Dynamic of changes in coronary artery calcification in early rheumatoid arthritis patients over 18 months
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The coronary artery calcification (CAC) progression may be useful noninvasive predictor of future cardiovascular events (CVE). The progression rate of CAC in patients with early rheumatoid arthritis (RA) is poorly understood. To assess the dynamic of CAC scores in early RA patients for 18 months, 74 RA adult patients (ACR/EULAR criteria, 2010, duration ≤ 12 months, with moderate/high RA activity, without prior administration of disease-modifying anti-rheumatic drugs or glucocorticoids) were enrolled within the framework of the observational study: women 73%, median age 56 years, median RA duration 6 months, median DAS28[ESR] 5.4. Most of the patients had multiple Traditional Risk Factors (TRFs) of Cardiovascular Disease (CVD). All patients at baseline and after 18 months underwent 32-row scanning for CAC scoring. In patients younger than 45 years (n = 16) any CAC was not detected during 18 months. Among patients older than 45 years four new events of CAC were detected. Among patients older than 45 years with baseline CAC (n = 34) increase in CAC scores was detected in 82% cases. Among them, Δ Agatston Score exceeded the median annual Agatston Score progression predicted for the general population according to the Multi-Ethnic Study of Atherosclerosis (MESA) data in 57% of early RA patients. The significant increase of Agatston Score in accordance with Sevrukov’s method was met in one patient with newly diagnosed CAC and among patients with baseline CAC—in 29%. The presence of CAC progression was associated with lower baseline total cholesterol (TC) level (p < 0.05). The extent of CAC progression associated with male gender and arterial hypertension (AH) (p < 0.05). Association between CAC dynamic and statin therapy, RA activity and cumulative inflammatory burden, response to anti-rheumatic therapy and the type of this therapy were not detected. Early RA patients older than 45 years have high incidence of CAC progression during 18 months. More than half of the early RA patients had the increase in AS which exceeded the median annual progression of Agatston Score in the MESA. The CAC progression was associated with male gender, AH and lower baseline TC level. We did not detect any association between CAC progression and statin therapy, RA activity and type of anti-rheumatic therapy.
KeywordsEarly rheumatoid arthritis Coronary artery calcification Cardiac MDCT Inflammation Anti-rheumatic therapy Treat-to-target
We would like to thank Elena L. Luchikhina, Galina V. Lukina, Dmitry E. Karateev, and Eugeniy L. Nasonov for contributing to data collection and sharing additional data on the study.
EVU and DSN contributed to the conception and design of the study, data collection and analysis, manuscript writing and final approval of the manuscript. TVP made substantial contributions to the conception and design, revision of draft manuscript, and approval of final version to be published. All authors read and approved the final version of the manuscript. IGK and EIM contributed to data collection and analysis, critical revision and final approval of the manuscript.
Compliance with ethical standards
Conflict of interest
There are not any potential conflicts of interest relevant to this article.
The research involved human participants.
All procedures performed in the study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study protocol had been approved by the local ethics committee in V.A. Nasonova Research Institute of Rheumatology (protocol #3, 24th of January 2012).
Informed consent was obtained from all individual participants included in the study.
There was not any targeted funding relevant to this article.
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