TY - JOUR
T1 - Coronary arterial calcification in rheumatoid arthritis
T2 - Comparison with the Multi-Ethnic Study of Atherosclerosis
AU - Giles, Jon T.
AU - Szklo, Moyses
AU - Post, Wendy
AU - Petri, Michelle
AU - Blumenthal, Roger S.
AU - Lam, Gordon
AU - Gelber, Allan C.
AU - Detrano, Robert
AU - Scott, William W.
AU - Kronmal, Richard A.
AU - Bathon, Joan M.
N1 - Funding Information:
The authors are indebted to the dedication and hard work of the ESCAPE RA Staff Marilyn Towns, Michelle Jones, Patricia Jones, Marissa Hildebrandt, and Shawn Franckowiak, and to the staff of the Johns Hopkins Bayview Medical Center General Clinical Research Center and the field center of the Baltimore MESA cohort and the MESA Coordinating Center at the University of Washington, Seattle. Dr Uzma Haque, Dr Clifton Bingham III, Dr Carol Ziminski, Dr Jill Ratain, Dr Ira Fine, Dr Joyce Kopicky-Burd, Dr David McGinnis, Dr Andrea Marx, Dr Howard Hauptman, Dr Achini Perera, Dr Peter Holt, Dr Alan Matsumoto, Dr Megan Clowse, Dr Gordon Lam and others generously recommended their patients for this study. The present work is supported by Grant Number AR 050026-01 from the National Institutes of Health, National Institute of Arthritis and Musculoskeletal and Skin Diseases, and contracts N01-HC-95159 through N01-HC-95166 and N01-HC-95169 from the National Heart, Lung, and Blood Institute.
PY - 2009/3/10
Y1 - 2009/3/10
N2 - Introduction: Although cardiovascular morbidity and mortality are increased in rheumatoid arthritis, little is known about the burden of subclinical coronary atherosclerosis in these patients. Methods: Using computed tomography, coronary artery calcification was measured in 195 men and women with rheumatoid arthritis aged 45 to 84 years without clinical cardiovascular disease and compared with 1,073 controls without rheumatoid arthritis enrolled in the Baltimore cohort of the Multi-Ethnic Study of Atherosclerosis. Results: The prevalence of coronary calcification (Agatston score > 0) was significantly higher in men, but not women, with rheumatoid arthritis after adjusting for sociodemographic and cardiovascular risk factors (prevalence ratio = 1.19; P = 0.012). Among participants with prevalent calcification, those with rheumatoid arthritis had adjusted mean Agatston scores 53 units higher than controls (P = 0.002); a difference greater for men than women (P for interaction = 0.017). In all analyses, serum IL-6 attenuated the association between rheumatoid arthritis and coronary calcification, suggesting its role as a potential mediator of enhanced atherosclerosis. Notably, increasing severity of rheumatoid arthritis was associated with a higher prevalence and extent of coronary calcification among both men and women with rheumatoid arthritis, and for all age categories. The largest percentage difference in coronary arterial calcification between rheumatoid arthritis patients and their nonrheumatoid arthritis counterparts was observed in the youngest age category. Conclusions: Increasing rheumatoid arthritis disease severity was associated with a higher prevalence and greater extent of coronary artery calcification, potentially mediated through an atherogenic effect of chronic systemic inflammation. Gender and age differences in association with coronary calcification suggest that preventive measures should be emphasized in men with rheumatoid arthritis, and considered even in younger rheumatoid arthritis patients with low levels of traditional cardiovascular risk factors.
AB - Introduction: Although cardiovascular morbidity and mortality are increased in rheumatoid arthritis, little is known about the burden of subclinical coronary atherosclerosis in these patients. Methods: Using computed tomography, coronary artery calcification was measured in 195 men and women with rheumatoid arthritis aged 45 to 84 years without clinical cardiovascular disease and compared with 1,073 controls without rheumatoid arthritis enrolled in the Baltimore cohort of the Multi-Ethnic Study of Atherosclerosis. Results: The prevalence of coronary calcification (Agatston score > 0) was significantly higher in men, but not women, with rheumatoid arthritis after adjusting for sociodemographic and cardiovascular risk factors (prevalence ratio = 1.19; P = 0.012). Among participants with prevalent calcification, those with rheumatoid arthritis had adjusted mean Agatston scores 53 units higher than controls (P = 0.002); a difference greater for men than women (P for interaction = 0.017). In all analyses, serum IL-6 attenuated the association between rheumatoid arthritis and coronary calcification, suggesting its role as a potential mediator of enhanced atherosclerosis. Notably, increasing severity of rheumatoid arthritis was associated with a higher prevalence and extent of coronary calcification among both men and women with rheumatoid arthritis, and for all age categories. The largest percentage difference in coronary arterial calcification between rheumatoid arthritis patients and their nonrheumatoid arthritis counterparts was observed in the youngest age category. Conclusions: Increasing rheumatoid arthritis disease severity was associated with a higher prevalence and greater extent of coronary artery calcification, potentially mediated through an atherogenic effect of chronic systemic inflammation. Gender and age differences in association with coronary calcification suggest that preventive measures should be emphasized in men with rheumatoid arthritis, and considered even in younger rheumatoid arthritis patients with low levels of traditional cardiovascular risk factors.
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U2 - 10.1186/ar2641
DO - 10.1186/ar2641
M3 - Article
C2 - 19284547
AN - SCOPUS:63849105627
SN - 1478-6354
VL - 11
JO - Arthritis Research and Therapy
JF - Arthritis Research and Therapy
IS - 2
M1 - R36
ER -