Patrick H Dessein

Vrije Universiteit Brussel | VUB · Department of Rheumatology

Background Patients with rheumatoid arthritis (RA) experience higher cardiovascular risk compared to individuals without inflammatory rheumatic disease. Observational studies indicate that methotrexate (MTX) may decrease cardiovascular risk in patients with RA. It is, however, unclear whether sex differentially impacts cardiovascular risk in MTX us...

Background Chronic inflammation contributes to enhanced cardiovascular risk in patients with rheumatoid arthritis (RA). Biologic disease modifying antirheumatic drugs (bDMARDs) have been shown to effectively control inflammation in many conventional synthetic DMARD non-responders and improve cardiovascular outcomes. Objectives We here explored whe...

Aims A lower heart rate (HR) increases central blood pressure through enhanced backward wave pressures (Pb). We aimed to determine whether these relationships are modified by increases in aortic stiffness. Methods Using non-invasive central pressure, aortic velocity and diameter measurements in the outflow tract (echocardiography), we assessed the...

Background A lower heart rate (HR) increases left ventricular (LV) ejection volume. Whether this contributes to the adverse effects of HR on central pulse pressure (PPc) through reservoir volume effects, is uncertain. Methods Using non-invasive central pressure, aortic velocity and diameter measurements in the outflow tract (echocardiography), we...

Purpose: We assessed whether aortic stiffness and pulsatile pressures can mediate chronic kidney disease (CKD)-associated impaired diastolic function. Participants and methods: In 276 black Africans including 46 CKD (19 non-dialysis; 27 dialysis) and 230 control subjects, pulse wave velocity (PWV) estimated aortic stiffness and pulsatile pressur...

Aims: Although peak aortic flow (Q) is now recognized as a major determinant of hypertension in Africa, current therapy has no proven ability to target this change. The mechanisms of this effect, therefore, require elucidation. We compared the intrafamilial aggregation and heritability of Q to that of the vascular determinants of pulse pressure (P...

Through both backward (Pb) and forward (Pf) wave effects, a lower heart rate (HR) associates with increased central (PPc), beyond brachial pulse pressure (PP). However, the relative contribution to Pf of aortic flow (Q) versus re-reflection of Pb, has not been determined. Using central pressure, aortic velocity and diameter measurements in the outf...

Aims: Whether renal mechanisms of hypertension primarily translate into increases in systemic vascular resistance (SVR) in all populations is uncertain. We determined whether renal mechanisms associate with either increases in SVR (and impedance to flow) or systemic flow in a community of African ancestry. Method: In a South African community sa...

Introduction: We hypothesized that post transplantation anaemia and persistent secondary hyperparathyroidism are potential determinants of diastolic function in stable kidney transplant recipients. Methods: We assessed traditional and non-traditional cardiovascular risk factors and determined carotid artery intima-media thickness and plaque by u...

Aim We hypothesized that arterial function and N-terminal natriuretic peptide (NT-proBNP) levels as a marker of volume overload, relate differently to E/e’ as an index of diastolic function in dialysis compared to non-dialysis patients with chronic kidney disease. We further examined whether cardiovascular risk factors attenuated these relationship...

Methods: Cardiovascular risk factors, aortic and cardiac function, atherosclerosis extent, and cardiovascular event rates were assessed in 115 consecutive predialysis (n = 67) and dialysis patients (n = 48) including 46 black and 69 other (32 Asian, 28 white, and 9 mixed race) participants. Data were analysed in multivariable regression models. R...

Introduction: It remains unclear why the optimal haemoglobin target is lower in patients with chronic kidney disease (CKD) than in non-CKD persons. Arteriosclerosis and consequent impaired arterial function comprise a central cardiovascular risk mechanism in CKD. We hypothesized that the optimal haemoglobin target depends on its opposing effects o...

Background: It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods: Five rheumatologists, one...

Background: In younger individuals, low absolute risk of cardiovascular disease (CVD) may conceal an increased risk age and relative risk of CVD. Calculation of risk age is proposed as an adjuvant to absolute CVD risk estimation in European guidelines. We aimed to compare the discriminative ability of available risk age models in prediction of CVD...

Rheumatoid arthritis (RA) impacts arterial and diastolic function. This study examined whether arterial properties can determine diastolic function in RA. In 173 RA patients, arterial function measures including carotid femoral pulse wave velocity (PWV), central systolic and pulse pressure, pulse pressure amplification, and the magnitude and timing...

