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P171 Cardiovascular Risk Evaluation in Behcet’s Patients — the Role of Chronic Inflammation in Arterial Stiffness

Artery Research volume 24, pages 130–132 (2018)Cite this article

Abstract

Introduction

Behcet’s disease (BD) is a chronic inflammatory syndrome with systemic manifestations. Systemic vasculitis contribute to vascular aging, increasing the arterial stiffness that can be inferred from the Pulse Wave Velocity (PWV) measurement. Carotid ultrasound evaluation allows vascular wall changes detection, as the increase of intima-media thickness (>IMT) and plaques. These alterations increase cardiovascular risk (CVR).

Methods

49 patients were included. Anthropometric, sociodemographic, laboratorial, comorbidities, medication, peripheral and central blood pressure, Systematic Coronary Risk Evaluation, PWV and carotid ultrasound abnormalities data were evaluated. To understand the role of chronic inflammation in arterial stiffness, comparative analyzes were performed with a control group with CVR factors and with a group of healthy individuals.

Results

The sample consisted mainly of women (61.2%), characterized by 30.6% of arterial hypertension, 32.7% of dyslipidemia, 4.1% of diabetes and 14.3% of obesity. PWV median value was 8.32m/s, with 30.6% PWV > 90th percentile of the normal reference population and 16.3% with target organ lesion. >IMT in the common carotid artery (CCA) and plaques were observed in 10.4% and 41.7%, respectively. In the obtained linear regression model, the variables systolic central blood pressure and ˃IMT in the ACC showed a statistically significant impact on PWV. In the established comparisons, PWV did not present statistically significant differences. Conclusion: The integrated analysis of the collected data made it possible to requalify the patients in the context of the CVR, allowing the early adoption of control measures. Chronic inflammation associated with BD did not lead to significant differences in arterial stiffness.

References

  1. Takeuchi M, Kastner DL, Remmers EF. The immunogenetics of Beh¸cet’s disease: A comprehensive review. J Autoimmun. 2015 Nov; 64: 137–48.

    Google Scholar 

  2. Gül A. Pathogenesis of Beh¸cet’s disease: autoinflammatory features and beyond. Semin Immunopathol 2015 Jul; 37(4): 413–8.

    Google Scholar 

  3. Feigenbaum A. Description of Behcet’s syndrome in the Hippocratic third book of endemic diseases. Br J Ophthalmol. 1956; 40(6): 355–357.

    Google Scholar 

  4. Zeidan MJ, Saadoun D, Garrido M, Klatzmann D, Six A, Cacoub P. Behçet’s disease physiopathology: a contemporary review. Auto Immun Highlights. 2016 Dec; 7(1): 4.

    Google Scholar 

  5. Alpsoy E. Behçet’s disease: A comprehensive review with a focus on epidemiology, etiology and clinical features, and management of mucocu-taneous lesions. J Dermatol. 2016 Jun; 43(6): 620–32.

    Google Scholar 

  6. Scherrer MAR, Rocha VB, Garcia LC. Behçet’s disease: review with emphasis on dermatological aspects. An Bras Dermatol. 2017 Jul-Aug; 92(4): 452–464.

    Google Scholar 

  7. Savey L, Resche-Rigon M, Wechsler B, Comarmond C, Piette JC, Cacoub P, Saadoun D. Ethnicity and association with disease manifestations and mortality in Behçet’s disease. Orphanet J Rare Dis. 2014 Dez; 27(9): 42.

    Google Scholar 

  8. Yazici Y, Yurdakul S, Yazici H. Behc¸et’s Syndrome. Current Rheumatology Reports. 2010 Dez; 12(6): 429–435.

    Google Scholar 

  9. Sachetto Z, Mahayri N, Ferraz R, Costallat L, Bertolo M. Behçet’s disease in Brazilian patients: demographic and clinical features. Rheumatology International. 2012 Jul; 32(7): 2063–2067.

