title: Rheumatoid arthritis is an independent risk factor for multi-vessel coronary artery disease: a case control study.
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+CD28null T cells by flow cytometry. These T cells have been previously implicated in the pathogenesis of CAD and RA. Indeed, CD4+CD28null 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+CD28null T cells in these patients may contribute to the progression of atherosclerosis.
authors.affiliation: Division of Rheumatology, Mayo Clinic, Rochester, MN, USA. kwarring@utmem.edu
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Warrington
authors.forename: Peter D
authors.initials: PD
authors.lastname: Kent
authors.forename: Robert L
authors.initials: RL
authors.lastname: Frye
authors.forename: James F
authors.initials: JF
authors.lastname: Lymp
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Kopecky
authors.forename: Jörg J
authors.initials: JJ
authors.lastname: Goronzy
authors.forename: Cornelia M
authors.initials: CM
authors.lastname: Weyand
mesh_terms: D000787:Angina Pectoris / Q000453:epidemiology / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000453:epidemiology* / Q000276:immunology; D001327:Autoimmune Diseases / Q000453:epidemiology* / Q000276:immunology; D018106:CD28 Antigens / Q000032:analysis; D015496:CD4-Positive T-Lymphocytes / Q000276:immunology*; D016022:Case-Control Studies; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000276:immunology; D006801:Humans; D015993:Life Tables; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
chemical_list: D018106:CD28 Antigens