Introduction: Increased cardiovascular (CV) morbidity and mortality is observed in inflammatory joint diseases (IJDs) such as rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. However, the management of CV disease in these conditions is far from being well established. Areas covered: This review summarizes the main epidemiologic...

Objectives: Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients. Methods: Disease characteristics, CVD risk factors and rele...

Rheumatoid arthritis (RA) is associated with increased cardiovascular morbidity, partly due to alterations in lipoprotein quantity, quality and cell cholesterol trafficking. Although cardiovascular disease significantly contributes to mortality excess in RA, cardiovascular prevention has been largely insufficient. Because of limited evidence, optim...

Background Aberrant hemostasis is implicated in the increased CVD risk experienced by patients with rheumatoid arthritis (RA) (1). Large circulating concentrations of plasminogen activator inhibitor-1 (PAI-1) predict cardiovascular event rates (2). PAI-1 levels are markedly smaller in American and African black populations than in those of European...

Background Smoking is a major risk factor for development of both cardiovascular disease (CVD) and rheumatoid arthritis (RA) and causes an attenuated response to antirheumatic treatment. Objectives The aim of this study was to compare disease activity and CVD risk factors across smoking status in RA patients. Further to evaluate the impact of smok...

Background Preventive pharmacotherapy for atherosclerotic cardiovascular disease (ACVD) is reportedly underused in patients with rheumatoid arthritis (RA). Whether this shortcoming is RA specific amongst patients with prevalent rheumatic and musculoskeletal diseases (RMD) is currently unknown. Objectives This study aimed to compare high ACVD risk...

Background The updated EULAR cardiovascular risk management (CVRM) guideline recommends cardiovascular disease risk assessment at least once every five years in all patients with rheumatoid arthritis (RA).¹ A literature search indicates that this guideline is marginally applied in clinical practice.² An important factor explaining dissimilarities i...

Background Patients with rheumatic and musculoskeletal diseases (RMDs) from developed populations often experience increased atherosclerotic cardiovascular disease (ACVD) risk. In European countries, increasing proportions of inhabitants originate in developing countries and are therefore reportedly at an earlier epidemiological transition stage, w...

Background Rheumatoid arthritis (RA) patients are at high risk of cardiovascular disease (CVD). Risk age estimations are recommended as adjuncts to assessment of absolute 10 year risk of fatal CVD events. Two risk age models based on the Systematic Coronary Risk Evaluation (SCORE) algorithm have been developed; the cardiovascular risk age and the v...

Background Patients with rheumatoid arthritis (RA) experience an increased risk of developing heart failure with a preserved ejection fraction. Although there is some evidence to support a role of chronic inflammation in the pathogenesis of impaired left ventricular (LV) function in RA,¹ the direct effects of inflammatory cytokines on the LV functi...

Background Patients with rheumatoid arthritis (RA) experience an increased frequency of heart failure with a preserved ejection fraction (HFpEF) (1). The treatment of HFpEF is currently suboptimal. Elucidation of the underlying pathophysiological mechanisms of HFpEF may provide potential targets for its management. Diastolic dysfunction often prece...

Background We recently reported that apelin concentrations are associated with reduced atherosclerosis and plaque vulnerability as well as improved aortic function in rheumatoid arthritis (RA)1,2. These relations were influenced by RA characteristics1,2. Besides protecting against atherosclerosis, apelin is also a vasoactive peptide that improves c...

Apelin can improve arterial function by enhancing the expression of endothelial nitric oxide synthase but this effect depends markedly on endothelial integrity. We hypothesized that inflammation influences the potential impact of apelin on arterial function in rheumatoid arthritis (RA). We assessed the associations of apelin concentrations with art...

Nesfatin is an anti-inflammatory molecule that reduces atherosclerotic cardiovascular risk. By contrast, visfatin has pro-inflammatory properties and is pro-atherogenic. We examined the potential impact of nesfatin and visfatin on atherosclerotic disease in 232 (113 black and 119 white) consecutive rheumatoid arthritis (RA) patients from 2 centers....

This study compared the estimated prevalence and potential determinants of left ventricular (LV) diastolic dysfunction upon applying different classification criteria in rheumatoid arthritis (RA). LV diastolic function was assessed echocardiographically by pulsed Doppler ( E/A ), tissue Doppler ( E/e′ , lateral and septal e′ ), and left atrial volu...

Objectives: Atherosclerotic cardiovascular disease risk is increased in rheumatoid arthritis (RA). Wave reflection occurs at arterial branching points, which are particularly prone to atherosclerosis. We explored the relationship of wave reflection with atherosclerosis in RA. Methods: One hundred and sixty three RA patients (110 white, 31 Asian,...

