Aortic and coronary calcifications in Takayasu arteritis

Background/Purpose:

We had previously shown, similar to patients with systemic lupus erythematosus (SLE), patients with Takayasu arteritis (TAK) had significantly more atherosclerotic plaques in the carotid arteries compared to the healthy controls (1). Moreover, we had observed that atherosclerotic plaques were more common in areas where arteritis was more prominent, implying that atherosclerosis  in TAK might be mainly due to local inflammation.

In this study, we aimed to investigate the presence of coronary artery (CAC) and thoracic aorta calcifications (ToAC) using multi-detector computed tomography (MDCT) in a larger cohort of TAK patients and controls. We again investigated the frequency of atherosclerotic plaques in the carotid arteries. These investigations enabled us to compare atherosclerotic lesions in different vessel beds in patients with TAK and controls and thus to test the hypothesis that atherosclerosis observed in TAK is primarly due to local factors.  

Methods:

We studied 47 female with TAK (mean age: 37.4 ± 8.0 SD years), 43 patients with SLE (mean age: 39.3 ± 8.1 years) and 70 healthy controls (mean age: 40.2 ± 5.2 years). Calcification in the coronary arteries and thoracic aorta was measured using  MDCT. Carotid artery plaques (CAP) were assessed using B-Mode ultrasonography.

Results:

Table 1 demonstrates the odds ratios for the surrogate markers of atherosclerosis among the study groups with healthy controls being the reference group. The OR for having atherosclerotic plaques was considerably higher (9 vs 4)  among the SLE patients as compared to the TAK patients while the frequency of CAC was significantly increased only among patients with SLE compared to the healthy controls. However, ToAC and CAP were significantly more common among both TAK  and SLE patients compared to the healthy controls. Calcification in the thoracic aorta was present in 45 % of TAK patients and its morphology was different than that observed in SLE. It was mostly circumferential in TAK, whereas punctuate or linear in SLE. As reported previously, similar to SLE patients, TAK patients were found to have increased risk for CAP. Moreover, among TAK patients CAC, ToAC and CAP were more likely to be seen in places where primary vasculitic lesions were frequent (coronary artery involvement: 67% vs 7 %, CAC (+) vs CAC (-), respectively, p =0.027; thoracic aorta involvement: 52 % vs 19 %, ToAC (+) vs ToAC (-),respectively, P= 0.029, and carotid artery involvement: 92 % vs 69 %, CAP (+) vs CAP (-), respectively, P=0.146).

Conclusion:

Unlike what is observed in SLE, atherosclerosis in TAK seems to be influenced by local rather than systemic factors.

Reference:

1)      Seyahi E, et al. Atherosclerosis in Takayasu arteritis. Ann Rheum Dis 2006; 65: 1202-7.

Table 1. Prevalence and the odds ratios of CAC, ToAC and CAP