Epicardial Adipose Tissue Volume As a Marker of Subclinical Coronary Atherosclerosis in Rheumatoid Arthritis

Abstract

Objectives To assess epicardial adipose tissue volume (EATv) and its link to coronary atherosclerosis and plaque morphology in patients with rheumatoid arthritis (RA) and age‐ and gender‐matched controls. Methods Computed tomography angiography evaluated EATv and coronary plaque in 139 RA patients and 139 non‐RA controls. All models assessing the effect of EATv on plaque adjusted for age, gender, hypertension, diabetes, dyslipidemia, smoking, family history of coronary artery disease, and obesity (body mass index≥30 kg/m²). Results Mean (±standard deviation [SD]) log‐transformed EATv was similar in RA (4.69±0.36) and controls (4.70±0.42). EATv was higher in RA patients with atherosclerosis versus those without (P=0.046). In stratified analyses, EATv associated with number of segments with plaque in RA (rate ratio=1.20 [95%CI 1.01‐1.41] per 1‐SD increment in EATv) but not controls (P‐for‐interaction=0.089). Likewise, EATv (per 1‐SD increment) related to the presence of multivessel or obstructive disease (odds ratio [OR]=1.63 [95%CI 1.04‐2.61]), noncalcified plaque (OR=1.78 [95%CI 1.17‐2.70]), and vulnerable plaque (OR=1.77 [95%CI 1.03‐3.04]) in RA but not controls (all P‐for‐interaction≤0.048). Among RA patients, EATv associated with number of segments with plaque in those with RAP‐for‐interaction≤0.017). Conclusion Despite similar EATv in RA and controls, EATv associated with greater plaque burden and presence of plaques with a noncalcified component and vulnerability features only in RA. EAT may be more pathogenic in RA and play a role in early‐stage atherosclerosis. Its value as a biomarker of subclinical atherosclerosis and cardiovascular risk in RA warrants further studies.