Objectives: Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA. Methods: In 13 rheumatology centres, data on CVD risk facto...

Objective: Arterial properties influence cardiovascular disease (CVD) risk. We identified potential determinants of arterial function in patients with rheumatoid arthritis (RA). Methods: Relationships of traditional cardiovascular risk factors and RA characteristics with arterial stiffness (pulse wave velocity), wave reflection (augmentation ind...

Background Heart failure contributes to the excess mortality experienced by patients with rheumatoid arthritis (RA) (1). Impaired diastolic function represents a pre-clinical cardiac alteration which is highly predictive of cardiac events and often progresses to heart failure. Diastolic dysfunction is the most common cause of heart failure in patie...

Background Nesfatin-1 comprises a peptide that is involved in appetite suppression, energy homeostasis and fluid regulation, and was recently documented to participate in a range of cardiometabolic pathways (1,2). There is currently a need for the identification of novel biomarkers in the elucidation of CVD risk and its stratification in persons wi...

Background In the non-rheumatoid arthritis (RA) population, arterial stiffness contributes to cardiovascular disease risk beyond brachial blood pressure and other established cardiovascular risk factors. The increased cardiovascular disease risk in RA is now well documented. In this regard, how RA impacts on arterial stiffness remains uncertain. O...

Arterial stiffness can enhance cardiovascular risk by increasing atherogenesis or adverse hemodynamic effects. We examined whether the arterial stiffness markers of aortic pulse wave velocity (PWV) and the augmentation index (AIx) are independently associated with carotid artery intima-media thickness (IMT) and plaque in patients with rheumatoid ar...

Objectives.: Cardiovascular disease (CVD) risk calculators developed for the general population do not accurately predict CVD events in patients with RA. We sought to externally validate risk calculators recommended for use in patients with RA including the EULAR 1.5 multiplier, the Expanded Cardiovascular Risk Prediction Score for RA (ERS-RA) and...

Omentin is an adipokine that reportedly protects against cardiometabolic risk. We investigated the relationships between omentin concentrations and subclinical cardiovascular disease in rheumatoid arthritis (RA). Omentin concentrations were measured in 213 (104 black; 109 white) RA patients. Relationships of omentin levels with those of endothelial...

Supplementary Table 1: Traditional risk factors and RA characteristics associated with diastolic function and left ventricular geometry. Supplemental Table 2: Non-significant associations of traditional risk factors and RA characteristics with markers of diastolic function and left ventricular geometry.

The age of onset of rheumatoid arthritis (RA) is an important outcome predictor. Northern countries report an age of RA onset of around 50 years, but apparently, variability exists across different geographical regions. The objective of the present study is to assess whether the age of onset of RA varies across latitudes worldwide. In a proof-of-co...

Patients with rheumatoid arthritis (RA) experience an increased cardiometabolic risk factor burden that is substantially driven by systemic inflammation. This occurs less consistently in patients with ankylosing spondylitis (AS). Psoriatic arthritis most strongly associates with excess adiposity and metabolic risk. RA patients also often have syste...

Background and aims: Apelin-APJ signaling reduces cardiovascular disease (CVD) risk. In rheumatoid arthritis (RA), the atherosclerosis burden and plaque vulnerability to rupture are increased. We explored relationships between apelin concentrations and subclinical CVD in RA. Methods: Apelin levels were measured in 235 (114 black, 121 white) RA p...

Objective: The recent Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimated glomerular filtration rate (eGFR) is recommended for use in European populations. However, because the relationship between creatinine and GFR varies between ethnicities, the CKD-EPI equation may not perform as well in African as it does in Cau...

Background Carotid ultrasonography (CU) and coronary artery calcification score (CAC) evaluated by multidetector computed tomography (MDCT) scanner are useful in detecting subclinical atherosclerosis and are good surrogate markers of cardiovascular morbidity and mortality in general population and in rheumatoid arthritis (RA). In RA, a good correla...

Background Carotid plaque (CP) detected by ultrasonography and carotid intima-media thickness (cIMT) are useful surrogate markers for subclinical atherosclerosis and good predictors of cardiovascular disease in the general population and rheumatoid arthritis (RA). Objectives Our aim was to determine if cIMT may predict the presence of carotid plaq...

Background Cardiovascular disease (CVD) risk calculators developed for the general population do not accurately predict CVD events in patients with rheumatoid arthritis (RA). Objectives To externally validate risk calculators recommended for use in patients with RA including the European League Against Rheumatism (EULAR) 1.5 multiplier, the Expand...

