Is the Calcium Score Useful for Rheumatoid Arthritis Patients at Low or Intermediate Cardiovascular Risk?

Area of Science:

• Cardiology
• Rheumatology
• Radiology

Background:

• Rheumatoid arthritis (RA) significantly increases cardiovascular disease (CVD) risk, making it the leading cause of mortality in RA patients.
• Standard CVD risk assessments may underestimate risk in RA patients, necessitating advanced diagnostic tools.
• Coronary artery calcification score (CACS) via cardiac computed tomography (CT) offers a direct measure of subclinical atherosclerosis.

Purpose of the Study:

• To evaluate the utility of CACS in cardiovascular work-up for RA patients.
• To determine the frequency of significant coronary artery calcification (CACS > 100) in RA patients.
• To assess CACS's role in cardiovascular risk reclassification in this population.

Main Methods:

• Descriptive, cross-sectional, single-center study involving 50 RA patients.
• Comprehensive cardiovascular work-up including risk factor assessment, lab tests, ECG, SATs echo-Doppler, and cardiac CT scan.
• Primary endpoint: frequency of patients with CACS > 100.

Main Results:

• 12 out of 50 patients (24%) had a CACS > 100, indicating notable atherosclerosis.
• 11 of these patients were initially classified as intermediate cardiovascular risk.
• Five patients' risk was reclassified from intermediate to high; two underwent angioplasty for silent myocardial ischemia.
• Age, sex, and smoking status were associated with elevated CACS; RA characteristics/treatments were not.

Conclusions:

• CACS is a valuable tool for detecting subclinical atherosclerosis in RA patients.
• Cardiac CT-based CACS aids in accurate cardiovascular risk stratification and reclassification in RA.
• This imaging modality can identify RA patients who may benefit from further cardiac intervention.