Research article

Rheumatoid arthritis is an independent risk factor for multi-vessel coronary artery disease: a case control study

Kenneth J Warrington¹ , Peter D Kent¹ , Robert L Frye² , James F Lymp⁴ , Stephen L Kopecky^2,3 , Jörg J Goronzy^1,5 and Cornelia M Weyand^1,5

¹  Division of Rheumatology, Mayo Clinic, Rochester, MN, USA

²  Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA

³  Mayo Alliance for Clinical Trials and the Mayo Clinic, Rochester, MN, USA

⁴  Division of Biostatistics, Mayo Clinic, Rochester, MN, USA

⁵  Emory University School of Medicine, Atlanta, GA, USA

author email corresponding author email

Arthritis Research & Therapy 2005, 7:R984-R991doi:10.1186/ar1775

Published:	29 June 2005

Abstract

The risk for cardiovascular (CV) disease is increased in rheumatoid arthritis (RA) but data on the burden of coronary atherosclerosis in patients with RA are lacking. We conducted a retrospective case-control study of Olmsted County (MN, USA) residents with RA and new-onset coronary artery disease (CAD) (n = 75) in comparison with age-and sex-matched controls with newly diagnosed CAD (n = 128). Angiographic scores of the first coronary angiogram and data on CV risk factors and CV events on follow-up were obtained by chart abstraction. Patients with RA were more likely to have multi-vessel coronary involvement at first coronary angiogram compared with controls (P = 0.002). Risk factors for CAD including diabetes, hypertension, hyperlipidemia, and smoking history were not significantly different in the two cohorts. RA remained a significant risk factor for multi-vessel disease after adjustment for age, sex and history of hyperlipidemia. The overall rate of CV events was similar in RA patients and controls; however, there was a trend for increased CV death in patients with RA. In a nested cohort of patients with RA and CAD (n = 27), we measured levels of pro-inflammatory CD4⁺CD28^null T cells by flow cytometry. These T cells have been previously implicated in the pathogenesis of CAD and RA. Indeed, CD4⁺CD28^null T cells were significantly higher in patients with CAD and co-existent RA than in controls with stable angina (P = 0.001) and reached levels found in patients with acute coronary syndromes. Patients with RA are at increased risk for multi-vessel CAD, although the risk of CV events was not increased in our study population. Expansion of CD4⁺CD28^null T cells in these patients may contribute to the progression of atherosclerosis.