Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis
Open Access
- 28 January 2011
- journal article
- research article
- Published by Wiley in Arthritis & Rheumatism
- Vol. 63 (5), 1211-1220
- https://doi.org/10.1002/art.30265
Abstract
Objective The role of atherosclerosis in the acute coronary syndromes (ACS) that occur in patients with rheumatoid arthritis (RA) has not been quantified in detail. We undertook this study to determine the extent to which ACS are associated with carotid atherosclerosis in RA. Methods We prospectively ascertained ACS, defined as myocardial infarction, unstable angina, cardiac arrest, or death due to ischemic heart disease, in an RA cohort. We measured carotid atherosclerosis using high‐resolution ultrasound. We used Cox proportional hazards models to estimate the association between ACS and atherosclerosis, adjusting for demographic features, cardiovascular (CV) risk factors, and RA manifestations. Results We performed carotid ultrasound on 636 patients whom we followed up for 3,402 person‐years. During this time, 84 patients experienced 121 new or recurrent ACS events, a rate of 3.5 ACS events per 100 patient‐years (95% confidence interval [95% CI] 3.0–4.3). Among the 599 patients without a history of ACS, 66 incident ACS events occurred over 3,085 person‐years, an incidence of 2.1 ACS events per 100 person‐years (95% CI 1.7–2.7). The incidence of new ACS events per 100 patient‐years was 1.1 (95% CI 0.6–1.7) among patients without plaque, 2.5 (95% CI 1.7–3.8) among patients with unilateral plaque, and 4.3 (95% CI 2.9–6.3) among patients with bilateral plaque. Covariates associated with incident ACS events independent of atherosclerosis included male sex, diabetes mellitus, and a cumulative glucocorticoid dose of ≥20 gm. Conclusion Atherosclerosis is strongly associated with ACS in RA. RA patients with carotid plaque, multiple CV risk factors (particularly diabetes mellitus or hypertension), many swollen joints, and a high cumulative dose of glucocorticoids, as well as RA patients who are men, are at high risk of ACS.Keywords
This publication has 53 references indexed in Scilit:
- Presalvage prostate‐specific antigen (PSA) and PSA doubling time as predictors of biochemical failure of salvage cryotherapy in patients with locally recurrent prostate cancer after radiotherapyCancer, 2006
- Modified disease activity scores that include twenty-eight-joint counts development and validation in a prospective longitudinal study of patients with rheumatoid arthritisArthritis & Rheumatism, 1995
- The mortality of rheumatoid arthritisArthritis & Rheumatism, 1994
- The pathogenesis of atherosclerosis: a perspective for the 1990sNature, 1993
- Cardiovascular Mortality in Patients with Rheumatoid ArthritisCardiology, 1989
- Detection of tumor necrosis factor α but not tumor necrosis factor β in rheumatoid arthritis synovial fluid and serumArthritis & Rheumatism, 1988
- The american rheumatism association 1987 revised criteria for the classification of rheumatoid arthritisArthritis & Rheumatism, 1988
- Clinical and serological features of severe vasculitis in rheumatoid arthritis: prognostic implications.Annals Of The Rheumatic Diseases, 1987
- Nonparametric Estimation from Incomplete ObservationsJournal of the American Statistical Association, 1958