    Google Scholar 

  10. Registo Informático de Doenças Auto-imunes - RIDAI, [visitado a 07/11/ 2017]; Disponivel em: https://www.ridai.org/doenca-de-behcet/02-11-2017

  11. Mahr A, Belarbi L, Wechsler Β, Jeanneret D, Dhote R, Fain O, Lhote F, Ramanoelina J, Coste J, Guillevin L. Population-Based Prevalence Study of Behçet’s Disease. Arthritis and Rheumatism. 2008 Nov; 58(12): 3951–3959.

    Google Scholar 

  12. Yazici H, Seyahi E, Yurdakul S. Behçet’s syndrome is not so rare: why do we need to know? Arthritis and Rheumatism. 2008 Nov; 58(12): 3640–3.

    Google Scholar 

  13. Scherrer M. Doença de Behçet: um enigma oriental. An Bras Dermatol. 1994;69: 323–6.

    Google Scholar 

  14. Al-Mutawa S, Hegab S. Behcet’s disease. Clinical and Experimental Medicine. 2004 Dez; 4(3): 103–131

    Google Scholar 

  15. Hatemi G, Seyahi E, Fresko I, Talarico R, Hamuryudan V. Behçet’s syndrome: a critical digest of the 2014–2015 literature-Review. Clin Exp Rheumatol. 2015 Jul; 33: S3–14

    Google Scholar 

  16. Galeone M, Colucci R, D’Erme AM, Moretti S, Lotti T. Potential Infectious Etiology of Behcet’s Disease- Review Article. Pathology Research International. 2012 Out: 1–4.

  17. Hatemi G, Ozguler Y, Direskeneli H, Mahr A, Gul A, Levi V, Aydin SZ, Mumcu G, Sertel-Berk O, Stevens RM, Yazici H, Merkel PA. Current Status, Goals, and Research Agenda for Outcome Measures Development in Behcet Syndrome: Report from OMERACT 2014. J Rheumatol. 2015 Dez; 42(12): 2436–2441.

    Google Scholar 

  18. Kaklamani VG, Vaiopoulos G, Kaklamanis PG. Behçet’s Disease. Semin Arthritis Rheum. 1998 Fev; 27: 197–217.

    Google Scholar 

  19. Kim DH, Cheon JH. Intestinal Behçet’s Disease: A True Inflammatory Bowel Disease or Merely an Intestinal Complication of Systemic Vasculitis? Yonsei Med J. 2016 Jan; 57(1): 22–32.

    Google Scholar 

  20. Kural-Seyahi E, Fresko I, Seyahi N, Ozyazgan Y, Mat C, Hamuryudan V, et al. The long-term mortality and morbidity of Behçet syndrome: a 2-decade outcome survey of 387 patients followed at a dedicated center. Medicine. 2003 Jan; 82: 60–76.

    Google Scholar 

  21. Shen C, LiW, Zhang Y, Li Q, Jiao Y, Zhang T, et al. Outcomes of surgery for patients with Behcet’s disease causing aortic pseudoaneurysm: a shift from open surgery to endovascular repair. Clinics. 2016; 71(6): 302–310.

    Google Scholar 

  22. International Study Group for Behçet’s Disease. Criteria for diagnosis of Behçet’s disease. Lancet. 1990 Mai; 335(8697): 1078–80.

    Google Scholar 

  23. Saadoun D, Wechsler B. Behçet’s disease. Orphanet Journal of Rare Diseases. 2012; 7(1): 20.

    Google Scholar 

  24. Davatchi F. Diagnosis/ Classification Criteria for Behcet’s Disease. Pathology Research International. 2012; 1–5.

  25. Hatemi G, Silman A, Bang D, Bodaghi B, Chamberlain AM, Gui A, et al. Management of Behcet disease: a systematic literature review for the European League Against Rheumatism evidence-based recommendations for the management of Behçet disease. Ann Rheum Dis. 2009;68: 1528–34.

    Google Scholar 

  26. Seyahi E. Behçet’s disease: how to diagnose and treat vascular involvement. Best Pract Res Clin Rheumatol. 2016;30: 279–9.

    Google Scholar 

  27. Upala S, Chung Yong W, Sanguankeo A. Increased Arterial Stiffness in Behçet’s Disease: a Systematic Review and Meta-Analysis. Korean Circ J. 2017 Jul; 47(4): 477–482.

