Advertisement

Rheumatoid arthritis patients have higher prevalence and burden of asymptomatic coronary artery disease assessed by coronary computed tomography: A systematic literature review and meta-analysis

Published:March 01, 2019DOI:https://doi.org/10.1016/j.ejim.2019.02.018

      Highlights

      • Meta-analysis of coronary CT studies linked rheumatoid arthritis with CAD.
      • Rheumatoid arthritis duration, disease activity and treatment affected CAD.
      • Asymptomatic CAD is increased in rheumatoid arthritis.

      Abstract

      Background

      Rheumatoid arthritis (RA) is associated with increased risk of coronary artery disease (CAD) and studies with coronary computed tomography have suggested increased rates of asymptomatic CAD determined by the coronary calcium score (CCS) in these patients. To synthesize the evidence on this topic, we conducted a systematic review and meta-analysis of the literature.

      Methods

      A systematic review was performed of data comparing the prevalence and burden of asymptomatic CAD in RA and controls using CCS with or without coronary computed tomographic angiography (CCTA). For the meta-analysis, pooled data provided the estimated risk ratio (RR) of CAD and weighted mean differences of CCS in patients with RA compared to controls.

      Results

      The search revealed 1841 results of which 1083 were screened and 26 full text papers were evaluated. Eight studies were included with data on 788 patients with RA and 1641 controls. Patients with RA had significantly increased risk of CAD (RR = 1.26 [95% CI 1.04–1.52]; p = .021) and increased weighted mean differences for CCS (48.25 [95% CI 26.97–69.53]; p < .001) compared to controls. Limited evidence suggested that patients with RA had a higher prevalence of moderate-severe (CCS > 100) CAD and more multivessel CAD, and RA duration and disease activity were associated with higher CCS, RA disease activity was linked with presence of high risk (non-calcified or mixed) coronary plaques, and treatment with methotrexate was tied to absence of CAD, respectively.

