Abstract
The risk for cardiovascular (CV) disease is increased in rheumatoid arthritis (RA) but data on the burden of coronary atherosclerosis in patients with RA are lacking. We conducted a retrospective case-control study of Olmsted County (MN, USA) residents with RA and new-onset coronary artery disease (CAD) (n = 75) in comparison with age-and sex-matched controls with newly diagnosed CAD (n = 128). Angiographic scores of the first coronary angiogram and data on CV risk factors and CV events on follow-up were obtained by chart abstraction. Patients with RA were more likely to have multi-vessel coronary involvement at first coronary angiogram compared with controls (P = 0.002). Risk factors for CAD including diabetes, hypertension, hyperlipidemia, and smoking history were not significantly different in the two cohorts. RA remained a significant risk factor for multi-vessel disease after adjustment for age, sex and history of hyperlipidemia. The overall rate of CV events was similar in RA patients and controls; however, there was a trend for increased CV death in patients with RA. In a nested cohort of patients with RA and CAD (n = 27), we measured levels of pro-inflammatory CD4+CD28null T cells by flow cytometry. These T cells have been previously implicated in the pathogenesis of CAD and RA. Indeed, CD4+CD28null T cells were significantly higher in patients with CAD and co-existent RA than in controls with stable angina (P = 0.001) and reached levels found in patients with acute coronary syndromes. Patients with RA are at increased risk for multi-vessel CAD, although the risk of CV events was not increased in our study population. Expansion of CD4+CD28null T cells in these patients may contribute to the progression of atherosclerosis.
Highlights
Inflammation plays a central role in the pathogenesis of atherosclerosis [1,2]
Demographic characteristics and coronary artery disease (CAD) risk factors The study population consisted of 79 patients with rheumatoid arthritis (RA) who had coronary angiography performed at Mayo Clinic for CAD symptoms
There was no significant difference in the percentage of individuals with traditional risk factors for CAD, including diabetes, hypertension, hyperlipidemia or smoking history in the study group when compared with controls (Table 1)
Summary
Inflammation plays a central role in the pathogenesis of atherosclerosis [1,2]. Markers of inflammation, such as C-reactive protein, are predictive of future cardiovascular (CV) events in healthy individuals and may be useful in identifying patients with coronary artery disease (CAD) who are at risk for recurrent CV events [3,4]. T-cell cytokines can drive macrophage activation in atherosclerotic lesions and can regulate the acute-phase response [1]. CD4+CD28null T cells have cytotoxic capability, can effectively kill endothelial cells in vitro, and may contribute to endothelial cell injury in coronary plaque [10]
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