Abstract
IntroductionAlthough cardiovascular morbidity and mortality are increased in rheumatoid arthritis, little is known about the burden of subclinical coronary atherosclerosis in these patients.MethodsUsing computed tomography, coronary artery calcification was measured in 195 men and women with rheumatoid arthritis aged 45 to 84 years without clinical cardiovascular disease and compared with 1,073 controls without rheumatoid arthritis enrolled in the Baltimore cohort of the Multi-Ethnic Study of Atherosclerosis.ResultsThe prevalence of coronary calcification (Agatston score > 0) was significantly higher in men, but not women, with rheumatoid arthritis after adjusting for sociodemographic and cardiovascular risk factors (prevalence ratio = 1.19; P = 0.012). Among participants with prevalent calcification, those with rheumatoid arthritis had adjusted mean Agatston scores 53 units higher than controls (P = 0.002); a difference greater for men than women (P for interaction = 0.017). In all analyses, serum IL-6 attenuated the association between rheumatoid arthritis and coronary calcification, suggesting its role as a potential mediator of enhanced atherosclerosis. Notably, increasing severity of rheumatoid arthritis was associated with a higher prevalence and extent of coronary calcification among both men and women with rheumatoid arthritis, and for all age categories. The largest percentage difference in coronary arterial calcification between rheumatoid arthritis patients and their nonrheumatoid arthritis counterparts was observed in the youngest age category.ConclusionsIncreasing rheumatoid arthritis disease severity was associated with a higher prevalence and greater extent of coronary artery calcification, potentially mediated through an atherogenic effect of chronic systemic inflammation. Gender and age differences in association with coronary calcification suggest that preventive measures should be emphasized in men with rheumatoid arthritis, and considered even in younger rheumatoid arthritis patients with low levels of traditional cardiovascular risk factors.
Highlights
Cardiovascular morbidity and mortality are increased in rheumatoid arthritis, little is known about the burden of subclinical coronary atherosclerosis in these patients
Increasing rheumatoid arthritis disease severity was associated with a higher prevalence and greater extent of coronary artery calcification, potentially mediated through an atherogenic effect of chronic systemic inflammation
Gender and age differences in association with coronary calcification suggest that preventive measures should be emphasized in men with rheumatoid arthritis, and considered even in younger rheumatoid arthritis patients with low levels of traditional cardiovascular risk factors
Summary
Cardiovascular morbidity and mortality are increased in rheumatoid arthritis, little is known about the burden of subclinical coronary atherosclerosis in these patients. Cardiovascular disease (CVD) is the leading cause of premature mortality in rheumatoid arthritis (RA) patients [1,2]. Coronary arterial calcification (CAC), a subclinical measure of atherosclerosis measured by computed tomography (CT), is associated with the degree of atherosclerotic plaque [8], and is strongly predictive of cardiovascular (CV) events, including those at low risk [9,10]. CAC: coronary artery calcification; CRP: C-reactive protein; CT: computed tomography; CV: cardiovascular; CVD: cardiovascular disease; DMARD: disease-modifying antirheumatic drug; ELISA: enzyme-linked immunosorbent assay; ESCAPE RA: Evaluation of Subclinical Cardiovascular disease And Predictors of Events in Rheumatoid Arthritis; IL: interleukin; MESA: Multi-Ethnic Study of Atherosclerosis; RA: rheumatoid arthritis. Increasing age and male gender are two of the strongest predictors of CAC [16], yet no previous studies have explored their interactions with RA with regard to CAC
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