Background/Purpose: Inflammation seems to play a central role in the development of atherosclerosis and inflammatory diseases seem to promote progression of coronary artery disease (CAD). Rheumatoid arthritis (RA) is associated with increased mortality, and evidence exists of a strong association between RA and premature cardiac events. However, knowledge of the severity and pattern of coronary artery calcifications in RA patients is still sparse. The aim of this study was to examine the prevalence and severity of CAD in RA patients from a large-scale cohort with chest pain referred for CAD rule out.

Methods: This was a cross sectional study in 39,534 patients from the Western Denmark Heart Registry. For each individual, data included cardiac CTs (CCT) with a registration of up to 40 variables including level of stenosis and calcification. RA patients were identified through linkage with the Danish National Patient Registry. All analyses were performed for overall RA and the serological subtypes: ‘sero-positive RA’ and ‘other RA’. In the studied region, RA-flares are controlled through escalation of disease modifying drugs and intra-articular or intramuscular glucocorticoid injections (GCI). The number of times a patient had received GCIs 3 years prior to the CCT was used as a surrogate marker for disease activity. The prevalence of having a coronary artery calcium score (CACS) > 0 among RA and non-RA patients was assessed by estimating odds ratios (OR) with [95% CI], adjusted for gender, age, Charlsons co-morbidity index, hypertension, lipid-lowing treatment, body mass index and smoking status.

Results: A total of 337 (0.9%) patients with RA were identified; 268 (79.5%) being sero-positive. Women accounted for 73.9% of the RA patients compared to 54.4% of the non-RA patients. Non-obstructive CAD was present in 35.6% of the RA patients vs. 31.7% of the non-RA patients, and 15.4% of the RA patients had a CACS > 400 vs. 10.1% in non-RA patients. OR for having a CACS > 0 was 1.17 [0.91-1.50] 95% CI for overall RA, 1.33 [1.00-1.77] for sero-positive RA and 0.72 [0.42-1.24] for other-RA. Patients who had received >1 GCI 3 years prior to the CCT had an OR at 1.49 [0.99-2.27] for having CACS > 0.

Conclusion: Based on data from a large CCT database, coronary artery calcifications are more frequent in RA patients with seropositive disease and high disease activity RA. In particular, the occurrence of severe calcifications is more frequent. These findings support the hypothesis that inflammatory disease may accelerate the atherosclerotic process leading to increased coronary artery calcification and risk of cardiac events.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-prevalence-of-coronary-artery-disease-in-patients-with-chest-pain-and-seropositive-rheumatoid-arthritis-an-analysis-from-a-clinical-computed-tomography-based-large-scale-population-cohort/