Asymptomatic coronary artery disease (CAD) has shown higher mean coronary calcium scores, high-risk plaques, multivessel disease, and prevalence among individuals with rheumatoid arthritis (RA) than those without, according to a study recently published in the European Journal of Internal Medicine.

This systematic review included 788 individuals with RA from 8 studies, as well as 1641 controls. Coronary calcium score with or without the use of coronary computed tomographic angiography was employed to identify asymptomatic CAD. To examine CAD prevalence among those with RA, individuals with coronary calcium scores above 0 were pooled with the total number of individuals with RA for comparison with comparable control data. This led to the study’s estimation of risk ratio for CAD. The chi-squared method was used to investigate heterogeneity between studies.

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Compared with controls, individuals with RA were at 1.26-times (95% CI, 1.04-1.52; P =.021) higher risk for CAD, as well as higher coronary calcium score weighted mean differences (48.25 [95% CI, 26.97-69.53]; P <.001). CAD was also more likely to be moderate to severe (coronary calcium score above 100) among those with RA compared with controls (risk ratio=1.16 [95% CI, 0.79-1.69]; P <.001). Furthermore, higher scores correlated with higher rates of multivessel CAD, RA disease activity correlated with high-risk plaques, and methotrexate treatment correlated with lack of CAD.

Limitations to this study include several small sample sizes, interstudy differences, differing clinical indications for coronary computed tomography, limited or lack of information on aspirin and statins, and a lack of certain CAD risk confounders.


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The study researchers conclude that “in patients with [rheumatoid arthritis], subclinical [coronary artery disease] is more prevalent, with higher mean [coronary calcium score], more multivessel disease, and more high-risk plaques compared to controls.”

This study received funding from the LEO Foundation and a Borregaard Clinical Scientist Fellowship from the NOVO Nordisk Foundation. Author J Abdulla has financial associations with Novartis.

Reference

Hansen PR, Feineis M, Abdulla J. 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 online February 28, 2019]. Eur J Intern Med. doi: 10.1016/j.ejim.2019.02.018