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. 2015 Nov 10:2:80.
doi: 10.3389/fmed.2015.00080. eCollection 2015.

Association of Chest Pain and Risk of Cardiovascular Disease with Coronary Atherosclerosis in Patients with Inflammatory Joint Diseases

Silvia Rollefstad  1 , Eirik Ikdahl  1 , Jonny Hisdal  2 , Tore Kristian Kvien  3 , Terje Rolf Pedersen  4 , Anne Grete Semb  1
Affiliations

Association of Chest Pain and Risk of Cardiovascular Disease with Coronary Atherosclerosis in Patients with Inflammatory Joint Diseases

Silvia Rollefstad et al. Front Med (Lausanne). .

Abstract

Objectives: The relation between chest pain and coronary atherosclerosis (CA) in patients with inflammatory joint diseases (IJD) has not been explored previously. Our aim was to evaluate the associations of the presence of chest pain and the predicted 10-year risk of cardiovascular disease (CVD) by use of several CVD risk algorithms, with CA verified by multidetector computed tomography (MDCT) coronary angiography.

Methods: Detailed information concerning chest pain and CVD risk factors was obtained in 335 patients with rheumatoid arthritis and ankylosing spondylitis. In addition, 119 of these patients underwent MDCT coronary angiography.

Results: Thirty-one percent of the patients (104/335) reported chest pain. Only six patients (1.8%) had atypical angina pectoris (pricking pain at rest). In 69 patients without chest pain, two thirds had CA, while in those who reported chest pain (n = 50), CA was present in 48.0%. In a logistic regression analysis, chest pain was not associated with CA (dependent variable) (p = 0.43). About 30% (Nagelkerke R (2)) of CA was explained by any of the CVD risk calculators: Systematic Coronary Risk Evaluation, Framingham Risk Score, or Reynolds Risk Score.

Conclusion: The presence of chest pain was surprisingly infrequently reported in patients with IJD who were referred for a CVD risk evaluation. However, when present, chest pain was weakly associated with CA, in contrast to the predicted CVD risk by several risk calculators which was highly associated with the presence of CA. These findings suggest that clinicians treating patients with IJD should be alert of coronary atherosclerotic disease also in the absence of chest pain symptoms.

Keywords: atherosclerosis; cardiovascular diseases; chest pain; inflammatory joint diseases; risk factors.

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Figures

Figure 1
Figure 1
Various types of chest pain in patients with rheumatoid arthritis (RA) and ankylosing spondylitis (AS).
Figure 2
Figure 2
Chest pain and coronary atherosclerosis in RA and AS. Presence of coronary atherosclerosis (examined with multidetector computed tomography) in rheumatoid arthritis and ankylosing spondylitis patients (n = 119) with and without chest pain. RA, rheumatoid arthritis; AS, ankylosing spondylitis.
Figure 3
Figure 3
Odds ratios for coronary atherosclerosis in RA and AS. Association of coronary atherosclerosis with chest pain and the calculated CVD risk by several risk calculators in patients with rheumatoid arthritis and ankylosing spondylitis. Statistics: the estimates are presented as odds ratios for the presence of CA. The odds ratios are analyzed per unit increase of CVD risk calculated by SCORE, Framingham Risk Score, and Reynolds Risk Score. RA, rheumatoid arthritis; AS, ankylosing spondylitis; SCORE, systematic coronary risk evaluation; CVD, cardiovascular disease.
Figure 4
Figure 4
Results of the MDCT coronary angiography. Flowchart of patients undergoing MDCT coronary angiography. MDCT, multidetector computed tomography; CA, coronary atherosclerosis; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting.
See this image and copyright information in PMC

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