Abstract
ObjectivesThe aim of this study was to assess the role of disease activity, line of treatment, and carotid atherosclerosis in the risk for acute coronary syndrome (ACS) in rheumatoid arthritis (RA) patients.Patients and methodsIn this prospective study, we ascertained ACS on 124 patients with RA. Disease activity score 28 was used for the assessment of RA activity. Insulin resistance was evaluated using homeostasis model assessment-insulin resistance. Carotid atherosclerosis was measured using high-resolution ultrasound. We used Cox’s proportional hazards models to estimate the association between ACS and atherosclerosis, cardiovascular (CV) risk factors, and RA line of treatment.ResultsAmong the 124 RA patients without a history of previous ACS, 16 incident ACS events occurred over 30 months. Old age, long RA disease duration, high BMI, and 10-year cardiovascular disease risk were associated with an increased risk for ACS. High mean disease activity score 28, rheumatoid factor, and anticitrullinated peptide antibodies (ACPA) levels were significantly associated with ACS risk. Treatment with disease-modifying antirheumatic drugs or biological disease-modifying antirheumatic drugs (DMARDs) did not alter the ACS risk. Logistic regression analysis showed that carotid plaques were a good predictor for ACS in RA patients.ConclusionThe main finding of this study was a general tendency toward an association of disease activity, rheumatoid factor, and ACPA with the risk for ACS. In addition, subclinical atherosclerosis detected by means of carotid intima-media thickness and the presence of carotid plaques were good predictors for RA patients with ACS. Treatment with any DMARD or biologic DMARDs was not linked to an altered risk for ACS.
Highlights
Cardiovascular disease (CVD) is considered the chief cause of death in rheumatoid arthritis (RA) patients
Patients with the following conditions were excluded from the study: (i) age under 18 years; (ii) RA overlap with other rheumatic diseases; (iii) individuals with a history of ischemic heart disease before the diagnosis of RA; (iv) cases of acute coronary syndrome (ACS) that began before the baseline visit were not counted in this study; (v) severe comorbid cases such as patients with end-stage renal failure, respiratory failure, and liver failure, which is likely to compromise survival or study participation; and (vi) unwillingness to cooperate with study procedures, or other inabilities
Serum insulin levels and Insulin resistance (IR) determined using the homeostasis model assessment (HOMA)-IR were found to be significantly higher in patients in the ACS group compared with the other group
Summary
Cardiovascular disease (CVD) is considered the chief cause of death in rheumatoid arthritis (RA) patients. RA increases the risk for cardiovascular (CV) mortality by up to 50% when compared with general population [1,2,3]. Systemic inflammation associated with RA appears to be a key factor of increased CV risk [1]. Histological evidence of inflammation and plaque instability in the coronary arteries of patients with RA was detected in a postmortem series compared with non-RA controls [9]. This supports the theory that the mechanisms responsible for CV events in RA may vary from those in the general population
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