Background Intima media thickness (IMT) and coronary artery calcification (CAC) quantification using multidetector computed tomography (MDCT) scanner are useful in detecting subclinical atherosclerosis and are good surrogate markers of cardiovascular morbidity and mortality in general population and in rheumatoid arthritis (RA) A good correlation b...

Objectives: Our objective was to examine associations of traditional and non-traditional cardiovascular risk factors with relative leukocyte telomere length and confounder adjusted relationships of relative telomere length with endothelial activation and carotid atherosclerosis in black and white African patients with rheumatoid arthritis (RA). M...

Targeted therapies in connective tissue diseases (CTDs) have led to improvements of disease-associated outcomes, but life expectancy remains lower compared to general population due to emerging co-morbidities, particularly due to excess cardiovascular risk. Cardiovascular magnetic resonance (CMR) is a noninvasive imaging technique which can provide...

Aim: To identify whether the more recently developed equation for estimated glomerular filtration rate (eGFR) [Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI)] is more closely associated with end-organ changes than previous equations in a group of black African descent. Methods: In 1221 randomly recruited participants of black Africa...

Objective: We determined the performance of the Framingham score and the Systematic COronary Risk Evaluation (SCORE) in assessing high-risk atherosclerosis in patients with rheumatoid arthritis (RA). Methods: We assembled 330 cases without established cardiovascular disease (CVD), diabetes, and moderate or severe chronic kidney disease among 451...

We previously reported that most patients with rheumatoid arthritis (RA) and moderate cardiovascular disease (CVD) risk according to the Systematic COronary Evaluation Score (SCORE) experience carotid artery plaque. In this study, we aimed to identify patient characteristics that can potentially predict carotid plaque presence in women with RA and...

Sleep disruption has been shown to be associated with modifications in immune activation. In the auto-immune disorder rheumatoid arthritis (RA), increased disease activity is correlated with increased sleep disruption. In this study, we investigated whether sleep is an independent predictor of RA disease activity. Methods: We recruited 112 RA patie...

Background Carotid artery plaque as identified by ultrasound represents very high risk atherosclerosis. Objectives We determined the performance of cardiovascular disease (CVD) risk equations including the Systematic COronary Risk Evaluation (SCORE) and Framingham score in predicting plaque presence in patients with rheumatoid arthritis (RA). Metho...

We examined the association of TNF-related apoptosis-inducing ligand (TRAIL) concentrations with cardiovascular disease (CVD) in rheumatoid arthritis (RA) and, since osteoprotegerin (OPG) can act as a decoy receptor for TRAIL, whether TRAIL concentrations impact on the OPG level-atherosclerotic CVD relation that was recently documented in the prese...

To determine whether kidney function independently relates to endothelial activation and ultrasound determined carotid atherosclerosis in black and white Africans with rheumatoid arthritis (RA). We calculated the Jelliffe, 5 Cockcroft-Gault equations, Salazar-Corcoran, Modification of Diet in Renal Disease (MDRD) and Chronic Kidney Disease Epidemio...

To the Editor: We thank Dr. Makrilakis and colleagues for their interest1 in our study of 236 patients with rheumatoid arthritis (RA) that documented a potential role of the adipokine chemerin in atherogenesis and cardiovascular disease (CVD) risk stratification2. Dr. Makrilakis, et al 1 reported on their own recent findings that interleukin 6 (...

Objective: We determined whether osteoprotegerin (OPG) concentrations are associated with established cardiovascular disease (CVD) among patients with rheumatoid arthritis (RA). Methods: OPG concentrations were measured by ELISA in 151 patients with RA (54 with CVD) and 62 age-matched control subjects without CVD. Established CVD was composed of...

To the Editor: Leptin is an adipokine that regulates appetite and energy expenditure1. Both high and low leptin production can further increase cardiovascular (CV) risk1. Leptin is also produced in inflamed joints and implicated in the pathophysiology of rheumatoid arthritis (RA)2. Whether leptin increases CV risk in RA is currently uncertain. T...

Rheumatoid arthritis (RA) enhances the risk of cardiovascular disease to a similar extent as diabetes. Whereas atherogenesis remains poorly elucidated in RA, traditional and nontraditional risk factors associate similarly and additively with CVD in RA. Current recommendations on CVD risk stratification reportedly have important limitations. Further...

Objective: Depending on physiological context, the adipokine chemerin can reduce or enhance cardiovascular risk. We investigated whether chemerin concentrations represent cardiovascular disease risk in rheumatoid arthritis (RA). Methods: We assessed ELISA-determined chemerin concentrations and those of 4 early endothelial activation molecules as...

