 25(OH)D was RESULTS In the vitamin D group, the mean ± SD baseline serum 25(OH)D of 38.0 ± 12.6 nmol/L increased to 96.9 ± 18.3 nmol/L after 4 weeks, 73.2 ± 13.7 nmol/L after 3 months, and 53.7 ± 9.2 nmol/L after 6 months. The total exposure to 25(OH)D during 6 months (area under the curve) was 1,870 ± 192 and 1,090 ± 377 nmol/L per week in the vitamin D and placebo groups, respectively (P < 0.001). Insulin sensitivity, endogenous glucose production, and glycemic control did not differ between or within groups after treatment (P = 0.52). First-phase insulin secretion did not change significantly after treatment (P = 0.10). CONCLUSIONS Replenishment with a large dose of vitamin D3 to patients with T2D and vitamin D deficiency did not change insulin sensitivity or insulin secretion. These findings do not support such use of therapeutic vitamin D3 supplementation to improve glucose homeostasis in patients with T2D.

Objective.Patients with rheumatoid arthritis (RA), a chronic inflammatory disease, have increased cardiovascular morbidity and mortality. We investigated whether early markers of RA inflammatory disease activity could predict later increased levels of pulse-wave velocity (PWV) and augmentation index (AIx), 2 measures of arterial stiffness.Methods.In total 238 patients with early RA were followed longitudinally and 108 were available for the 15-year followup examination. Comprehensive baseline clinical and radiographic data were collected in 1992. Arterial stiffness, measured as AIx and PWV (Sphygmocor apparatus), was recorded at the 15-year followup. Adjusted logistic univariate and multivariate analyses were performed with levels of AIx and PWV as the dependent variables, and variables reflecting baseline RA disease activity as possible predictors. The validity of the final models was examined in linear regression analyses.Results.Baseline C-reactive protein (CRP) above the median predicted increased AIx (OR 3.52, 95% CI 1.04–11.90) and PWV (OR 4.84, 95% CI 1.39–16.83) at the 15-year assessment in multivariate models. Patients with elevated baseline CRP had significantly higher AIx (ß = 2.67, 95% CI 0.06–5.31, p = 0.045) and lnPWV (ß = 0.08, 95% CI 0.01–0.14, p = 0.02) after 15 years, after adjustments for age, sex, heart rate (AIx only) and mean arterial pressure.Conclusion.Inflammation early in the RA disease course was associated with increased AIx and PWV after 15 years. These findings support the importance of early control of the inflammatory process in patients with RA.

Chronic inflammatory arthropathies such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA) are associated with an increased risk of cardiovascular disease. TNF-α antagonists may improve vascular function in these patients and thus be beneficial with regard to cardiovascular disease. This study evaluated arterial stiffness and disease activity between two infusions with a TNF-α antagonist (infliximab) in patients with inflammatory arthropathies on long-term infliximab therapy. Augmentation index (AIx), aortic pulse wave velocity (aPWV), and disease activity were measured in 17 patients with RA, AS, or PsA who had been treated with infliximab for at least 12 months. The patients were examined immediately before their infliximab infusion and thereafter every 10th day until their next infusion scheduled at week 4-8. AIx and aPWV did not change during the period between two infliximab infusions. The patients had a temporary improvement in the general disease activity assessed on visual analogue scales by the patients (P = 0.04) and the investigator (P = 0.02) after the infusion. In the group of patients with RA, the Disease Activity Score (DAS28) changed significantly in a similar manner (P = 0.003). C-reactive protein and erythrocyte sedimentation rate remained unchanged. Infliximab infusions did not alter aortic pulse wave velocity or augmentation index in patients with inflammatory arthropathies who were on long-term infliximab therapy. Reductions in the general disease activity and DAS28 were not reflected in alterations of aortic stiffness or augmentation index.