    Google Scholar 

  28. Hingorani AD, Cross J, Kharbanda RK, et al. Acute systemic inflammation impairs endothelium-dependent dilatation in humans. Circulation. 2000;102: 994–9. 3.

    Google Scholar 

  29. Klocke R, Cockcroft JR, Taylor GJ, Hall IR, Blake DR. Arterial stiffness and central blood pressure, as determined by pulse wave analysis, in rheumatoid arthritis. Ann Rheum Dis. 2003;62: 414–8.

    Google Scholar 

  30. Kayikçioğlu M, Aksu K, Hasdemir C, et al. Endothelial functions in behçet’s disease. Rheumatol Int. 2006;26: 304–8.

    Google Scholar 

  31. Haznedaroglu E, Karaaslan Y, Büyükaşjk Y, et al. Selectin adhesion molecules in behçet’s disease. Ann Rheum Dis. 2000;59: 61–3.

    Google Scholar 

  32. Oztürk MA, Unverdi S, Oktar SO, et al. Vascular endothelial growth factor and carotid intima-media thickness in patients with behçet’s disease. Clin Rheumatol. 2008;27: 961–6.

    Google Scholar 

  33. Kiraz S, Ertenli I, Oztürk MA, Haznedaroğlu IC, Celik I, Calgüneri M. Pathological haemostasis and “prothrombotic state” in behçet’s disease. Thromb Res. 2002;105: 125–33.

    Google Scholar 

  34. Rhee MY, Chang HK, Kim SK. Intima-media thickness and arterial stiffness of carotid artery in Korean patients with behçet’s disease. J Korean Med Sci. 2007;22: 387–92.

    Google Scholar 

  35. Patel RS, Al Mheid I, Morris AA, et al. Oxidative stress is associated with impaired arterial elasticity. Atherosclerosis. 2011;218: 90–5.

    Google Scholar 

  36. Van Bortel M, Luc et al. Expert consensus document on the measurement of aortics tiffness in daily practice using carotid-femoral pulse wave velocity. Journal of Hypertension. 2011;30: 445–448.

    Google Scholar 

  37. Boutouyrie P, Vermeersch SJ. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: establishing normal and reference values. European Heart Journal. 2010;31: 2338–2350.

    Google Scholar 

  38. Avina-Zubieta JA, Thomas J, Sadatsafavi M, Lehman AJ, Lacaille D. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a metaanalysis of observational studies. Ann Rheum Dis. 2012;71: 1524–1529.

    Google Scholar 

  39. Torres FS, Moreira CM, Vianna FF, Gus M. Intima-media thickness measurement for cardiovascular risk assessment. Rev Bras Hipertens. 2007; 14(3): 167–171.

    Google Scholar 

  40. Kanters SDJM, Algra A, van Leeuwen M, et al. Reproducibility of in vivo carotid intima-media thickness measurements: a review. Stroke. 1997;28: 665–71.

    Google Scholar 

  41. Stensland-Bugge E, Bonaa KH, Joakimsen O. Reproducibility of ultra-sonographically determined intima-media thickness is dependent on arterial wall thickness. The Tromso Study. Stroke. 1997;28: 1972–80.

    Google Scholar 

  42. O’Leary DH, Polak JF. Intima-media thickness: a tool for atherosclerosis imaging and event prediction. Am J Cardiol. 2002; 90(suppl): 18L–21L.

    Google Scholar 

  43. Sol AI, Bots ML, Grobbee DE, et al. Carotid intima-media thickness at different sites: relation to incident myocardial infarction. The Rotterdam Study. Eur Heart J. 2002;23: 934–40.

    Google Scholar 

  44. Roman MJ, Naqvi TZ, Gardin JM, et al. American Society of Echocardiography Report. Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society for Vascular Medicine and Biology. Vasc Med. 2006;11: 201–11.

    Google Scholar 

  45. European Society of Cardiology. Intima-media thickness: Appropriate evaluation and proper measurement, described. E-Journal of Cardiology Practice, [visitado a 17/10/2017]; Disponível em:https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-13/lntima-media-thickness-Appropriate-evaluation-and-proper measurement-described.

