RESEARCH - Coronary arterial calcification in RA: comparison to the multi-ethnic study of atherosclerosis

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Arthritis Research & Therapy 2009, 11:R36doi:10.1186/ar2641

Published: 10 March 2009

Coronary arterial calcification in rheumatoid arthritis: comparison to

the multi-ethnic study of atherosclerosis

Jon T Giles , Moyses Szklo , Post , Petri , S

Blumenthal , Gordon Lam , Allan C Gelber , Detrano , W

Jr , A Kronmal and Joan M Bathon

Abstract (provisional)

Introduction

Although cardiovascular morbidity and mortality are increased in

rheumatoid arthritis (RA), little is known about the burden of

subclinical coronary atherosclerosis in these patients.

Methods

Using computed tomography, coronary artery calcification was measured

in 195 men and women with rheumatoid arthritis aged 45 to 84 years

without clinical cardiovascular disease and compared to 1,073 controls

without rheumatoid arthritis enrolled in the Baltimore cohort of the

Multi-Ethnic Study of Atherosclerosis.

Results

The prevalence of coronary calcification (Agatston score > 0) was

significantly higher in men, but not women, with rheumatoid arthritis

after adjusting for sociodemographic and cardiovascular risk factors

(prevalence ratio 1.19; P=0.012). Among participants with prevalent

calcification, those with rheumatoid arthritis had adjusted mean

Agatston scores of 53 units higher than controls (P=0.002); a

difference greater for men than women (P for interaction=0.017). In

all analyses, serum interleukin-6 attenuated the association between

rheumatoid arthritis and coronary calcification, suggesting its role

as a potential mediator of enhanced atherosclerosis. Notably,

increasing severity of rheumatoid arthritis was associated with a

higher prevalence and extent of coronary calcification among both men

and women with rheumatoid arthritis, and for all age categories. The

largest percentage difference in coronary arterial calcification

between rheumatoid arthritis patients and their non-rheumatoid

arthritis counterparts was observed in the youngest age category.

Conclusions

Increasing rheumatoid arthritis disease severity was associated with a

higher prevalence and greater extent of coronary artery calcification,

potentially mediated through an atherogenic effect of chronic systemic

inflammation. Gender and age differences in associations with coronary

calcification suggest that preventive measures should be emphasized in

men with rheumatoid arthritis, and considered even in younger

rheumatoid arthritis patients with low levels of traditional

cardiovascular risk factors.

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http://arthritis-research.com/content/pdf/ar2641.pdf

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