Calcification of coronary arteries in early rheumatoid arthritis prior to anti-rheumatic therapy

Abstract

Accelerated coronary atherosclerosis is common in patients with rheumatoid arthritis (RA). To examine coronary artery calcification (CAC) frequency and severity, its correlation with traditional risk factors (TRF) of cardiovascular diseases (CVD) and inflammatory markers in patients with early RA prior to anti-rheumatic therapy. RA adult patients (ACR/EULAR criteria, 2010, duration ≤ 12 months, without prior administration of disease-modifying anti-rheumatic drugs, glucocorticoids) underwent 32-row scanning for CAC scoring. Agatston, volume and mass calcium scores were calculated. Additionally, we used calculators on the website of the Multi-Ethnic Study of Atherosclerosis. 74 RA patients (women n = 54 (73%), median age 56 years, median RA duration 6 months) with moderate/high RA activity (median DAS28 [ESR] 5.4) were enrolled within the framework of the observational study. Most of the patients had multiple TRFs of CVD and subclinical organ damage. CAC has been detected in 34 (46%) early RA patients. Calcification severity was significantly higher in men and in patients with ischemic heart disease (IHD). In patients younger than 45 years (n = 16) CAC was not detected. Among patients older than 45 years (n = 58), the frequency of CAC was 59%: asymptomatic patients-n = 46 (48%), IHD patients-n = 12 (100%). Among asymptomatic patients the presence of CAC associated with a significantly higher frequency of arterial hypertension (1.6 fold) compared with cases without CAC. Coronary age in asymptomatic patients with CAC and IHD patients was significantly greater than their actual age. More than half of early RA patients older 45 years had CAC. The presence and severity of CAC correlated positively with TRFs, but not with lipid levels and RA activity.

Accelerated atherosclerosis in rheumatoid arthritis: a systematic review

“… 68 In another prospective study, coronary artery calcification (CAC) was detected in 46% of RA patients. 69 Other studies also reported similar findings. 72 , 90 In a prospective study by Wahlin et al , patients with RA who had CAC were found to have increased values of DAS28 and ESR, implying that inflammation plays a role in mediating RA-induced CAC.…”

“…68 In another prospective study, coronary artery calcification (CAC) was detected in 46% of RA patients. 69 Other studies also reported similar findings. 74 This study also reported that once RA patients developed CAC, the rate of progression was found to be similar to the progression seen in control participants.…”

According to the 2019 updated European League Against Rheumatism (EULAR) recommendations for the treatment of systemic lupus erythematosus: debatable issues and comments

“…Повышение риска сердечно-сосудистых заболеваний (ССЗ) при СКВ может быть обусловлено как традиционными кардиоваскулярными факторами риска (ТФР), так и факторами, связанными с самим заболеванием (активностью болезни, ВН, присутствием aФЛ и использованием ГК) [139][140][141]. Формирование атеросклеротических бляшек в сосудах, кальцификация коронарных артерий, увеличение толщины комплекса интима-медиа (КИМ)ранние проявления поражения сердечно-сосудистой системы у больных СКВ [142,143].…”

Detection of common pathogenesis of rheumatoid arthritis and atherosclerosis via microarray data analysis

“…Recently, a meta-analysis demonstrated that RA patients exhibited increased coronary calcium scores [ 3 ]. Remarkably, RA is related with traditional CV risk factors [ 4 ], subclinical atherosclerosis [ 5 , 6 ], arrhythmias [ 7 ], and coronary calcifications [ 8 , 9 ].…”