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.


Higher Prevalence, Extent and Severity of Vulnerable Coronary Plaque in 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:

Higher incidence of myocardial infarctions (MI), sudden cardiac death, and worse survival after MI have all been reported in patients with RA. This risk exceeds traditional risk factors (RF) and insinuates accelerated atherogenesis in RA. We prospectively evaluated the presence, extent, total burden, and differences in the quality of coronary plaque in asymptomatic pts with RA compared to matched controls.

Methods:

We report on the first 74 of 150 recruited pts with RA from a single center. Demographic, serologic, metabolic, Disease Activity Score (DAS28-3v-ESR), radiographic parameters and treatments are quarterly recorded. 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. RA pts were matched for age, gender, hypertension, diabetes, smoking, dyslipidemia and family history with controls undergoing CTA for evaluation of coronary arteriosclerosis. 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 RA vs. controls, adjusted for conventional risk factors were developed.

Results:

Asymptomatic RA pts have higher prevalence and more extensive total coronary plaque (table); higher numbers have 2 or 3-vessel disease (p=0.04 for both), and total plaque burden in RA is greater than controls (p=0.01). More importantly, RA pts have higher prevalence, extent and severity of "vulnerable" plaque; 54% of diseased arterial segments in RA pts vs. 21% in controls harbor NC plaque (p=0.0001), and NC plaque burden score is superior in RA (p=0.0001). RA pts have 6-fold the risk and 87% higher burden risk of NC plaque vs. controls adjusted for age, sex and Framingham RF.

VariablesRA=74Controls=74p-value
n (%) with plaque62.251.40.18
n (%) with Normal atreries28 (37.8)36 (48.6)0.2
  1-vessel dz28 (37.8)30 (40.5)0.62
  2-vessel dz14 (18.9)6 (8.1)0.04
  3-vessel dz4 (5.4)2 (2.7)0.04
n (%) diseased segments (296)67 (22.6)48 (16.2)0.11
  Non-calcified36 (53.7)10 (20.8)0.0001
  Mixed15 (22.4)7 (14.6)0.06
  Calcified16 (23.9)31 (64.6)0.001
Total plaque burden score6.4 ± 4.84.3 ± 4.10.01
  Non-calcified3.2 ± 4.31 ± 2.90.0001
  Mixed1.7 ± 2.90.9 ± 2.30.01
  Calcified1.5 ± 3.42.4 ± 3.30.19
  Non-calcified6.061 (ref)0.0001
  Mixed2.41 (ref)0.002
  Calcified0.381 (ref)0.009
Relative Risk-total burden score*1.381 (ref)0.02
  Non-calcified1.871 (ref)0.001
  Mixed1.431 (ref)0.01
  Calcified0.731 (ref)0.05
*Relative risk regression analysis: per standard deviation increase in burden

Conclusion:

Asymptomatic RA pts have greater extent, severity and risk of coronary plaque compared to controls matched for all traditional risk factors. More importantly, they have higher prevalence, severity, burden and risk of "vulnerable", rupture-prone plaque that might account for the higher incidence of future MIs.

To cite this abstract, please use the following information:
Karpouzas, George A., Ahmadi, Naser, Choi, Tae-Young, Hajsadeghi, Fereshteh, Munoz, Silvia, Budoff, Mathew; Higher Prevalence, Extent and Severity of Vulnerable Coronary Plaque in Asymptomatic Patients with Rheumatoid Arthritis (RA). [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2164
DOI: 10.1002/art.29928

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