Coronary artery calcium score in female rheumatoid arthritis patients: Associations with apolipoproteins and disease biomarkers

Abstract

Aims and methods In rheumatoid arthritis (RA), cardiovascular (CV) comorbidities are a major cause of mortality. Coronary Calcium Score (CCS) assessed by computed tomography has been associated with RA prognosis. In this work, we aimed to assess CCS in female RA patients and determine CCS association with different clinical, laboratory and imaging disease parameters. Results We evaluated 60 female patients, with a mean age of 53.6 ± 10.4 years, a mean Disease Activity Score of 28 joints (DAS28) (4v) and Health Assessment Questionnaire (HAQ) of 4.542 ± 1.317 and 1.488 ± 0.631, respectively, and a disease duration of 14.7 ± 10.3 years. Mean CCS value was 35.192 ± 117.786. CCS > 10 was significantly associated with CV risk factors (age: odds ratio [OR] = 1.120; P = .002, body mass index [BMI] ≥ 25 kg/m2: OR = 0.271; P = .025, high‐density lipoprotein [HDL]: OR = 0.011; P = .025, low‐density lipoprotein/ HDL ratio: OR = 2.084; P = .030, apolipoprotein A1 [ApoA1]: OR = 0.965; P = .014, apolipoprotein B/ApoA1 [ApoB/ApoA1] ratio: OR = 59.834; P = .011, homocysteine: OR = 1.287; P = .045, diabetes: OR = 10.400; P = .043, and anti‐diabetic therapy: OR = 10.667, P = .041), disease parameters (C‐reactive protein [CRP]: OR = 1.038; P = .046, DAS[4v]: OR = 1.900; P = .009, DAS28[4v; CRP]: OR = 1.700; P = .019, DAS[3v]: OR = 1.947; P = .010, DAS28[3v; CRP]: OR = 1.696; P = .022, HAQ: OR = 3.299; P = .023, erosion score: OR = 1.015; P = .012, and total modified Sharp/van der Heijde Score: OR = 1.008; P = .035), biomarkers (osteoprotegerin: OR = 1.505; P = .022), and bone mineral density (femoral: OR = 0.005; P = .018, lumbar spine: OR = 0.001; P = .002, left hand: OR = 7.9 × 10−9; P = .005, and osteoporosis: OR = 6.628; P = .007). After adjustment for age and BMI, significant associations were maintained with ApoA1, ApoB/ApoA1 ratio, homocysteine, CRP, DAS(4v), DAS(4v; CRP), DAS(3v) and DAS(3v; CRP). A sensitivity analysis undertaken after excluding the 6 diabetics yielded similar results. Conclusions Our work reinforces the hypothesis that in RA, CCS may be a useful tool in CV risk assessment, particularly valuable in poorer controlled patients with certain lipoprotein profiles.

Serum biomarkers for arterial calcification in humans: A systematic review

“…Three of 23 studies that analyzed a possible association between PTH and arterial calcification found a positive association ( Tuersun et al, 2020 ; Wu et al, 2016b ; Billington et al, 2016 ) and twenty no association ( Alagoz et al, 2014 ; Arad et al, 1998 ; Billington et al, 2020 ; Grønhøj et al, 2016 ; Barbarash et al, 2016 ; Cancela et al, 2012 ; Davaine et al, 2016 ; Diederichsen et al, 2017 ; Golovkin et al, 2016 ; Masai et al, 2013 ; Pirro et al, 2013 ; Torii et al, 2016 ; Razavi et al, 2021 ; Martín-Reys et al, 2016 ; Cm et al, 2009 ; Bellasi et al, 2013 ; Soares et al, 2015 ; Bernandes et al, 2019 ; Kim et al, 2012 ; Watson et al, 1997 ). In the included articles there were two studies that were longitudinal ( Alagoz et al, 2014 ; Diederichsen et al, 2017 ).…”