  46. Yolbas S, Gözel Ν, Dağli MN, Koca SS, Dönder E. Carotid artery stiffness in Behçet’s disease. Eur J Rheumatol. 2017 Jun; 4(2): 122–126.

    Google Scholar 

  47. Yildirim A, Karakaş MS, Kilinç AY, Altekin RE, Yalçinkaya AS. Evaluation of arterial stiffness and subclinical atherosclerosis in patients with Behçet’s disease without cardiovascular involvement. Turk Kardiyol Dem Ars. 2016 Oct; 44(7): 575–581.

    Google Scholar 

  48. Oztürk MA, Unverdi S, Oktar SO, Bukan N, Gülbahar O, Ureten K, et al. Vascular endothelial growth factor and carotid intima-media thickness in patients with Behçet’s disease. Clin Rheumatol. 2008;27: 961–6.

    Google Scholar 

  49. Messedi M, Frigui M, Ben Mahfoudh K, Feki H, Ben Mahfoudh ST, Mnif J, et al. Intima-media thickness of carotid artery in patients with Behçet’s disease. Arch Med Res. 2011;42: 398–404

    Google Scholar 

  50. Hong SN, Park JC, Yoon NS, Lee SR, Kim KH, Hong YJ, et al. Carotid artery intima-media thickness in Behcet’s disease patients without significant cardiovascular involvement. Korean J Intern Med. 2008;23: 87–93. Crossref.

    Google Scholar 

  51. Upala S, Yong WC, Sanguankeo A. Increased Arterial Stiffness in Behçet’s Disease: a Systematic Review and Meta-Analysis. Korean Circ J. 2017 Jul; 47(4): 477–482.

    Google Scholar 

  52. Seyahi E, Ugurlu S, Cumali R, Balci H, Ozdemir O, Melikoglu M, et al. Atherosclerosis in Behçet’s Syndrome. Semin Arthritis Rheum. 2008;38: 1–12. Crossref

    Google Scholar 

  53. Rhee MY, Chang HK, Kim SK. Intima-media thickness and arterial stiffness of carotid artery in Korean patients with Behçet’s disease. J Korean Med Sci. 2007;22: 387–92.

    Google Scholar 

  54. Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organization technical report series. 2000; 894: i–xii, 1253.

  55. Mancia G, de Backer G, Dominiczak A, et al. 2007 Guidelines for the management of arterial hypertension: the Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). J Hypertens. 2007; 25: 1105Y1187.

    Google Scholar 

  56. Van Bortel L et al. Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. European Society of Hypertension Working Group on Vascular, S., Function, and European Network for Noninvasive Investigation of Large, A. Journal of Hypertension. 2012; 30(3), 445–448.

    Google Scholar 

  57. Direção Geral de Saúde. Norma de Orientação Clínica - Avaliação do Risco Cardiovascular SCORE, Lisboa, 2013 (actualização 2015).

  58. Cunha PG, Cotter J, Oliveira P, Vila I, Boutouyrie P, Laurent S, Nilsson PM, Scuteri A, Sousa N. Pulse wave velocity distribution in a cohort study: from arterial stiffness to early vascular aging. Journal of Hypertension.2015; 33(1): 1–8.

    Google Scholar 

  59. Yazici H, Tuzun Y, Pazarli H, et al. Influence of age of onset and patient’s sex on the prevalence and severity of manifestations of Behcet’s syndrome. Ann Rheum Dis. 1984; 43(6): 783–789.

    Google Scholar 

  60. Nihal S, Kutlubay EZ, Ucar D, Hatemi I, Uygunoglu U, Siva A, Hatemi G. Behçet’s syndrome: providing integrated care. J Multidiscip Healthc. 2017;10: 309–319.

    Google Scholar 

  61. DGS (2016). A saúde dos portugueses 2016. Lisboa: Portugal. Direção-Geral da Saúde. ISSN: 2183-5888.

  62. Lopes C et al. (2017). Inquérito alimentar nacional – de atividade física. IAN-AF, 2015–2016. Porto: Universidade do Porto.

