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.


Coronary Atherosclerosis in Patients with RA and Acute Coronary Events: No Different Than in the Rest of Us?

Holmqvist1,  Marie E., Jacobsson3,  Lennart T. H., Alfredsson1,  Lars, James4,  Stefan, Askling2,  Johan

Karolinska Institutet
Karolinska University Hospital
Malmö University Hospital
Uppsala University Hospital

The risk of ischemic heart disease (IHD) and the prevalence of atherosclerosis is increased in patients with rheumatoid arthritis (RA) compared to the general population. Based on individuals with clinical manifestations of IHD, few, and conflicting, studies that compare patients with RA and general population comparators with respect to extent of coronary artery disease (CAD) have been published.

Objective:

To investigate whether angiographic patterns differ between patients with RA, known to be at increased risk of CAD, and the general population, at the time of clinical manifestations of acute CAD (unstable angina, ST-elevation myocardial infarction [STEMI], silent infarction and central chest pain).

Methods:

RA patients diagnosed 1995–2006 with<18 months symptom duration at diagnosis included in the Swedish RA register were identified, n=6,919. For each patient, 5 sex/age/residential area/calendar time-matched general population comparators were identified, n=34,638. Participants were linked to the national Swedeheart register, which includes information on indication for angiography and number of vessels with>50% stenosis for all subjected, and also presenting symptoms, status at admission and discharge diagnosis for all admitted to coronary care units (CCU). Relative risks (RR) and 95% CI were estimated using proportional hazards models. To compare the odds of different angiography patterns, logistic regression models were fitted with RA (yes/ no) as the independent variable, and extent of atherosclerosis classified according to the number of vessels with significant stenosis as the dependent variable.

Results:

218 (3.2%) patients and 737 (2.1%) controls underwent angiography due to any ischemic heart disease (stable and unstable angina, STEMI, silent infarction or central chest pain) after study entry, RR=1.5 (95% CI 1.2, 1.7). Of those, 168 (77%) patients with RA and 534 (72%) comparators were investigated due to acute CAD. The proportion of patients with RA that underwent angiography due to STEMI was slightly higher, although no statistically significantly so, than in the population comparator (33% of the patients with RA and 26% of the comparators underwent angiography due to STEMI). There was no difference in the extent of atherosclerosis when patients with RA were compared to general population comparators.

Logistic regression modeling the risk of having significant stenosis in the below specified vessels comparing patients with RA who underwent angiography due to unstable angina, STEMI, central chest pain or silent myocardial ischemia to general population comparators who underwent angiography for the same reasons. Odds ratios (OR) and 95% confidence interval (CI) adjusted for age at angiography and sex.

 Patients with RA with outcome, n (% of all with angiography results)Comparators with outcome, n (% of all with angiography results)OR (95% CI)
Left main artery*13 (8.2)30 (5.9)1.4 (0.7, 2.8)
-LMA0 (0)1 (0.2)
-LMA+1 coronary1 (0.6)4 (0.8)0.7 (0.08, 6.8)
-LMA+2 coronary3 (1.9)6 (1.2)1.6 (0.4, 6.4)
-LMA+3 coronaries9 (5.7)19 (3.8)1.5 (0.7, 3.4)
1 coronary47 (29.8)162 (32.0)0.9 (0.6, 1.3)
2 coronaries37 (23.4)110 (21.7)1.1 (0.7, 1.7)
3 coronaries26 (16.5)90 (17.8)0.9 (0.6, 1.4)
Normal coronaries35 (22.2)115 (22.7)1.0 (0.6, 1.6)
*including all with afflicted LMAs regardless of status of other vessels. 10 patients with RA were missing on findings on angiography and 27 comparators.

Conclusion:

These results confirm the increased risk of ischemic heart disease in RA, and further suggest that the angiographic pattern is similar among patients with RA and general population controls who develop acute CAD. This indicates that the increased risk of IHD/CAD in RA is not explained by more widespread atherosclerosis in those who develop acute IHD/CAD.

To cite this abstract, please use the following information:
Holmqvist, Marie E., Jacobsson, Lennart T. H., Alfredsson, Lars, James, Stefan, Askling, Johan; Coronary Atherosclerosis in Patients with RA and Acute Coronary Events: No Different Than in the Rest of Us? [abstract]. Arthritis Rheum 2010;62 Suppl 10 :2259
DOI: 10.1002/art.30022

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