“…In total, 30 studies performed analyses on a possible association between 25-hydroxyvitamin D (25(OH)D) and arterial calcifications ( Billington et al, 2020 ; Grønhøj et al, 2016 ; Tuersun et al, 2020 ; Zagura et al, 2011 ; Davaine et al, 2016 ; Liu et al, 2019 ; Pirro et al, 2013 ; Awan et al, 2010 ; Razavi et al, 2021 ; Bernandes et al, 2019 ; Kim et al, 2012 ; de Boer et al, 2009 ; Cheru et al, 2019 ; Doherty et al, 1997 ; El Mokadem et al, 2021 ; Eyyüpkoca et al, 2021 ; Ho et al, 2015 ; Kiani et al, 2013 ; Lai et al, 2013 ; Lee et al, 2016 ; Lim et al, 2012 ; Michos et al, 2009 ; Moradi and Foroutanfar, 2017 ; Nikolova et al, 2021 ; Rodrigues et al, 2021 ; Sajjadieh et al, 2020 ; Satilmis et al, 2015 ; Shikuma et al, 2012 ; Sung et al, 2016 ; Janus et al, 2021 ). Of these, ten studies found a negative association between 25(OH)D and arterial calcification ( Zagura et al, 2011 ; Pirro et al, 2013 ; de Boer et al, 2009 ; Doherty et al, 1997 ; El Mokadem et al, 2021 ; Eyyüpkoca et al, 2021 ; Lai et al, 2013 ; Lee et al, 2016 ; Moradi and Foroutanfar, 2017 ; Nikolova et al, 2021 ), two a positive association ( Zagura et al, 2011 ; Sung et al, 2016 ) and nineteen no significant association ( Billington et al, 2020 ; Grønhøj et al, 2016 ; Tuersun et al, 2020 ; Davaine et al, 2016 ; Liu et al, 2019 ; Awan et al, 2010 ; Razavi et al, 2021 ; …”

“…In total, 38 studies are published that investigated a possible association between OPG and arterial calcification ( Barbarash et al, 2016 ; Chai et al, 2017 ; Davaine et al, 2016 ; Diederichsen et al, 2017 ; Golovkin et al, 2016 ; Liu et al, 2019 ; Torii et al, 2016 ; Bernandes et al, 2019 ; Abedin et al, 2007 ; Asanuma et al, 2007 ; Bakhireva et al, 2008 ; Berezin and Kremzer, 2013a ; Bezerra et al, 2005 ; Dekker et al, 2021 ; Esteghamati et al, 2014 ; Frost et al, 2008 ; Golledge et al, 2008 ; Hosbond et al, 2014a ; Ketlogetswe et al, 2015 ; Kiani et al, 2017 ; Lieb et al, 2010 ; Liu et al, 2020 ; Mohammadpour et al, 2012 ; Nugroho and Widorini, 2017 ; Omland et al, 2007 ; Park et al, 2006 ; Pérez de Ciriza et al, 2014 ; Poornima et al, 2014 ; Poornima et al, 2018 ; Quercioli et al, 2012 ; Vinholt et al, 2013 ; Hosbond et al, 2014b ; Hwang et al, 2012 ; Kwon et al, 2016 ; Pesaro et al, 2018 ; Salari et al, 2017 ; Stȩpień et al, 2012 ; Wilund et al, 2008 ). Nineteen studies indicated a positive association ( Barbarash et al, 2016 ; Chai et al, 2017 ; Liu et al, 2019 ; Torii et al, 2016 ; Abedin et al, 2007 ; Asanuma et al, 2007 ; Dekker et al, 2021 ; Esteghamati et al, 2014 ; Golledge et al, 2008 ; Ketlogetswe et al, 2015 ; Liu et al, 2020 ; Nugroho and Widorini, 2017 ; Oml...…”

“…Eleven studies were performed investigating a possible association between RANKL and arterial calcification ( Davaine et al, 2016 ; Bernandes et al, 2019 ; Bakhireva et al, 2008 ; Bezerra et al, 2005 ; Ketlogetswe et al, 2015 ; Lieb et al, 2010 ; Mohammadpour et al, 2012 ; Poornima et al, 2014 ; Quercioli et al, 2012 ; Hwang et al, 2012 ; Pesaro et al, 2018 ). Four reported a negative association ( Davaine et al, 2016 ; Bezerra et al, 2005 ; Ketlogetswe et al, 2015 ; Poornima et al, 2014 ), three a positive association ( Quercioli et al, 2012 ; Hwang et al, 2012 ; Pesaro et al, 2018 ) and four no significant association ( Bernandes et al, 2019 ; Bakhireva et al, 2008 ; Lieb et al, 2010 ; Mohammadpour et al, 2012 ). There was one longitudinal study included that did not report a significant association ( Lieb et al, 2010 ).…”

Cardiovascular Health in Patients With Rheumatoid Arthritis

“…26 Additionally, the use of CAC in patients with risk-enhancing factors such as RA is useful in helping to reclassify risk and enhance decision-making regarding statin therapy. 27,28 Age is a major driver of 10-year risk estimation for CVD events. Many patients with RA are diagnosed at a younger age with lower cholesterol levels and therefore will likely score low on risk scoring systems.…”