Rheumatoid Arthritis Increases Risk of Multi-vessel CAD

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Rheumatoid Arthritis Increases Risk of Multi-vessel CAD

Review

ATLANTA, June 28-Rheumatoid arthritis is an independent risk factor for

multi-vessel coronary artery disease, according to researchers here.

In a retrospective case-control study, a team of Emory investigators

said " this results in a trend towards increased frequency of

cardiovascular death for patients with rheumatoid arthritis. " The Emory

group suggested that cardiovascular screening should be incorporated

into standard care of rheumatoid arthritis patients.

" The fact that rheumatoid arthritis predisposes to coronary artery

disease needs to be an integral part of management, " said Cornelia A.

Weyand, M.D. the lead author, in the June 29 issue of Arthritis

Research & Therapy.

" Doctors and patients need to be vigilant and patients, even those who

are asymptomatic, need to be screened for coronary artery disease, "

said Dr. Weyand. " Coronary artery disease risk reduction needs to

become a part of rheumatoid arthritis management. "

The link between rheumatoid arthritis and coronary artery disease may

also be a consideration in the evolving story of nonsteroidal

anti-inflammatory drugs (NSAIDs) and cardiovascular disease. NSAIDs are

a stable of treatment for rheumatoid arthritis, yet recent reports

suggest that, with the exception of aspirin, all NSAIDs appear to

increase the risk of cardiovascular disease.

Dr. Weyand said the " fact that rheumatoid arthritis is a risk factor to

coronary artery disease needs to be considered " when selecting

therapeutic regimens. She said that the decision comes down to a

" trade-off between benefits and risk, and patients and their physicians

need to make a decision that fits the individual circumstances. "

The study was a retrospective case-control study that compared 75

patients with rheumatoid arthritis and new onset coronary artery

disease with 128 age- and sex-matched newly diagnosed coronary artery

disease patients who did not have rheumatoid arthritis. First coronary

angiograms and cardiovascular risk factors, and cardiovascular events

were compared.

Among the findings:

* Patients with rheumatoid arthritis were significantly more likely

to have multi-vessel disease on first angiogram (P = 0.002).

* There were no significant differences in known coronary artery

disease risk factors such as diabetes, hypertension, hyperlipidemia,

and smoking between the two groups.

* There were no significant differences in cardiovascular event

rate between the cohorts but there was a trend for increased mortality

among the patients with rheumatoid arthritis.

* Flow cytometry conducted in a subset of 27 patients with both

coronary artery disease and rheumatoid arthritis detected significantly

higher concentrations of CD4+ and CD28null T cells than in controls (P

= 0.001). These levels were similar to levels observed in patients with

acute coronary syndromes.

The authors only adjusted for traditional Framingham risk factors, and

they pointed out that smoking " could have a synergistic effect with

chronic inflammation due to rheumatoid arthritis, resulting in

increased atherogenesis. " Their study, however, did not include

detailed data on amounts of tobacco used, which could be a limiting

factor.

Other limitations were a lack of family history data, and the

possibility that elevated homocysteine levels observed in patients with

rheumatoid arthritis could explain the increased risk of coronary

artery disease.

Finally, the authors noted that the presence of rheumatoid arthritis,

which is itself a painful condition, may de-sensitize patients to chest

pain, thus patients put off seeking treatment for coronary artery

disease symptoms until later in the course of disease.

The study was consistent with several previous studies indicating that

patients with rheumatoid arthritis have increased morbidity and

mortality resulting from cardiovascular disease. In one study, for

example, researchers found that rheumatoid arthritis patients carried

twice the risk of congestive heart failure as those without rheumatoid

arthritis.