Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Lower Prevalence and Severity of Vulnerable Coronary Plaque in a-TNF-Exposed Asymptomatic Patients with Rheumatoid Arthritis (RA).

Karpouzas1,  George A., Ahmadi2,  Naser, Choi2,  Tae-Young, Hajsadeghi2,  Fereshteh, Munoz2,  Silvia, Budoff2,  Mathew

Harbor-UCLA, Long Beach, CA
Harbor-UCLA

Background:

Tumor necrosis factor-a inhibitors (TNFi) have been recently reported to decrease the risk of myocardial infarction (MI) in patients (pts) with RA. The exact mechanisms, however, as well as the effects on coronary plaque quantity and composition are largely unknown. We prospectively evaluated the presence, total burden, and differences in the quality of coronary plaque in asymptomatic RA pts treated with TNFi vs. DMARDs alone.

Methods:

We report on the first 74 of 150 recruited pts from a single center. Pt characteristics, including traditional risk factors and treatments are shown in table 1. Pts underwent 64+ slice cardiac Computed Tomography Angiography (CTA); this non-invasive modality includes an initial non-contrast phase assessing coronary calcium, followed by a contrast scan that detects plaque with equal accuracy to conventional angiography, and is superior in the assessment of non-calcified, lipid-rich, non-obstructive or "vulnerable" plaque. Individual coronary trees were evaluated for plaque volume and composition by standard methods (American Heart Association). Non-parametric tests were used for data analysis; regression models for plaque prevalence ratios (PR) and relative risk for plaque burden in TNFi vs. DMARD treated pts, adjusted for conventional risk factors were constructed.

Results:

TNFi treated individuals had significantly longer disease duration (table 1). Despite that, they had significantly lower extent and severity of total plaque compared to DMARD treated pts; they exhibited lower numbers of affected coronary segments (p=0.009) and less total plaque burden score (p=0.03). More importantly, they displayed lower prevalence and severity of "vulnerable" plaque; TNFi exposed pts had significantly fewer segments harboring NC/ mixed plaque (p=0.01) and significantly lower NC/ mixed plaque burden score (p=0.04). TNFi treated pts had 76% less risk for the presence of "vulnerable" plaque (p=0.006) and 16% lower burden of NC/ mixed plaque risk vs. DMARD treated pts, adjusted for age, sex and Framingham RF (p=0.03).

nDMARDs=27TNFi=47p-value
Age (yrs)53 ± 1253 ± 100.9
Gender (% female)85910.5
Disease duration (yrs)7 ± 5.612 ± 7.60.0004
Diabetes (%)1190.6
Hypertension (%)48430.7
Smoking (%)19250.5
Family history of CAD (%)440.9
Statin therapy (%)41350.6
DAS28-3v-ESR2.8 ± 0.83.3 ± 1.10.1
ESR (mm/hr)25.3 ± 18.526 ± 16.30.8
CRP (mg/dl)0.7 ± 1.11 ± 1.70.4
Time on TNFi (months)NA51.8 ± 25.9
n (%) with plaque17 (63)28 (60)0.7
n (%) total evaluated segments108 (100)188 (100)
n (%) diseased segments34 (31.5)33 (17.6)0.009
Non-calcified/mixed calcified27 (25)24 (12.8)0.01
7 (6.5)9 (4.8)0.6 
Total plaque burden score3.9 ± 3.22.3 ± 3.30.03
Non-calcified/mixed calcified3.6 ± 3.22.1 ± 2.80.04
 2.2 ± 3.13 ± 2.60.2
Prevalence Ratio for any plaque1 (ref)0.83 (CI:0.4–2.6)0.67
non-calcified/mixed calcified1 (ref)0.24 (CI:0.09–0.6)0.006
 1 (ref)1.28 (CI:0.7–2.04)0.49
Relative Risk-total burden score*1 (ref)0.85 (CI:0.74–0.99)0.03
Non-calcified/mixed calcified1 (ref)0.84 (CI:0.09–0.6)0.03
 1 (ref)1.37 (CI:0.8–1.6)0.38
*relative risk regression analysis: per standard deviation increase in burden score

Conclusion:

TNFi-exposed asymptomatic RA pts have significantly lower prevalence and severity of total, but more importantly, "vulnerable" coronary plaque compared to DMARD treated pts, despite significantly longer disease duration. These findings insinuate additional favorable effects of TNFi on plaque homeostasis and stabilization and may reflect less future cardivascular morbidity.

To cite this abstract, please use the following information:
Karpouzas, George A., Ahmadi, Naser, Choi, Tae-Young, Hajsadeghi, Fereshteh, Munoz, Silvia, Budoff, Mathew; Lower Prevalence and Severity of Vulnerable Coronary Plaque in a-TNF-Exposed Asymptomatic Patients with Rheumatoid Arthritis (RA). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1046
DOI: 10.1002/art.28813

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