Coronary Atherosclerosis in Rheumatoid Arthritis: Could Endothelial Progenitor Cells Be the Missing Link?

Abstract

Patients with rheumatoid arthritis (RA) have a reduced life expectancy of 5–10 years1, largely driven by its association with an increased risk of cardiovascular disease (CVD), which accounts for about half of all deaths in patients with RA2. The reasons for such a disproportionately high risk compared to the general population are not yet fully understood, but conventional risk factors alone do not appear to fully account for the difference3. It follows that conventional CV risk stratification tools, such as the Framingham risk score, used so widely in primary prevention in the general population, may not be as well suited for use in patients with RA. Arguably the most appropriate algorithm of CV risk assessment for this cohort of patients may be the Reynolds risk score, which includes the measurement of high sensitivity C-reactive protein (CRP), reflecting the underlying inflammatory nature to atherosclerosis4. Another tool to improve coronary risk stratification is coronary artery calcium (CAC) scoring by computed tomography, which has gained popularity in recent years. High CAC scores have been associated with an increase in all-cause mortality5, and patients with RA have a higher prevalence and a greater burden of coronary calcification than non-RA controls. Therefore, its application for measuring subclinical atherosclerosis in this patient cohort could be utilized. However, pathophysiological links between arterial calcium deposition and atherosclerotic plaque formation are not completely clear, and clinical utility of CAC as well as the Reynolds risk score as a risk stratification tool has not been well validated in RA patients; therefore, the challenge of trying to predict patients who are most at risk continues6. The process of atherogenesis has been fundamentally linked to endothelial injury unbalanced by appropriate endothelial recovery, which appears to be at least partly attributable … Address correspondence to Dr. Shantsila; E-mail: shantsila{at}yandex.ru