Abstract
Objective. A long-term follow-up of patients with rheumatoid arthritis (RA) to evaluate factors related to coronary artery calcification (CAC). Methods. All 22 eligible patients (4 males/18 females, mean age 65 years, and RA-duration 30–36 years) from the original (baseline; n = 39) study of atherosclerosis were included. Inflammation, cardiovascular risk factors, and biomarkers were measured at baseline. At follow-up 13 years later, CAC was assessed by computed tomography (CT) and the grade of inflammation was measured. Multivariate analysis of differences between patients with low (0–10) and high CAC (>10) was done by orthogonal projection to latent structures (OPLS). Results. Ten patients had CAC 0–10 and 12 had >10 (range 18–1700). Patients with high CAC had significantly higher ESR (24.3 versus 9.9 mm/h) and swollen joint count (2 versus 0). The OPLS models discriminated between patients having high or low CAC. With only baseline variables, the sensitivity was 73% and the specificity 82%. The model that also included inflammatory variables from follow-up had a sensitivity of 89% and a specificity of 85%. Exclusion of baseline intima media thickness and plaque from the latter model modestly reduced the accuracy (sensitivity 80% and specificity 83%). Conclusions. CAC is related to inflammation in patients with RA.
Highlights
Morbidity and mortality due to cardiovascular disease (CVD) are increased in rheumatoid arthritis (RA) [1,2,3] reflecting the additional burden of atherosclerosis [4,5,6]
Increased intima media thickness (IMT) is an early sign of atherosclerosis and has been found to predict future CVD in the general population [7] as well as in RA [8, 9]
Ten patients were classified into the low CAC group (0–10) and 12 into the high CAC group (>10)
Summary
Morbidity and mortality due to cardiovascular disease (CVD) are increased in rheumatoid arthritis (RA) [1,2,3] reflecting the additional burden of atherosclerosis [4,5,6]. Increased IMT is an early sign of atherosclerosis and has been found to predict future CVD in the general population [7] as well as in RA [8, 9]. Another way to assess subclinical atherosclerosis is computed tomography (CT) of the coronary arteries, where the amount of calcium is quantified using the Agatston method [10]. As is the case for other measures of atherosclerosis, the prevalence of CAC is higher in RA than in the general population [14,15,16,17,18]. For other measures of atherosclerosis, the association with inflammation is somewhat uncertain [19]
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