Research article

Coronary arterial calcification in rheumatoid arthritis: comparison with the Multi-Ethnic Study of Atherosclerosis

Jon T Giles^1,6 , Moyses Szklo² , Wendy Post^1,2 , Michelle Petri^1,6 , Roger S Blumenthal¹ , Gordon Lam^1,6 , Allan C Gelber^1,2,6 , Robert Detrano³ , William W Scott Jr⁴ , Richard A Kronmal⁵ and Joan M Bathon^1,6

¹  Department of Medicine, The Johns Hopkins University, The Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287, USA

²  Department of Epidemiology, The Johns Hopkins University, The Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287, USA

³  Department of Radiological Sciences, University of California at Irvine, Medical Sciences Building, Irvine, CA 92697, USA

⁴  Department of Radiology, The Johns Hopkins University, The Johns Hopkins Hospital, 600 N Wolfe Street, Baltimore, MD 21287, USA

⁵  Department of Biostatistics, University of Washington, F-600, Health Sciences Building, 1705 NE Pacific Street, Seattle, WA 98195, USA

⁶  Division of Rheumatology, The Johns Hopkins University, 5200 Eastern Avenue, Suite 4100, Baltimore, MD 21224, USA

author email corresponding author email

Arthritis Research & Therapy 2009, 11:R36doi:10.1186/ar2641

Published:	10 March 2009

Abstract

Introduction

Although cardiovascular morbidity and mortality are increased in rheumatoid arthritis, little is known about the burden of subclinical coronary atherosclerosis in these patients.

Methods

Using computed tomography, coronary artery calcification was measured in 195 men and women with rheumatoid arthritis aged 45 to 84 years without clinical cardiovascular disease and compared with 1,073 controls without rheumatoid arthritis enrolled in the Baltimore cohort of the Multi-Ethnic Study of Atherosclerosis.

Results

The prevalence of coronary calcification (Agatston score > 0) was significantly higher in men, but not women, with rheumatoid arthritis after adjusting for sociodemographic and cardiovascular risk factors (prevalence ratio = 1.19; P = 0.012). Among participants with prevalent calcification, those with rheumatoid arthritis had adjusted mean Agatston scores 53 units higher than controls (P = 0.002); a difference greater for men than women (P for interaction = 0.017). In all analyses, serum IL-6 attenuated the association between rheumatoid arthritis and coronary calcification, suggesting its role as a potential mediator of enhanced atherosclerosis. Notably, increasing severity of rheumatoid arthritis was associated with a higher prevalence and extent of coronary calcification among both men and women with rheumatoid arthritis, and for all age categories. The largest percentage difference in coronary arterial calcification between rheumatoid arthritis patients and their nonrheumatoid arthritis counterparts was observed in the youngest age category.

Conclusions

Increasing rheumatoid arthritis disease severity was associated with a higher prevalence and greater extent of coronary artery calcification, potentially mediated through an atherogenic effect of chronic systemic inflammation. Gender and age differences in association with coronary calcification suggest that preventive measures should be emphasized in men with rheumatoid arthritis, and considered even in younger rheumatoid arthritis patients with low levels of traditional cardiovascular risk factors.