The chronic inflammatory state of rheumatoid arthritis and other inflammatory arthropathies, such as ankylosing spondylitis and psoriatic arthritis, contributes to the accelerated atherosclerosis associated with these conditions. This study evaluates the effect of treatment with tumor necrosis factor (TNF)-α antagonists on arterial stiffness in patients with inflammatory arthropathies. A total of 60 patients with rheumatoid arthritis, ankylosing spondylitis, or psoriatic arthritis and clinical indication for anti–TNF-α therapy were included. Thirty-five patients started with anti–TNF-α therapy and were compared with a nontreatment group of 25 patients. Aortic stiffness (aortic pulse wave velocity), augmentation index, and disease activity were assessed at baseline and after 3 months. Aortic pulse wave velocity (mean±SD) was reduced in the treatment group but not in the control group (−0.50±0.78 m/s versus 0.05±0.54 m/s, respectively; P =0.002). Concomitantly, C-reactive protein and the disease activity score were reduced in the treatment group (−9.3±20.2 mg/L [ P P =0.004]). Augmentation index remained unchanged in both groups (0.1±7.1% versus −1.0±5.8%, respectively; P =0.53). In a multivariate linear regression model, only treatment with TNF-α antagonist and change in mean arterial pressure predicted alterations in aortic pulse wave velocity. In summary, anti–TNF-α therapy improved aortic stiffness in patients with inflammatory arthropathies. These findings support the idea that anti-inflammatory treatment has a favorable effect on cardiovascular risk in patients with inflammatory arthropathies.

Background: Cardiovascular disease is prevalent in type 2 diabetes, and both endothelial dysfunction and arterial stiffness may contribute in the pathogenesis. Low levels of vitamin D are associated with both type 2 diabetes and cardiovascular disease. Aim: To evaluate the effect of vitamin D supplementation on endothelial function and arterial stiffness in subjects with type 2 diabetes and hypovitaminosis D. Methods: Sixty-two subjects with type 2 diabetes and serum 25-hydroxy-vitamin D [25(OH)D]

Cardiovascular morbidity and mortality are increased in patients with inflammatory arthropathies such as rheumatoid arthritis (RA), ankylosing spondylitis (AS), and psoriatic arthritis (PsA).1 The systemic inflammation associated with these diseases seems to contribute importantly to the observed accelerated atherosclerosis. Previous results suggest that treatment with tumor necrosis factor (TNF)-α antagonists may reduce the risk of cardiovascular events in patients with RA.2 Aortic pulse wave velocity (aPWV), a measure of aortic stiffness, and carotid intima media thickness (CIMT) are both predictors of cardiovascular events3,4 and are increased in patients with inflammatory arthropathies.5,6 We have recently reported that 3 months of anti-TNF-α therapy improved aortic stiffness in such patients.7 However, results regarding the long-term effects of this treatment on aortic stiffness are limited, and data concerning CIMT are conflicting.6,8–11 There is also a lack of knowledge about associations between soluble inflammatory biomarkers and aPWV and CIMT in patients with inflammatory arthropathies. Calprotectin is a protein complex compounded by the S100A8 and S100A9 proteins, also referred to as myeloid-related proteins (MRP)-8 and MRP-14, which is secreted by activated neutrophils and monocytes.12 In inflammatory arthropathies, calprotectin is associated with the disease activity and synovial inflammation,13,14 and anti-TNF-α therapy has been demonstrated to reduce both the number of infiltrating MRP-8 and MRP-14 expressing macrophages in synovial tissue and serum calprotectin levels.14 Plasma calprotectin has also been reported to predict cardiovascular events15 and to be a marker of acute coronary syndromes.16 Recent results have indicated that the protein complex promote vascular inflammation by recruitment of neutrophils and macrophages, stimulates vascular smooth muscle cell proliferation, and enhances atherosclerotic lesion formation in a MRP-14 knockout mice model.17 Thus, calprotectin might have a direct role in vascular pathology. The objective of this study was to evaluate the effects of 1-year anti-TNF-α therapy on aPWV and CIMT in patients with RA, AS, and PsA compared to a nontreatment group of patients with similar inflammatory activity and to explore possible associations with calprotectin.

Background: Population studies have indicated that both the presence of osteoporosis and serum levels of calcium are associated with an increased risk of cardiovascular disease. Objective: To investigate the association between bone loss, calcium intake and levels of the reactive hyperemia index (RHI) and augmentation index (AIx), two measures of endothelial function and surrogate markers of cardiovascular disease, in a cohort of patients with RA. Methods: Two hundred and thirty eight patients with early RA were comprehensively examined at baseline with registration of clinical and radiographic data. At the 15-year follow-up these examinations were repeated in 153 patients and additionally the RHI (ITAMAR) and AIx (Sphygmocor) were recorded. Results: Calcium substitution, ever vs never was associated with lower levels of RHI and higher AIx β(SE) −0.12 (0.05) p=0.03 and 4.03 (1.19) p=0.001 respectively, in models that were adjusted for age, sex and CVD risk factors. Measures of bone mineral density or rate of bone loss were not significantly related to AIx or RHI. In models that were adjusted for current CVD risk factors, RA disease activity and use of disease modifying anti-rheumatic drugs, current use of calcium substitution was a significant independent predictor of AIx β(SE) 5.21 (2.38) p=0.03, model r2 0.56, but not of RHI. Conclusion: Calcium supplementation was associated with increased arterial stiffness in this cohort of patients with RA. Residual confounding cannot be ruled-out.

