SAT0544 CORONARY PLAQUE PROGRESSION IN RHEUMATOID ARTHRITIS: ROLE OF INFLAMMATION, CARDIAC RISK FACTORS, MEDICATIONS AND IMPACT ON EVENT RISK

Abstract

Background Patients with Rheumatoid Arthritis (RA) exhibit higher prevalence, burden and different composition of occult coronary plaque compared with age and gender-matched controls. Moreover, plaque burden on coronary computed tomography angiography (CCTA) predicted long-term cardiovascular events (CVE) in RA beyond cardiac risk factors or scores. Objectives To evaluate change in coronary plaque burden and composition, predictors thereof and its impact on CVE risk in RA. Methods One hundred-one participants with a baseline CCTA underwent a follow-up evaluation in 83±3.6 months. Plaque load was reported as segment involvement score (SIS-number of segments with plaque); segment stenosis score (SSS- cumulative stenosis over all evaluable segments) and total plaque score (TPS- collective plaque amount over all segments). Plaque composition was defined as non-calcified (NCP), mixed (MP) or calcified (CP). Coronary artery calcium (CAC) was quantified by the Agatston method. Robust logistic regression models evaluated predictors of increased plaque burden compared to non-progression. Independent predictors entered as continuous variables included age, time-averaged c-reactive protein (CRP), cumulative prednisone dose, bDMARD exposure (years), and statin exposure (years). Gender, hypertension, dyslipidemia, diabetes, and presence of IgA anti-beta2-glycoprotein1 antibodies (a-b2GPI-IgA) constituted dichotomous independent variables. Cox proportional hazards models assessed the role of SIS, SSS, TPS and CAC progression on incident CVE risk 14±2.7 months later, after adjustment for cardiac risk scores, or baseline plaque load. Results Total plaque burden increased in 42% of patients; progression was predicted by older age, higher cumulative inflammation (TA-CRP) and higher total prednisone dose (table 1). Longer exposure to bDMARDs and statins was linked to lower risk of NCP progression (all p Conclusion Change in coronary atherosclerosis burden and consistency was differentially impacted by Inflammation, cardiac risk factors, a-b2PI-IgA presence and medications such as prednisone, biologics and statins and independently predicted cardiovascular events in RA. ¶p Disclosure of Interests George Karpouzas Grant/research support from: Pfizer, Consultant for: Sanofi-Genzyme-Regeneron, Janssen, Roche-Genentech, Pfizer, Speakers bureau: BMS, Sanofi-Genzyme-Regeneron, Janssen, Roche-Genentech, Sarah Ormseth: None declared, Elizabeth Hernandez: None declared, Matthew Budoff: None declared