  63. Instituto Nacional de Estatistica. Inquérito Nacional de Saúde. 2014.

  64. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Report of the national cholesterol education program (NCEP). Executive Summary of The Third Report of the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA. 2001;285: 2486–2497.

    Google Scholar 

  65. Malik S, Wong ND, Franklin SS, et al. Impact of the metabolic syndrome on mortality from coronary heart disease, and all cause in United States adults. Circulation. 2004;110: 1245–1250.

    Google Scholar 

  66. Cuspidi C, Sala C, Tadic M, Gherbesi E, Grassi G, Mancia G. Association of metabolic syndrome with carotid thickening and plaque in the general population: A meta-analysis. J Clin Hypertens (Greenwich). 2017; 1–7.

  67. Alecu C, Gueguen S, Aubry C, Salvi P, Perret-Guillaume C, Ducrocq X, Vespignani P, Benetos A. Determinants of arterial stiffness in an apparently healthy population over 60 years. Journal of Human Hypertension. 2006;20: 749–756.

    Google Scholar 

  68. Popele NM, Grobbee DE, Bots ML, Asmar R, Topouchian J, Reneman RS, Hoeks A, Kuip D, Hofman A, Witteman J. Association Between Arterial Stiffness and Atherosclerosis. The Rotterdam Study. AHA Journal-Stroke. 2001;32: 454–460.

    Google Scholar 

  69. Sehestedt T, Jeppesenk J, Hansen TW, Wachtell K, Ibsen H, Torp-Pedersen C, Hildebrandt Ρ, Olsen ΜΗ. Risk prediction is improved by adding markers of subclinical organ damage to SCORE. Eur Heart J. 2010; 31(7): 883–91.

    Google Scholar 

  70. Wang F, Ye P, Luo L, Xiao W, Qi L, Bian S, et al. Association of serum lipids with arterial stiffness in a population-based study in Beijing. Eur J Clin Invest. 2011; 41(9): 929–36.

    Google Scholar 

  71. Safar ME, Czernichow SB, Blacher J. Obesity, arterial stiffness, and cardiovascular risk. J Am Soc Nephrol. 2006; 17(4 Suppl 2): S109–11.

    Google Scholar 

  72. Mäki-Petäjä KM et al. Rheumatoid Arthritis is associated with increased Aortic Pulse-Wave Velocity which is reduced by Anti—Tumor Necrosis Factor Therapy. Circulation AHA. 2006;114: 1185–1192.

    Google Scholar 

  73. Kürüm T, Yildiz M, Soy M, Ozbay G, Alimgil L, Tüzün B. Arterial distensibility as determined by carotid-femoral pulse wave velocity in patients with behçet’s disease. Clin Rheumatol. 2005;24: 134–8.

    Google Scholar 

  74. Caldas CA, Borba EF, Bortolotto LA, Medeiros DM, Bonfa E, Gonçalves CR. Increased arterial stiffness assessed by pulse wave velocity in behçet’s disease and its association with the lipid profile. J Eur Acad Dermatol Venereol. 2013;27: 454–9.

    Google Scholar 

  75. Chang HK, Kim SK, Lee SS, Rhee MY. Arterial stiffness in behçet’s disease: increased regional pulse wave velocity values. Ann Rheum Dis. 2006;65: 415–6.

    Google Scholar 

  76. Yilmaz S, Celik G, Esmen SE. Assessment of arterial stiffness in patients with inactive and active behçet’s disease. Scand J Rheumatol. 2014;43: 63–9.

    Google Scholar 

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  1. Hospital Senhora da Oliveira, Guimarães, Portugal

    Maria Guimarães, Glória Alves, Cristina Cunha & Marta Cunha

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Guimarães, M., Alves, G., Cunha, C. et al. P171 Cardiovascular Risk Evaluation in Behcet’s Patients — the Role of Chronic Inflammation in Arterial Stiffness. Artery Res 24, 130–132 (2018). https://doi.org/10.1016/j.artres.2018.10.224

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Artery Research

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