CT calcium score of coronary artery calcification progression in rheumatoid arthritis over a 10-year period and risk factors for progression

Abstract

OBJECTIVE: Rheumatoid arthritis (RA) patients are at increased risk of arterial calcification resulting in higher cardiovascular mortality. Computed tomography coronary calcium score (CTCCS) is a well-established modality for calculating coronary arterial calcification (CAC) and prognostication of major adverse cardiovascular events. The study’s aims were to: (i) assess the rate of CAC progression in RA patients compared to predicted calculations (ii) investigate independent risk factors of CAC progression. METHODS: 85 RA patients with no history of cardiovascular disease were enrolled. CTCCS was measured on enrollment, and on average 9.8 ± 0.2 years later. Patients’ predicted CTCCS was calculated using a CAC calculation software and compared with the actual CTCCS. Coronary CTCCS progression was defined by the “SQRT method”. Variables such as disease duration, drugs used, lipids, hypertension and diabetes mellitus were included in a multivariate regression analysis to determine risk factors of CAC progression. RESULT: 49 patients (mean age 54 years, 89.8% female, mean RA duration of 13 years) had a complete data set at the end of follow-up. The absolute increase of CTCCS and the percentage of RA patients with CTCCS progression were all significantly higher than predicted (110.2 ± 165.3 Agatston units vs 62.9 ± 209.7 Agatston units, p= 0.01; 61.1% vs 13.9%, p<0.01). After multivariate analysis age and systolic blood pressure (SBP) were shown to be independent risk factors for progression (p=0.04, p=0.01 respectively). CONCLUSION: RA patients had a significantly greater rate of CAC progression than predicted. Age and SBP were independent risk factors of progression.