Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis

Matthew R. Evans, Agustin Escalante, Daniel F. Battafarano, Gregory L. Freeman, Daniel H. O'Leary, Inmaculada Del Rincon

Research output: Contribution to journalArticle

129 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1211-1220
Number of pages10
JournalArthritis and Rheumatism
Volume63
Issue number5
DOIs
StatePublished - May 2011

Fingerprint

Carotid Artery Diseases
Acute Coronary Syndrome
Rheumatoid Arthritis
Confidence Intervals
Atherosclerosis
Glucocorticoids
Diabetes Mellitus
Incidence
Unstable Angina
Heart Arrest
Proportional Hazards Models
Myocardial Ischemia
Coronary Artery Disease

ASJC Scopus subject areas

  • Immunology
  • Immunology and Allergy
  • Rheumatology
  • Pharmacology (medical)

Cite this

Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. / Evans, Matthew R.; Escalante, Agustin; Battafarano, Daniel F.; Freeman, Gregory L.; O'Leary, Daniel H.; Del Rincon, Inmaculada.

In: Arthritis and Rheumatism, Vol. 63, No. 5, 05.2011, p. 1211-1220.

Research output: Contribution to journalArticle

Evans, Matthew R. ; Escalante, Agustin ; Battafarano, Daniel F. ; Freeman, Gregory L. ; O'Leary, Daniel H. ; Del Rincon, Inmaculada. / Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis. In: Arthritis and Rheumatism. 2011 ; Vol. 63, No. 5. pp. 1211-1220.
@article{856c6a3f8ba54a689fb893dfe4c673b8,
title = "Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis",
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.",
author = "Evans, {Matthew R.} and Agustin Escalante and Battafarano, {Daniel F.} and Freeman, {Gregory L.} and O'Leary, {Daniel H.} and {Del Rincon}, Inmaculada",
year = "2011",
month = "5",
doi = "10.1002/art.30265",
language = "English (US)",
volume = "63",
pages = "1211--1220",
journal = "Arthritis and Rheumatology",
issn = "2326-5191",
publisher = "John Wiley and Sons Ltd",
number = "5",

}

TY - JOUR

T1 - Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis

AU - Evans, Matthew R.

AU - Escalante, Agustin

AU - Battafarano, Daniel F.

AU - Freeman, Gregory L.

AU - O'Leary, Daniel H.

AU - Del Rincon, Inmaculada

PY - 2011/5

Y1 - 2011/5

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=79955562395&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=79955562395&partnerID=8YFLogxK

U2 - 10.1002/art.30265

DO - 10.1002/art.30265

M3 - Article

C2 - 21305526

AN - SCOPUS:79955562395

VL - 63

SP - 1211

EP - 1220

JO - Arthritis and Rheumatology

JF - Arthritis and Rheumatology

SN - 2326-5191

IS - 5

ER -