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Rheumatoid Arthritis as a Risk Factor for Coronary Artery Calcification and Obstructive Coronary Artery Disease in Patients with Chest Pain: A Registry Based Cross-Sectional Study

Authors Tinggaard AB, de Thurah A, Andersen IT, Riis AH, Therkildsen J, Winther S, Hauge EM, Bøttcher M

Received 24 February 2020

Accepted for publication 11 May 2020

Published 24 June 2020 Volume 2020:12 Pages 679—689


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Professor Vera Ehrenstein

Andreas Bugge Tinggaard,1 Annette de Thurah,2 Ina Trolle Andersen,3 Anders Hammerich Riis,3 Josephine Therkildsen,1 Simon Winther,4 Ellen-Margrethe Hauge,2 Morten Bøttcher1

1Department of Cardiology, Hospital Unit West, Herning, Denmark; 2Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark; 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark; 4Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark

Correspondence: Andreas Bugge Tinggaard Tel +0045 30272717

Purpose: To examine the occurrence and severity of coronary artery disease (CAD) in patients with rheumatoid arthritis (RA) compared to non-RA patients in a population referred for coronary computed tomography angiography (CTA) due to chest pain.
Patients and Methods: In this cross-sectional study, 46,210 patients from a national CTA database were included. Patients with RA were stratified on serology, treatment with conventional synthetic or biological disease-modifying antirheumatic drugs (DMARDs), and the need for relapse or flare treatment with intraarticular or -muscular glucocorticoid injections (GCIs). Primary outcomes were coronary artery calcium score (CACS) > 0 and CACS ≥ 400, and secondary outcome was obstructive CAD. Associations between RA and outcomes were examined using logistic regression and results were adjusted for age, sex, cardiovascular risk factors and comorbidities.
Results: A total of 395 (0.9%) RA patients were identified. In overall RA, crude odds ratio (OR) for having CACS > 0 was 1.48 (1.21– 1.82) and 1.52 (1.15– 2.01) for CACS ≥ 400, whereas adjusted ORs were 1.08 (0.86– 1.36) and 1.21 (0.89– 1.65), respectively. Seropositive RA patients had adjusted OR of 1.16 (0.89– 1.50) for CACS > 0 and 1.37 (0.98– 1.90) for CACS ≥ 400. Patients who had received ≥ 1 GCI in the period of 3 years prior to the CTA had an adjusted OR of 1.37 (0.94– 2.00) for having CACS > 0 and 1.46 (0.92– 2.31) for CACS ≥ 400.
Conclusion: This is the first large-scale, CTA-based study examining the occurrence and severity of CAD in RA patients with symptoms suggestive of cardiovascular disease. A higher prevalence of coronary artery calcification was found in RA patients. After adjusting for age, sex, cardiovascular risk factors and comorbidities, the tendency was less pronounced. We found a trend for increased coronary calcification in RA patients being seropositive or needing treatment with GCI for a relapse or flare.

Keywords: rheumatoid arthritis, computed tomography angiography, coronary artery disease, coronary artery calcium score, cross-sectional

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