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Published on: February 7, 2015
Associations between coronary and carotid artery atherosclerosis in patients with inflammatory joint diseases
Mona Svanteson1,2, Silvia Rollefstad3, Nils Einar Kløw1,2
1Department of Radiology, Oslo University Hospital, Oslo, Norway.
Insights
Patients with inflammatory joint diseases (IJD) often lack cardiac symptoms despite coronary artery disease (CAD). Combining carotid ultrasonography measurements with age can improve cardiovascular risk stratification in IJD patients.
Area of Science:
- Cardiology
- Rheumatology
- Medical Imaging
Background:
- Patients with inflammatory joint diseases (IJD) have a low association between cardiac symptoms and coronary artery disease (CAD).
- Objective markers are needed for improved cardiovascular risk stratification in IJD patients.
- Carotid artery plaques are common in IJD patients.
Purpose of the Study:
- To evaluate the prevalence and characteristics of CAD in IJD patients with carotid artery plaques.
- To assess associations between carotid ultrasonographic findings and coronary plaques.
- To develop a risk prediction model for CAD in IJD patients.
Main Methods:
- Eighty-six IJD patients with carotid artery plaque underwent coronary CT angiography (CCTA).
- CAD was evaluated using the modified 17-segment AHA model, assessing calcium score, plaque composition, segment involvement score, and segment stenosis score.
- Logistic and linear regression analyses correlated findings with carotid artery plaques and cardiovascular disease risk factors.
Main Results:
- 66% of patients had CAD, with 43% having mixed or soft coronary plaques.
- 13% had obstructive CAD.
- The best risk prediction model (AUC: 0.832) combined age ≥55 years, carotid intima-media thickness ≥0.7 mm, and carotid plaque height ≥1.5 mm.
Conclusions:
- Carotid plaque presence alone is insufficient for identifying CAD risk in IJD patients.
- A combination of ultrasonographic measurements and age can aid in cardiovascular risk stratification for IJD patients.
- Further research may refine risk prediction models for this population.
Objective:
Low association between cardiac symptoms and coronary artery disease (CAD) in patients with inflammatory joint diseases (IJD) demands for objective markers to improve cardiovascular risk stratification. Our main aim was to evaluate the prevalence and characteristics of CAD in patients with IJD with carotid artery plaques. Furthermore, we aimed to assess associations of carotid ultrasonographic findings and coronary plaques.
Methods:
Eighty-six patients (61% female) with IJD (55 with rheumatoid arthritis, 21 with ankylosing spondylitis and 10 with psoriatic arthritis) and carotid artery plaque were referred to coronary CT angiography (CCTA). CAD was evaluated using the modified 17-segment American Heart Association model. Calcium score, plaque composition, segment involvement score and segment stenosis score were assessed and correlated to the carotid artery plaques and cardiovascular disease risk factors in logistic and linear regression analyses. Risk prediction models were tested with various cut-off values for associating variables.
Results:
Fifty-five patients (66%) had CAD assessed by CCTA and 36 (43%) of these had coronary plaques defined as either mixed or soft. Eleven patients (13%) had obstructive CAD. The best risk prediction model (area under the curve: 0.832, 95% CI 0.730 to 0.935) included the combination of variables with cut-off values: age ≥55 years (OR: 12.18, 95% CI 2.80 to 53.05), the carotid-intima media thickness ≥0.7 mm (OR: 4.08, 95% CI 1.20 to 13.89) and carotid plaque height ≥1.5 mm (OR: 8.96, 95% CI 1.68 to 47.91), p<0.05.
Conclusion:
Presence of carotid plaque is alone not sufficient to identify patients at risk for CAD, and a combination of ultrasonographic measurements may be useful in risk stratification of patients with IJD.
Trial Registration Number:
NCT01389388, Results.
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