Associations between coronary and carotid artery atherosclerosis in patients with inflammatory joint diseases

Mona Svanteson, Silvia Rollefstad, Nils Einar Kløw, Jonny Hisdal, Eirik Ikdahl, Anne Grete Semb, Ylva Haig, Mona Svanteson, Silvia Rollefstad, Nils Einar Kløw, Jonny Hisdal, Eirik Ikdahl, Anne Grete Semb, Ylva Haig

Abstract

Objective: Low association between cardiac symptoms and coronary artery disease (CAD) in patients with inflammatory joint diseases (IJD) demands for objective markers to improve cardiovascular risk stratification. Our main aim was to evaluate the prevalence and characteristics of CAD in patients with IJD with carotid artery plaques. Furthermore, we aimed to assess associations of carotid ultrasonographic findings and coronary plaques.

Methods: Eighty-six patients (61% female) with IJD (55 with rheumatoid arthritis, 21 with ankylosing spondylitis and 10 with psoriatic arthritis) and carotid artery plaque were referred to coronary CT angiography (CCTA). CAD was evaluated using the modified 17-segment American Heart Association model. Calcium score, plaque composition, segment involvement score and segment stenosis score were assessed and correlated to the carotid artery plaques and cardiovascular disease risk factors in logistic and linear regression analyses. Risk prediction models were tested with various cut-off values for associating variables.

Results: Fifty-five patients (66%) had CAD assessed by CCTA and 36 (43%) of these had coronary plaques defined as either mixed or soft. Eleven patients (13%) had obstructive CAD. The best risk prediction model (area under the curve: 0.832, 95% CI 0.730 to 0.935) included the combination of variables with cut-off values: age ≥55 years (OR: 12.18, 95% CI 2.80 to 53.05), the carotid-intima media thickness ≥0.7 mm (OR: 4.08, 95% CI 1.20 to 13.89) and carotid plaque height ≥1.5 mm (OR: 8.96, 95% CI 1.68 to 47.91), p<0.05.

Conclusion: Presence of carotid plaque is alone not sufficient to identify patients at risk for CAD, and a combination of ultrasonographic measurements may be useful in risk stratification of patients with IJD.

Trial registration number: NCT01389388, Results.

Keywords: atherosclerosis; computed tomography; inflammatory joint diseases; plaques.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Difference in carotid atherosclerosis measurements (c-IMT, plaque height, number of carotid plaques) between patients with and without CAD. X2 analysis including all patients (n=83): mean c-IMT; p<0.01, mean carotid plaque height; p=0.02 and mean number of carotid plaques; p=0.01. AS, ankylosing spondylitis; c-IMT, carotid-intima media thickness; PsA, psoriatic arthritis; RA, rheumatoid arthritis.

