<p>Rheumatoid Arthritis as a Risk Factor for Coronary Artery Calcification and Obstructive Coronary Artery Disease in Patients with Chest Pain: A Registry Based Cross-Sectional Study</p>

Abstract

Purpose: To examine the occurrence and severity of coronary artery disease (CAD) in patients with rheumatoid arthritis (RA) compared to non-RA patients in a population referred for coronary computed tomography angiography (CTA) due to chest pain. Patients and Methods: In this cross-sectional study, 46,210 patients from a national CTA database were included. Patients with RA were stratified on serology, treatment with conventional synthetic or biological disease-modifying antirheumatic drugs (DMARDs), and the need for relapse or flare treatment with intraarticular or-muscular glucocorticoid injections (GCIs). Primary outcomes were coronary artery calcium score (CACS) >0 and CACS ≥400, and secondary outcome was obstructive CAD. Associations between RA and outcomes were examined using logistic regression and results were adjusted for age, sex, cardiovascular risk factors and comorbidities. Results: A total of 395 (0.9%) RA patients were identified. In overall RA, crude odds ratio (OR) for having CACS >0 was 1.48 (1.21-1.82) and 1.52 (1.15-2.01) for CACS ≥400, whereas adjusted ORs were 1.08 (0.86-1.36) and 1.21 (0.89-1.65), respectively. Seropositive RA patients had adjusted OR of 1.16 (0.89-1.50) for CACS >0 and 1.37 (0.98-1.90) for CACS ≥400. Patients who had received ≥1 GCI in the period of 3 years prior to the CTA had an adjusted OR of 1.37 (0.94-2.00) for having CACS >0 and 1.46 (0.92-2.31) for CACS ≥400. Conclusion: This is the first large-scale, CTA-based study examining the occurrence and severity of CAD in RA patients with symptoms suggestive of cardiovascular disease. A higher prevalence of coronary artery calcification was found in RA patients. After adjusting for age, sex, cardiovascular risk factors and comorbidities, the tendency was less pronounced. We found a trend for increased coronary calcification in RA patients being seropositive or needing treatment with GCI for a relapse or flare.

Dexamethasone is Associated With a Lower Risk of the Progression of Thoracic Aortic Calcification in Breast Cancer Survivors

“…This study also revealed that the level of increased TAC Agatston scores was negatively correlated with the cumulative dose and cycle of dexamethasone, and logistic regression analysis suggested that dexamethasone was a protective factor for the progression of TAC in breast cancer survivors. However, a study was found that intra-articular or intra-muscular injections glucocorticoid increased the level of coronary artery calcification scores (Tinggaard et al, 2020). In addition, Evans M et al observed that higher cumulative prednisone dose was associated with the incidence of adverse cardiovascular events in rheumatoid arthritis patients (Evans et al, 2011;Karpouzas et al, 2020).…”

“…Radiotherapy is a common treatment for breast cancer patients and has been observed to promote coronary and aorta calcification in patients with Hodgkin lymphoma (Apter et al, 2006). Glucocorticoid is frequently used as adjuvant drugs in chemotherapy or endocrine therapy in breast cancer patients, and studies have found that glucocorticoid promoted VC in vivo and in vitro (Kirton et al, 2006;Tinggaard et al, 2020). Furthermore, dexamethasone is the most commonly type of glucocorticoid in cancer therapy.…”

Musculoskeletal diseases in Marfan syndrome: a nationwide registry study

“…All four groups were subdivided into main groups and subgroups. For use of DMARD (Disease Modifying Antirheumatic Drug) we applied the Anatomical Therapeutic Chemical code (ATC) and the treatment procedure code as described previously [ 17 ]. The validity of some rheumatic diagnoses in the Danish registries has been investigated earlier, with positive predictive findings of approximately 88% for rheumatoid arthritis [ 18 ].…”

Musculoskeletal Diseases in Marfan Syndrome – A Nationwide Registry Study.

“…All four groups were subdivided into main groups and subgroups. For the use of DMARDS we used the Anatomical Therapeutic Chemical code (ATC) and the treatment procedure code as described previously [17]. The validity of some rheumatic diagnoses in the Danish registries have been investigated earlier, with positive predictive ndings of approximately 88% for rheumatoid arthritis [18] .…”