Assessment of subclinical atherosclerosis risk by measuring carotid intima media thickness and carotid femoral pulse wave velocity in patients with Behcet's disease

Behçet's disease (BD) is a chronic inflammatory disease which was defined as a complex of oral and genital ulcers and hypopyon uveitis by a Turkish dermatologist Prof. Dr. Hulusi Behçet in 1937 with involvement of many organ systems (joint, pulmonary, gastrointestinal, urogenital, cardiac, vascular and nervous system). Its basic pathology is vaculitis. Despite the advances in diagnosis and treatment of atherosclerotic cardiovascular disease, it is still the leading cause of death worldwide. Atherosclerosis is defined as a multifactorial disease that affects the large and medium-sized arteries, in which chronic inflammation has a role in pathogenesis. Although very complex mechanisms play a role in the development of atherosclerosis, it may be prevented by modification of the identified risk factors. Chronic inflammation has a role in the pathogenesis atherosclerosis and many studies were performed recently in different patient groups with chronic inflammatory diseases (SLE, RA, psoriasis etc.) to determine the progression of atherosclerotic process. In this study, we evaluated Behçet's disease in this context, which is relatively frequent in our country. 30 patients with Behçet's disease and 30 volunteers with no atherosclerotic risk factors except smoking, who were referred to Akdeniz University Medical Faculty Hospital between September 2014 - May 2015, were enrolled in this study. Prior to the measurements a detailed history, physical examination and laboratory results were recorded. Then carotid intima-media thickness by B-mode ultrasonography and carotid-femoral pulse wave velocity by pressure sensitive transducer were measured. Basic characteristic including age, gender, smoking, blood pressure, heart rate and laboratory results (LDL, creatinine, fasting blood glucose, leukocyte and platelet counts) except hemoglobin were similar in patient and control groups. The patient group was divided into two subgroups, including mucocutaneous and systemic involvement, except gender, the basic characteristic features of the groups were similar. 66.7% of the mucocutaneous group (10/15); 20% of the systemic group (3/15) were female in gender. Maximum carotid intima-media thickness (cIMT) was 0.751±0.077 mm in patient group and 0.735±0.079 mm in control group. Mean carotid intima-media thickness was 0.643±0.07 mm in patient group and 0.629±0.069 mm in control group. Both parameters tended to be higher in patient group but they did not reach to statistical significance. Measured carotid-femoral pulse wave velocity (PWV) was 6,35±1.05 m/sn in patient group and 5.75±0.83 m/sn in control group, and the difference between the two groups were statistically significant (p = 0.017). In patient subgroup analyses, there was no significant difference in maximum/mean cIMT and carotid-femoral PWV measurements between the mucocutaneous and systemic involvement groups (p valve respectively; 0,927, 0,920 ve 0,600). Regression analyses showed that, there was a statistically significant, positive moderate correlation between max cIMT and carotid-femoral PWV in all study groups, (r=0.661;p<0.001), there was also a statistically significant, positive strong correlation between mean cIMT and carotid-femoral PWV (r=0.717;p<0.001). Mean duration of disease was 9.2±9.4 years for the patients. There was statistically significant, positive weak correlation between max/mean cIMT and carotid-femoral PWV with duration of disease. In this study, like the previous studies in patients with Behçet's disease, cIMT ve carotid-femoral PWV values, which were used to determine the subclinical atherosclerosis, were higher than the healthy volunteers. Unlike previous studies, combined use of these two methods, determined a positive correlation between cIMT and carotid-femoral PWV values by regression analysis which is an important finding. In addition, in the study carotid-femoral PWV is found to be more sensitive method than cIMT. Small number of patients and lack of follow-up period are the limitations of this study, for the evaluation of subclinical atherosclerosis and determination of clinical results in patients with Behçet's disease. Therefore, there is a need for larger studies with long term follow up.