References

    1. Han C, Robinson DW, Hackett MV, et al. . Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol 2006;33:2167–72.
    1. Tobin AM, Veale DJ, Fitzgerald O, et al. . Cardiovascular disease and risk factors in patients with psoriasis and psoriatic arthritis. J Rheumatol 2010;37:1386–94. 10.3899/jrheum.090822
    1. Lindhardsen J, Ahlehoff O, Gislason GH, et al. . The risk of myocardial infarction in rheumatoid arthritis and diabetes mellitus: a Danish nationwide cohort study. Ann Rheum Dis 2011;70:929–34. 10.1136/ard.2010.143396
    1. Maradit-Kremers H, Nicola PJ, Crowson CS, et al. . Cardiovascular death in rheumatoid arthritis: a population-based study. Arthritis Rheum 2005;52:722–32. 10.1002/art.20878
    1. Rollefstad S, Ikdahl E, Hisdal J, et al. . Association of Chest Pain and Risk of Cardiovascular Disease with Coronary Atherosclerosis in Patients with Inflammatory Joint Diseases. Front Med 2015;2:80 10.3389/fmed.2015.00080
    1. Crowson CS, Gabriel SE. Towards improving cardiovascular risk management in patients with rheumatoid arthritis: the need for accurate risk assessment. Ann Rheum Dis 2011;70:719–21. 10.1136/ard.2010.145482
    1. Perk J, De Backer G, Gohlke H, et al. . European Guidelines on cardiovascular disease prevention in clinical practice (version 2012): The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Atherosclerosis 2012;223:1–68. 10.1016/j.atherosclerosis.2012.05.007
    1. Corrales A, González-Juanatey C, Peiró ME, et al. . Carotid ultrasound is useful for the cardiovascular risk stratification of patients with rheumatoid arthritis: results of a population-based study. Ann Rheum Dis 2014;73:722–7. 10.1136/annrheumdis-2012-203101
    1. Semb AG, Ikdahl E, Hisdal J, et al. . Exploring cardiovascular disease risk evaluation in patients with inflammatory joint diseases. Int J Cardiol 2016;223:331–6. 10.1016/j.ijcard.2016.08.129
    1. Budoff MJ, Dowe D, Jollis JG, et al. . Diagnostic performance of 64-multidetector row coronary computed tomographic angiography for evaluation of coronary artery stenosis in individuals without known coronary artery disease: results from the prospective multicenter ACCURACY (Assessment by Coronary Computed Tomographic Angiography of Individuals Undergoing Invasive Coronary Angiography) trial. J Am Coll Cardiol 2008;52:1724–32. 10.1016/j.jacc.2008.07.031
    1. Arbustini E, Dal Bello B, Morbini P, et al. . Plaque erosion is a major substrate for coronary thrombosis in acute myocardial infarction. Heart 1999;82:269–72. 10.1136/hrt.82.3.269
    1. van Velzen JE, Schuijf JD, de Graaf FR, et al. . Diagnostic performance of non-invasive multidetector computed tomography coronary angiography to detect coronary artery disease using different endpoints: detection of significant stenosis vs. detection of atherosclerosis. Eur Heart J 2011;32:637–45. 10.1093/eurheartj/ehq395
    1. Evans MR, Escalante A, Battafarano DF, et al. . Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. Arthritis Rheum 2011;63:1211–20. 10.1002/art.30265
    1. Rollefstad S, Ikdahl E, Hisdal J, et al. . Rosuvastatin-Induced Carotid Plaque Regression in Patients With Inflammatory Joint Diseases: The Rosuvastatin in Rheumatoid Arthritis, Ankylosing Spondylitis and Other Inflammatory Joint Diseases Study. Arthritis Rheumatol 2015;67:1718–28. 10.1002/art.39114
    1. Klass O, Kleinhans S, Walker MJ, et al. . Coronary plaque imaging with 256-slice multidetector computed tomography: interobserver variability of volumetric lesion parameters with semiautomatic plaque analysis software. Int J Cardiovasc Imaging 2010;26:711–20. 10.1007/s10554-010-9614-3
    1. Austen WG, Edwards JE, Frye RL, et al. . A reporting system on patients evaluated for coronary artery disease. Report of the Ad Hoc Committee for Grading of Coronary Artery Disease, Council on Cardiovascular Surgery, American Heart Association. Circulation 1975;51(4 Suppl):5–40. 10.1161/01.CIR.51.4.5
    1. Agatston AS, Janowitz WR, Hildner FJ, et al. . Quantification of coronary artery calcium using ultrafast computed tomography. J Am Coll Cardiol 1990;15:827–32. 10.1016/0735-1097(90)90282-T
    1. Raff GL, Chinnaiyan KM, Cury RC, et al. . SCCT guidelines on the use of coronary computed tomographic angiography for patients presenting with acute chest pain to the emergency department: a report of the Society of Cardiovascular Computed Tomography Guidelines Committee. J Cardiovasc Comput Tomogr 2014;8:254–71. 10.1016/j.jcct.2014.06.002
    1. Roman MJ, Naqvi TZ, Gardin JM, et al. . Clinical application of noninvasive vascular ultrasound in cardiovascular risk stratification: a report from the American Society of Echocardiography and the Society of Vascular Medicine and Biology. J Am Soc Echocardiogr 2006;19:943–54. 10.1016/j.echo.2006.04.020
    1. Semb AG, Rollefstad S, Provan SA, et al. . Carotid plaque characteristics and disease activity in rheumatoid arthritis. J Rheumatol 2013;40:359–68. 10.3899/jrheum.120621
    1. Touboul PJ, Hennerici MG, Meairs S, et al. . Mannheim carotid intima-media thickness and plaque consensus (2004-2006-2011). An update on behalf of the advisory board of the 3rd, 4th and 5th watching the risk symposia, at the 13th, 15th and 20th European Stroke Conferences, Mannheim, Germany, 2004, Brussels, Belgium, 2006, and Hamburg, Germany, 2011. Cerebrovasc Dis 2012;34:290–6. 10.1159/000343145
    1. Karpouzas GA, Malpeso J, Choi TY, et al. . Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease. Ann Rheum Dis 2014;73:1797–804. 10.1136/annrheumdis-2013-203617
    1. Piepoli MF, Hoes AW, Agewall S, et al. . European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016;2016:207–74.
    1. Goff DC, Lloyd-Jones DM, Bennett G, et al. . 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2014. 2014;63(25 Pt B):2935–59. 10.1016/j.jacc.2013.11.005
    1. van den Oord SC, Sijbrands EJ, ten Kate GL, et al. . Carotid intima-media thickness for cardiovascular risk assessment: systematic review and meta-analysis. Atherosclerosis 2013;228:1–11. 10.1016/j.atherosclerosis.2013.01.025
    1. Blanke P, Naoum C, Ahmadi A, et al. . Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. JACC Cardiovasc Imaging 2016;9:1280–8. 10.1016/j.jcmg.2015.12.027
    1. Andreini D, Pontone G, Mushtaq S, et al. . A long-term prognostic value of coronary CT angiography in suspected coronary artery disease. JACC Cardiovasc Imaging 2012;5:690–701. 10.1016/j.jcmg.2012.03.009
    1. Hulten E, Villines TC, Cheezum MK, et al. . Usefulness of coronary computed tomography angiography to predict mortality and myocardial infarction among Caucasian, African and East Asian ethnicities (from the CONFIRM [Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter] Registry). Am J Cardiol 2013;111:479–85. 10.1016/j.amjcard.2012.10.028
    1. Corrales A, Parra JA, González-Juanatey C, et al. . Cardiovascular risk stratification in rheumatic diseases: carotid ultrasound is more sensitive than Coronary Artery Calcification Score to detect subclinical atherosclerosis in patients with rheumatoid arthritis. Ann Rheum Dis 2013;72:1764–70. 10.1136/annrheumdis-2013-203688
    1. Qi L, Tang LJ, Xu Y, et al. . The Diagnostic Performance of Coronary CT Angiography for the Assessment of Coronary Stenosis in Calcified Plaque. PLoS One 2016;11:e0154852 10.1371/journal.pone.0154852

Source: PubMed

Sponsorer och medarbetare

Medicinska tillstånd

Läkemedelsinterventioner

3
Prenumerera