Associations between coronary and carotid artery atherosclerosis in patients with inflammatory joint diseases

Abstract

Objective: Low association between cardiac symptoms and coronary artery disease (CAD) in patients with inflammatory joint diseases (IJD) demands for objective markers to improve cardiovascular risk stratification. Our main aim was to evaluate the prevalence and characteristics of CAD in patients with IJD with carotid artery plaques. Furthermore, we aimed to assess associations of carotid ultrasonographic findings and coronary plaques.

Methods: Eighty-six patients (61% female) with IJD (55 with rheumatoid arthritis, 21 with ankylosing spondylitis and 10 with psoriatic arthritis) and carotid artery plaque were referred to coronary CT angiography (CCTA). CAD was evaluated using the modified 17-segment American Heart Association model. Calcium score, plaque composition, segment involvement score and segment stenosis score were assessed and correlated to the carotid artery plaques and cardiovascular disease risk factors in logistic and linear regression analyses. Risk prediction models were tested with various cut-off values for associating variables.

Results: Fifty-five patients (66%) had CAD assessed by CCTA and 36 (43%) of these had coronary plaques defined as either mixed or soft. Eleven patients (13%) had obstructive CAD. The best risk prediction model (area under the curve: 0.832, 95% CI 0.730 to 0.935) included the combination of variables with cut-off values: age ≥55 years (OR: 12.18, 95% CI 2.80 to 53.05), the carotid-intima media thickness ≥0.7 mm (OR: 4.08, 95% CI 1.20 to 13.89) and carotid plaque height ≥1.5 mm (OR: 8.96, 95% CI 1.68 to 47.91), p<0.05.

Conclusion: Presence of carotid plaque is alone not sufficient to identify patients at risk for CAD, and a combination of ultrasonographic measurements may be useful in risk stratification of patients with IJD.

Trial registration number: NCT01389388, Results.

Keywords: atherosclerosis; computed tomography; inflammatory joint diseases; plaques.

Figure 1

Difference in carotid atherosclerosis measurements (c-IMT, plaque height, number of carotid plaques) between patients with and without CAD. X² analysis including all patients (n=83): mean c-IMT; p<0.01, mean carotid plaque height; p=0.02 and mean number of carotid plaques; p=0.01. AS, ankylosing spondylitis; c-IMT, carotid-intima media thickness; PsA, psoriatic arthritis; RA, rheumatoid arthritis.