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. 2020 Jun 24:12:679-689.
doi: 10.2147/CLEP.S251168. eCollection 2020.

Rheumatoid Arthritis as a Risk Factor for Coronary Artery Calcification and Obstructive Coronary Artery Disease in Patients with Chest Pain: A Registry Based Cross-Sectional Study

Andreas Bugge Tinggaard  1 , Annette de Thurah  2 , Ina Trolle Andersen  3 , Anders Hammerich Riis  3 , Josephine Therkildsen  1 , Simon Winther  4 , Ellen-Margrethe Hauge  2 , Morten Bøttcher  1
Affiliations

Rheumatoid Arthritis as a Risk Factor for Coronary Artery Calcification and Obstructive Coronary Artery Disease in Patients with Chest Pain: A Registry Based Cross-Sectional Study

Andreas Bugge Tinggaard et al. Clin Epidemiol. .

Abstract

Purpose: To examine the occurrence and severity of coronary artery disease (CAD) in patients with rheumatoid arthritis (RA) compared to non-RA patients in a population referred for coronary computed tomography angiography (CTA) due to chest pain.

Patients and methods: In this cross-sectional study, 46,210 patients from a national CTA database were included. Patients with RA were stratified on serology, treatment with conventional synthetic or biological disease-modifying antirheumatic drugs (DMARDs), and the need for relapse or flare treatment with intraarticular or -muscular glucocorticoid injections (GCIs). Primary outcomes were coronary artery calcium score (CACS) >0 and CACS ≥400, and secondary outcome was obstructive CAD. Associations between RA and outcomes were examined using logistic regression and results were adjusted for age, sex, cardiovascular risk factors and comorbidities.

Results: A total of 395 (0.9%) RA patients were identified. In overall RA, crude odds ratio (OR) for having CACS >0 was 1.48 (1.21-1.82) and 1.52 (1.15-2.01) for CACS ≥400, whereas adjusted ORs were 1.08 (0.86-1.36) and 1.21 (0.89-1.65), respectively. Seropositive RA patients had adjusted OR of 1.16 (0.89-1.50) for CACS >0 and 1.37 (0.98-1.90) for CACS ≥400. Patients who had received ≥1 GCI in the period of 3 years prior to the CTA had an adjusted OR of 1.37 (0.94-2.00) for having CACS >0 and 1.46 (0.92-2.31) for CACS ≥400.

Conclusion: This is the first large-scale, CTA-based study examining the occurrence and severity of CAD in RA patients with symptoms suggestive of cardiovascular disease. A higher prevalence of coronary artery calcification was found in RA patients. After adjusting for age, sex, cardiovascular risk factors and comorbidities, the tendency was less pronounced. We found a trend for increased coronary calcification in RA patients being seropositive or needing treatment with GCI for a relapse or flare.

Keywords: computed tomography angiography; coronary artery calcium score; coronary artery disease; cross-sectional; rheumatoid arthritis.

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Conflict of interest statement

Professor Ellen-Margrethe Hauge reports personal fees from Sanofi, Sobi, AbbVie, UCB, grants from Novartis, and received travel reimbursement from Sobi and Celgene, outside the submitted work. The authors received no financial support for the research, authorship or publication of this article. The authors report no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of the patient inclusion. Abbreviations: CT, computed tomography; WDHR, Western Denmark Heart Registry; CPR, personal identification number; CAD, coronary artery disease; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; CACS, coronary artery calcium score; RA, rheumatoid arthritis.
See this image and copyright information in PMC

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