Increased coronary‐artery atherosclerosis in rheumatoid arthritis: Relationship to disease duration and cardiovascular risk factors

Abstract

Objective. To compare the prevalence and severity of coronary-artery atherosclerosis in patients with early and established rheumatoid arthritis (RA) and controls.Methods. Electron-beam computed tomography was used to measure the extent of coronary-artery calcification in 227 subjects, of whom 70 had early RA, 71 had established RA, and 86 were controls. Coronaryartery calcification calculated according to the Agatston calcium score was compared in patients and controls, and its relationship to clinical characteristics was examined. Adjusted odds ratios (ORs) were obtained with the use of proportional odds logistic regression models to determine independent associations of early and established RA and coronary-artery calcification.Results. Calcium scores were higher in patients with established RA (median 40.2, interquartile range [IQR] 0-358.8) compared with those with early disease (median 0, IQR 0-42.6) and controls (median 0, IQR 0-19.2) (P ‫؍‬ 0.001). Coronary-artery calcification occurred more frequently in patients with established RA (60.6%) than in patients with early RA (42.9%) and control subjects (38.4%) (P ‫؍‬ 0.016) The OR for the likelihood of having more severe coronary-artery calcification (defined as an Agatston score >109) in patients with established disease was 3.42 (P ‫؍‬ 0.002) after adjusting for cardiovascular risk factors. Among patients with RA, smoking (OR 1.02, P ‫؍‬ 0.04) and an elevated erythrocyte sedimentation rate (OR 1.02, P ‫؍‬ 0.05) were associated with more severe coronary-artery calcification after adjustment for age and sex.Conclusion. The prevalence and severity of coronary calcification is increased in patients with established RA and is related, in part, to smoking and an increased erythrocyte sedimentation rate.

Cardiovascular Manifestations of Rheumatologic Diseases

“…16 The presence and amount of coronary calcification are also related to duration of RA. 17 In addition, lower levels of circulating endothelial progenitor cells, markers of the capacity for vascular regeneration that are inversely related to cardiovascular risk, are associated with heightened disease activity in RA patients. 18 Taken together, these studies suggest that extent and duration of inflammatory burden, as opposed to specific disease aspects, determine premature atherosclerosis in RA.…”

Serum osteoprotegerin is increased and independently associated with coronary-artery atherosclerosis in patients with rheumatoid arthritis

“…These patients are part of an ongoing study to identify cardiovascular risk factors in RA. 4 In order to determine if any findings occurred early in the disease process, and thus might play a role in pathogenesis, we recruited two groups of patients: those with early RA (<6 years of disease) and those with long-standing RA (>10 years of disease). Control subjects were recruited from patients' acquaintances, by advertisement, and from a database of volunteers maintained by the General Clinical Research Center.…”

Consenso 2012 da Sociedade Brasileira de Reumatologia sobre o manejo de comorbidades em pacientes com artrite reumatoide

“…Regarding the non-invasive tests that demonstrate the presence of subclinical atherosclerosis, studies have confi rmed that carotid atherosclerosis with plaques is frequent, 49 as well as a higher coronary artery calcium score on computed tomographic angiography. 50 The prevalences of acute myocardial infarction (AMI) and congestive heart failure (CHF) are higher in patients with RA. 51,52 Such conditions reduce survival and increase mortality of patients with RA.…”