Background Whereas chemerin contributes to the pathophysiology of rheumatoid arthritis (RA) (1), its role in the enhanced cardiovascular disease risk in RA is unknown. In non-RA subjects, dependent on physiological context, chemerin can reduce or enhance cardiovascular risk (2). Objectives We investigated whether chemerin concentrations represent c...

Background Whereas retinol binding protein 4 (RBP) enhances metabolic risk and atherogenesis in non-rheumatoid arthritis (RA) subjects (1,2), its role in atherogenesis in patients with RA is currently unknown. Objectives We investigated the independent relationships of RBP4 concentrations with cardiometabolic risk, endothelial activation and caroti...

In the present study, we examined the potential impact of adiponectin on carotid ultrasound determined atherosclerosis in 210 (119 black and 91 white) RA patients in mixed regression models. Total adiponectin concentrations were smaller in patients with compared to those without the metabolic syndrome (MetS) defined waist criterion (median (range)...

Background Osteoprotegerin (OPG) may participate in the pathophysiology of rheumatoid arthritis (RA) (1). Recently reported evidence further supports a potential involvement of OPG in endothelial activation and subclinical atherosclerosis in RA (2). Objectives We determined whether osteoprotegerin (OPG) concentrations are independently related to...

Retinol binding protein 4 (RBP) enhances metabolic risk and atherogenesis. Whether RBP4 contributes to cardiovascular risk in rheumatoid arthritis (RA) is unknown. We assessed RBP4 concentrations and those of endothelial activation molecules including E-selectin, vascular cell adhesion molecule-1, intercellular adhesion molecule-1 and monocyte chem...

Osteoprotegerin (OPG) may contribute to the link between systemic inflammation and increased cardiovascular risk. We investigated the relationship of OPG concentrations with endothelial activation and carotid atherosclerosis in rheumatoid arthritis (RA). OPG concentrations and those of endothelial activation molecules were measured by using ELISA i...

Background Leptin and particularly adiponectin are likely involved in the pathophysiology of rheumatoid arthritis (RA) and therefore potential new therapeutic targets. In the general population, leptin enhances and adiponectin reduces cardiovascular metabolic risk. Hence, adiponectin inhibition would be expected to result in increased cardiovascula...

Background The metabolic syndrome (MetS) and its components are associated with atherosclerosis in patients with rheumatoid arthritis (RA) that belong to developed populations [1-2]. Whereas approximately 80% of ACVD now occurs in developing countries [3], the impact of metabolic risk factors on atherosclerotic cardiovascular disease (ACVD) in pati...

Background Reported findings on the relationship between adiposity and atherosclerotic cardiovascular disease (ACVD) risk in rheumatoid arthritis (RA) are contradictory and originate in developed populations [1-4], whereas approximately 80% of ACVD now occurs in developing countries [5]. Objectives To ascertain the associations of anthropometric me...

Background Compared to persons from developed populations, those that belong to developing populations are at an earlier epidemiological health transition stage [1-3]. Accordingly, black Africans still experience a distinctly low prevalence of atherosclerotic cardiovascular disease [2-3]. It is unknown whether this protection is present in patients...

We examined the potential impact of demographic characteristics on the independent leptin-metabolic cardiovascular risk factor and leptin-endothelial activation relationships in black and white patients with RA. Leptin concentrations and those of endothelial activation molecules including soluble E-selectin, vascular cell adhesion molecule-1, inter...

Adipo(cyto)kines are mostly produced by adipose tissue and orchestrate the adverse impact of excess adiposity on cardiovascular risk. Adipokines also contribute importantly to the pathophysiology of rheumatoid arthritis. Congruent with data reported in previous investigations, Kang and colleagues report in this issue of Arthritis Research & Therapy...

Whether adiponectin levels associate with atherogenesis in RA is uncertain. We examined the independent relationships of total and high molecular weight (HMW) adiponectin concentrations with cardiometabolic risk and surrogate markers of enhanced early atherogenesis in black and white patients with RA. We determined total and HMW adiponectin concent...

Vitamin D is a steroid hormone that is best known for its central role in calcium and phosphate homeostasis1,2,3. Vitamin D deficiency [serum 25 OH-hydroxyvitamin D (25(OH)D) < 20 ng/ml] is complicated by rickets in children and osteomalacia in adults. Further, vitamin D deficiency and insufficiency [serum 25(OH)D < 30 ng/ml] contribute to osteopor...