      Conclusions

      In patients with RA, asymptomatic CAD is more prevalent, with higher mean CCS, more multivessel disease, and more high-risk plaques compared to controls.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to European Journal of Internal Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Nurmohamed M.T.
        • Heslinga M.
        • Kitas G.D.
        Cardiovascular comorbidity in rheumatic diseases.
        Nat Rev Rheum. 2015; 11: 693-704
        • Lindhardsen J.
        • Ahlehoff O.
        • Gislason G.H.
        • Madsen O.R.
        • Olesen J.B.
        • Torp-Pedersen C.
        • et al.
        The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus – A Danish nationwide cohort study.
        Ann Rheum Dis. 2011; 70: 929-934
        • Wang P.
        • Guan S.Y.
        • Xu S.Z.
        • Li H.M.
        • Leng R.X.
        • Li X.P.
        • et al.
        Increased carotid intima-media thickness in rheumatoid arthritis: an update meta-analysis.
        Clin Rheumatol. 2016; 35: 315-323
        • Di Minno M.N.
        • Ambrosino P.
        • Lupoli R.
        • De Minno A.
        • Tasso M.
        • Peluso R.
        • et al.
        Clinical assessment of endothelial function in patients with rheumatoid arthritis; a meta-analysis of literature studies.
        Eur J Clin Med. 2015; 26: 835-842
        • Crowson C.S.
        • Matteson E.L.
        • Roger V.L.
        • Therneau T.M.
        • Gabriel S.E.
        Usefulness of risk scores to estimate the risk of cardiovascular disease in patients with rheumatoid arthritis.
        Am J Cardiol. 2012; 110: 420-424
        • Crowson C.S.
        • Rollefstad S.
        • Kitas G.D.
        • van Riel P.L.
        • Gabriel S.E.
        • Semb A.G.
        • et al.
        Challenges of developing a cardiovascular risk calculator for patients with rheumatoid arthritis.
        PLoS One. 2017 Mar 23; 12e0174656
        • Crowson C.S.
        • Gabriel S.E.
        • Semb A.G.
        • van Riel P.L.
        • Karpouzas G.
        • Dessein P.H.
        • et al.
        Rheumatoid arthritis-specific cardiovascualr risk scores are not superior to general risk scores: a validation analysis of patients from seven countries.
        Rheumatol. 2017; 57: 1102-1110
        • Yiu K.H.
        • Mok M.Y.
        • Wang S.
        • Ooi G.C.
        • Khnog P.L.
        • Lau C.S.
        • et al.
        Prognostic role of coronary calcification in patients with rheumatoid arthritis and systemic lupus erythromatosus.
        Clin Exp Rheumatol. 2012; 30: 345-350
        • Detrano R.
        • Guerci A.D.
        • Carr J.J.
        • Bild D.E.
        • Burke G.
        • Folsom A.R.
        • et al.
        Coronary calcium as a predictor of coronary events in four racial groups or ethnic groups.
        N Engl J Med. 2008; 358: 1336-1345
        • Moher D.
        • Shamseer L.
        • Clarke M.
        • Ghersi D.
        • Liberati A.
        • Petticrew M.
        • et al.
        Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement.
        Syst Rev. 2015 Jan 1; 4: 1
        • Moons K.G.M.
        • de Groot J.A.H.
        • Bouwmeester W.
        • Vergouwe Y.
        • Mallett S.
        • et al.
        Critical appraisal and data extration for systematic reviews of prediction modelling studies: the CHARMS checklist.
        PLoS Med. 2014; 11e1001744
        • Chung C.P.
        • Oeser A.
        • Raggi P.
        • Gebretsadik T.
        • Shintani A.K.
        • Sokka T.
        • et al.
        Increased coronary-artery atherosclerosis in rheumatoid arthritis – relationship to disease duration and cardiovascular risk factors.
        Arthritis Rheum. 2005; 52: 3045-3053
        • Kao A.H.
        • Wasko M.C.
        • Krishnaswami S.
        • Wagner J.
        • Edmundowicz D.
        • Shaw P.
        • et al.
        C-reactive protein and coronary artery calcium in asymptomatic women with systemic lupus erythematosus or rheumatoid arthritis.
        Am J Cardiol. 2008; 102: 755-760
        • Giles J.T.
        • Szklo M.
        • Post W.
        • Petri M.
        • Blumenthal R.S.
        • Lam G.
        • et al.
        Coronary arterial calcification in rheumatoid arthritis: comparison with the multi-ethnic study of atherosclerosis.
        Arthritis Res Ther. 2009; 11: R36
        • Wang S.
        • Yiu K.H.
        • Mok M.Y.
        • Ooi G.C.
        • Khong P.L.
        • Mak K.F.
        • et al.
        Prevalence and extent of calcification over aorta, coronary and carotid arteries in patients with rheumatoid arthritis.
        J Intern Med. 2009; 266: 445-452
        • Ma N.H.
        • Teh C.L.
        • Rapaee A.
        • Lau K.B.
        • Fong A.Y.
        • Hi S.
        • et al.
        Subclinical coronary artery disease in Asian rheumatoid arthritis patients who were in remission: a pilot study.
        Int J Rheum Dis. 2010; 13: 223-229
        • Abdel-Khalek M.A.
        • El-Barbary A.M.
        • Essa S.A.
        • Ghobashi A.S.
        Serum hepcidin: a direct link between anemia of inflammation and coronary artery atherosclerosis in patients with rheumatoid arthritis.
        J Rheumatol. 2011; 38: 2153-2159
        • Karpouzas G.A.
        • Malpeso J.
        • Choi T.Y.
        • Li D.
        • Munoz S.
        • Budoff M.J.
        Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease.
        Ann Rheum Dis. 2014; 73: 1797-1804
        • Paccou J.
        • Renard C.
        • Liabeuf S.
        • Kamel S.
        • Fardellone P.
        • Massy Z.A.
        • et al.
        Coronary and abdominal aorta calcification in rheumatoid arthritis: relationships with traditional cardiovascular risk factors, disease characteristics, and concomitant treatments.
        J Rheumatol. 2014; 41: 2137-2144