p< 0.05), augmentation index (AIx, 22.0 7.0 vs 13.1 5.2%, p

Background: Chronic inflammatory arthropathies such as rheumatoid arthritis (RA), ankylosing spondylitis (AS) and psoriatic arthritis (PsA) are associated with an increased risk of cardiovascular disease. TNF-α antagonists are previously reported to improve vascular function in these patients and thus be beneficial with regard to cardiovascular disease. Aims: To examine the effect of one year treatment with Tumor Necrosis Factor (TNF)-α antagonists on arterial stiffness and carotid intima media thickness (cIMT) in patients with inflammatory arthropathies, and furthermore to explore possible associations between changes in the vascular measurements and Calprotectin which is a proinflammatory protein (S100A8/S100A9) associated with both inflammatory arthropathies, endothelial dysfunction and acute coronary events. Methods and Results: A total of 53 patients with RA, AS or PsA and clinical indication for anti-TNF-α therapy were included. 36 patients started with anti-TNF-α therapy and were compared with a non-treatment group of 17 patients. Aortic pulse wave velocity (aPWV), augmentation index (AIx) (Sphygmocor), cIMT (ArtLab) and Calprotectin were measured at baseline and after one year. aPWV (mean±SD) was reduced in the treatment group, but not in the control group (−0.51±0.80m/s versus 0.11±0.48m/s, respectively; P=0.001). AIx and cIMT did not change in any of the groups. In the treatment group, change in aPWV correlated with change in Calprotectin (r=0.36, P=0.04). Conclusion: These findings indicate that long term anti-TNF-α therapy improves aortic stiffness in patients with inflammatory arthropathies, and that the improvement is correlated with reduction in the proinflammatory protein Calprotectin.

Background: Patients with rheumatoid arthritis (RA) have increased cardiovascular morbidity and mortality. Objective: To explore whether early markers of RA inflammatory disease activity could predict later cardiovascular disease and arterial stiffness, and to describe the impact of later use of disease-modifying antirheumatic drugs (DMARDs) on arterial stiffness. Methods: Two hundred and thirty eight patients with early RA were comprehensively examined at baseline. At the 15-year follow-up these examinations were repeated and additionally patient-reported cardiovascular disease (CVD) and arterial stiffness, pulse wave velocity (PWV) (Sphygmocor apparatus), recorded. Adjusted logistic and linear regression analyses were performed. Results: Cardiovascular disease was reported by 33% patients at the 15 year follow-up. Baseline RA disease duration, high sensitivity CRP and scores of Stanford Health Assessment Questionnaire (HAQ) and the Ritchie Index predicted patient-reported CVD in separate models adjusted for age, sex, diabetes and smoking (p

Introduction Disease activity in patients with rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity and mortality, of which N-terminal pro-brain natriuretic peptide (NT-proBNP) is a predictor. Our objective was to examine the cross-sectional and longitudinal associations between markers of inflammation, measures of RA disease activity, medication used in the treatment of RA, and NT-proBNP levels (dependent variable). Methods Two hundred thirty-eight patients with RA of less than 4 years in duration were followed longitudinally with three comprehensive assessments of clinical and radiographic data over a 10-year period. Serum samples were frozen and later batch-analyzed for NT-proBNP levels and other biomarkers. Bivariate, multivariate, and repeated analyses were performed. Results C-reactive protein (CRP) levels at baseline were cross-sectionally associated with NT-proBNP levels after adjustment for age and gender (r 2 adjusted = 0.23; P < 0.05). At the 10-year follow-up, risk factors for cardiovascular disease were recorded. Duration of RA and CRP levels were independently associated with NT-proBNP in the final model that was adjusted for gender, age, and creatinine levels (r 2 adjusted = 0.38; P < 0.001). In the longitudinal analyses, which adjusted for age, gender, and time of follow-up, we found that repeated measures of CRP predicted NT-proBNP levels (P < 0.001). Conclusion CRP levels are linearly associated with levels of NT-proBNP in cross-sectional and longitudinal analyses of patients with RA. The independent associations of NT-proBNP levels and markers of disease activity with clinical cardiovascular endpoints need to be further investigated.