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Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis

Matthew R Evans1, Agustín Escalante, Daniel F Battafarano

  • 1Brooke Army Medical Center, Fort Sam Houston, Texas, USA.

Arthritis and Rheumatism
|February 10, 2011
PubMed

Insights

Acute coronary syndromes (ACS) are strongly linked to atherosclerosis in rheumatoid arthritis (RA) patients. Identifying carotid plaque and risk factors like diabetes can help predict ACS events in this population.

Area of Science:

  • Rheumatology
  • Cardiology
  • Vascular Medicine

Background:

  • Rheumatoid arthritis (RA) is an autoimmune disease associated with increased cardiovascular risk.
  • The specific contribution of atherosclerosis to acute coronary syndromes (ACS) in RA patients requires detailed quantification.

Purpose of the Study:

  • To determine the association between carotid atherosclerosis and the occurrence of ACS in patients with rheumatoid arthritis.
  • To quantify the extent to which atherosclerosis contributes to ACS events in an RA cohort.

Main Methods:

  • Prospective cohort study involving 636 RA patients followed for 3,402 person-years.
  • Measurement of carotid atherosclerosis via high-resolution ultrasound.
  • Cox proportional hazards models used to assess the association between ACS and atherosclerosis, adjusting for covariates.

Main Results:

  • Atherosclerosis was significantly associated with ACS in RA patients.
  • The incidence of ACS increased with the presence and extent of carotid plaque (1.1 events/100 patient-years without plaque, 4.3 events/100 patient-years with bilateral plaque).
  • Independent predictors of ACS included male sex, diabetes mellitus, and cumulative glucocorticoid dose (≥ 20 gm).

Conclusions:

  • Atherosclerosis is a significant contributor to ACS in patients with RA.
  • RA patients with carotid plaque, multiple cardiovascular risk factors (diabetes, hypertension), numerous swollen joints, high cumulative glucocorticoid dose, or male sex are at elevated risk for ACS.
Abstract

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