Session Information
Title: Rheumatoid Arthritis - Clinical Aspects II: Clinical Features & Comorbidity/Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Background/Purpose: Computed tomography angiography (CTA) reliably evaluates coronary plaque presence, severity, burden, and composition. CT characteristics of culprit lesions in acute coronary syndromes (ACS) include low attenuation plaques (LAP) consistent with necrotic core, positive remodeling (PR) and spotty calcifications. Increasing numbers of those vulnerability features yields progressively higher risk for future ACS (within 2 years) compared to their absence. We studied 150 asymptomatic, patients with Rheumatoid Arthritis (RA) and an equal number of age and sex-matched controls for plaque vulnerability features using CTA.
Methods: A standard 15-segment American Heart Association model was used for evaluation. Plaque composition was defined as non-calcified (NCP), mixed- partially calcified (MP), or fully calcified (CP). Plaques in both groups were evaluated for all 3 vulnerability features. Fasting lipid assessments, including total Cholesterol (TC), HDL-c, LDL-c, VLDL-c, particle sizes thereof, and apolipoproteins B100 and A1 were completed. Both IgG and IgM antibodies against oxidized LDL in relative light units (RLU), as well as oxidized phospholipids on apoB100 particles were measured as indicators of oxidative stress. Non-parametric ANOVA and Fisher’s tests were used as appropriate for comparisons among groups.
Results: In the RA group, 107 (71%) patients had a total of 303 plaques, compared to 68 (45%) in the controls with 135 plaques (p<0.0001). Twenty-four (16%) RA subjects had 41 plaques with ≥1 vulnerable characteristic (VP+) compared to none in the control group (p<0.0001, table); 8 (5.3%) had plaques with≥2, and 6 (4%) had all 3 characteristics. Thirty-one of 84 (37%) MP in RA had ≥1 VP characteristic, compared to 10/156 (6.4%) of NCP (p<0.0001); higher numbers of VP features were only present on MP. In general, VP were moderately sized and 66% rendered <50% luminal stenosis. Subjects with vulnerable plaque features (VP+) had higher Framingham scores, TC/HDL-c (pro-atherogenic index), small particle LDL (LDL4), and apoB/A1 ratio, compared to those with plaque lacking vulnerability characteristics (VP-), or those without plaque (table).
Conclusion: Coronary plaques of asymptomatic patients with RA frequently display vulnerability features, by contrast to controls, and increasing numbers of those segregate preferentially on moderate sized, non-occlusive MP. Their presence associates with higher Framingham scores, pro-atherogenic index, smaller sized oxidation-prone LDL, and apoB/A1 ratios.
|
Parameter |
VP (+) |
VP (-) |
Plaque (-) |
p-value |
|
RA-n patients=150 |
24 |
83 |
43 |
<0.0001 |
|
Controls-n patients=150 |
0 |
68 |
82 |
|
|
RA-n plaques=303 |
41 |
262 |
n/a |
<0.0001 |
|
Controls-n plaques=135 |
0 |
135 |
n/a |
|
|
Parameters in subjects with RA (mean± SEM) |
||||
|
Framingham Score |
6.3±1.3 |
3.6±0.5 |
2±0.5 |
<0.0001 |
|
Total Cholesterol (mg/dl) |
175.7±8.2 |
170.2±3.9 |
161.5±4.8 |
0.26 |
|
HDL-c (mg/dl) |
46.7±2.5 |
53.2±1.5 |
49.9±2.4 |
0.07 |
|
Total Chol/ HDL ratio |
3.92±0.21 |
3.36±0.11 |
3.43±0.14 |
0.026 |
|
HDL2 (md/dl) |
12.1±1.2 |
15.2±0.8 |
13.5±1.1 |
0.06 |
|
HDL3 (mg/dl) |
34.7±1.5 |
38.1±0.8 |
36.3±1.4 |
0.15 |
|
LDL-total (mg/dl) |
104±6.5 |
94.6±3.7 |
92.6±3.6 |
0.2 |
|
LDL1 (mg/dl) |
14.2±1.4 |
13.2±0.8 |
12.8±0.9 |
0.7 |
|
LDL2 (mg/dl) |
21±2.7 |
21.9±1.4 |
22.7±1.7 |
0.7 |
|
LDL3 (mg/dl) |
37.1±2.8 |
30.6±1.5 |
31.4±1.6 |
0.09 |
|
LDL4 (mg/dl) |
12.5±1.5 |
9.1±0.7 |
8.4±1.1 |
0.01 |
|
Triglycerides (mg/dl) |
163.4±20.5 |
142.5±10 |
144.7±11.9 |
0.6 |
|
VLDL1, 2 (mg/dl) |
11.3±1.3 |
9.9±0.5 |
9.5±0.5 |
0.5 |
|
VLDL3 (mg/dl) |
13.7±0.8 |
12.7±0.4 |
11.7±0.4 |
0.1 |
|
ApoB/A1 ratio |
0.64±0.03 |
0.56±0.02 |
0.59±0.02 |
0.045 |
|
OxPL/apoB100 (NanoM PC) |
11.4±1.2 |
11.7±0.5 |
11.4±0.9 |
0.7 |
|
Ox-MDA-LDL IgG (RLU) |
14,366±2,490 |
11,095±707 |
10,587±1,011 |
0.7 |
|
Ox-MDA-LDL IgM (RLU) |
28,195±2,833 |
28,082±1,169 |
27,036±1,365 |
1 |
Disclosure:
G. A. Karpouzas,
None;
J. Malpeso,
None;
T. Y. Choi,
None;
S. Munoz,
None;
M. Budoff,
None.
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