        • Arnett F.C.
        • Edworthy S.
        • Bloch D.
        • McShane D.
        • Fries J.
        • Cooper N.
        • et al.
        The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis.
        Arthritis Rheum. 1988; 31: 315-324
        • Agatston A.S.
        • Janowitz W.R.
        • Hildner F.J.
        • Zusmer N.R.
        • Viamonte M.
        • Detrano R.
        Quantification of coronary artery calcium using ultrafast computed-tomography.
        J Am Coll Cardiol. 1990; 15: 827-832
        • Abbara S.
        • Blanke P.
        • Maroules C.D.
        • Cheezum M.
        • Choi A.D.
        • Han B.K.
        • et al.
        SCCT guidelines for the performance and acquisition of coronary computed tomographic angiography: a report of the society of cardiovascular computed tomography guidelines committee: endorsed by the North American Society for Cardiovascular Imaging (NASCI).
        J Cardiovasc Comput Tomogr. 2016; 10: 435-449
        • Aubry M.C.
        • Maradit-Kremers H.
        • Reinalda M.S.
        • Crowson C.S.
        • Edqards W.D.
        • Gabriel S.E.
        Differences in atherosclerotic coronary heart disease between subjects with and without rheumatoid arthritis.
        J Rheumatol. 2007; 34: 937-942
        • Mantel Ä.
        • Holmqvist M.
        • Jernberg T.
        • Wållberg-Jonsson S.
        • Askling J.
        Rheumatoid arthritis is associated with a more severe presentation of acute coronary syndrome and worse short-term prognosis.
        Eur Heart J. 2015; 36: 3413-3422
        • Micha R.
        • Imumura F.
        • Von Ballmoos W.
        • Solomon D.H.
        • Hernán M.A.
        • Ridker P.
        • et al.
        Systematic review and meta-analysis of methotrexate use and risk of cardiovascular disease.
        Am J Cardiol. 2011; 108: 1362-1370
        • Westlake S.L.
        • Colebatch A.N.
        • Blaird J.
        • Curzen N.
        • Kiely P.
        • Quinn M.
        • et al.
        Tumour necrosis factor antagonists and the risk of cardiovascular disease in patients with rheumatoid arthritis: a systematic literature review.
        Rheumatology. 2011; 50: 518-531
        • van den Oever I.A.M.
        • Van Sijl A.M.
        • Baylan U.
        • ter Wee M.M.
        • Schalkwijk C.G.
        • Krijen P.A.J.
        • et al.
        Comparing inflammatory cell density in the myocardium and coronary arteries in rheumatoid arthritis patients versus controls with myocardial infarction: a post-mortem case-control study.
        Int J Cardiol. 2016; 209: 74-76
        • Semb A.G.
        • Rollefstad S.
        • Provan S.A.
        • Kvien T.K.
        • Stranden E.
        • Olsen I.C.
        • et al.
        Carotid plaque characteristics and disease activity in rheumatoid arthritis.
        J Rheumatol. 2013; 40: 359-368
        • Agca R.
        • Heslinga S.C.
        • Rollefstad S.
        • Heslinga M.
        • McInnes I.B.
        • Peters M.J.L.
        • Södergren A.
        • et al.
        EULAR recommendations for cardiovascular disease risk mangement in patients with rheumatoid arthritis and other forms of inflammatory joint disorders: 2015/2016 update.
        Ann Rheum Dis. 2017; 76: 17-28
        • Evans M.R.
        • Escalente A.
        • Battafarano D.F.
        • Freeman G.L.
        • O'Leary D.H.
        • del Rincón I.
        Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis.
        Arthritis Rheum. 2011; 63: 1211-1220
        • Svanteson M.
        • Rollefstad S.
        • Kløw N.E.
        • Hisdal J.
        • Ikdahl E.
        • Semb A.G.
        • et al.
        Associations between coronary and carotid artery atherosclerosis in patients with inflammatory joint diseases.
        RMD Open. 2017; 3e000544https://doi.org/10.1136/rmdopen-2017-000544
        • Rueda-Gotor J.
        • Llorca J.
        • Corrales A.
        • Parra J.A.
        • Portilla V.
        • Genre F.
        • et al.
        Cardiovascular risk stratification in axial spondylarthritis: carotid ultrasound is more sensitive than coronary artery calcification score to detect high-cardiovascular risk axial spodyloarthritis patients.
        Clin Exp Rheumatol. 2018; 36: 73-80
        • Holmqvist M.
        • Ljung L.
        • Askling J.
        Acute coronary syndrome in new-onset rheumatoid arthritis: a population-based nationwide cohort study of time trends in risks and excess risks.
        Ann Rheum Dis. 2017; 76: 1642-1647
        • Hjuler K.F.
        • Bøttcher M.
        • Vestergaard C.
        • Bøtker H.E.
        • Iversen L.
        • et al.
        Association between changes in coronary artery disease progression and treatment with biological agents for severe psoriasis.
        JAMA Dermatol. 2016; 152: 1114-1121
        • Andelius L.
        • Mortensen M.B.
        • Nørgaard B.L.
        • Abdulla J.
        Impact of statin therapy on coronary plaque burden and composition assessed by computed tomographic angiography: a systematic review and meta-analysis.
        Eur Heart J Cardiovasc Imag. 2018; 19: 850-859
        • Murphy L.B.
        • Sacks J.J.
        • Brady T.J.
        • Hootman J.M.
        • Chapman D.P.
        Anxiety and depression among US adults with arthritis: prevalence and correlates.
        Arthritis Care Res. 2012; 64: 968-976
        • Shih M.
        • Hootman J.M.
        • Kruger J.
        • Helmick C.G.
        Physical activity in men and women with arthritis National Health Interview Survey, 2002.
        Am J Prev Med. 2006; 30: 385-393
        • Jacobs P.
        • Bisonette R.
        • Guenther L.C.
        Socioeconomic burden of immune-mediated inflammatory diseases-focusing on work productivity and disability.
        J Rheumatol Suppl. 2011; 88: 55-61