title: C-reactive protein and coronary artery calcium in asymptomatic women with systemic lupus erythematosus or rheumatoid arthritis.
abstract: Patients with systemic lupus erythematosus (SLE) and those with rheumatoid arthritis (RA) have increased risk for atherosclerotic cardiovascular disease. The aims of this study were to compare the presence of coronary artery calcium (CAC) in age- and race-matched women with SLE, those with RA, and healthy controls without diabetes mellitus or history of myocardial infarction, angina pectoris, or stroke and to investigate its relation with traditional risk factors, inflammation, and endothelial activation. Study subjects completed cardiovascular risk factor assessment and electron-beam computed tomography that measured CAC. The 2 patient groups had similar prevalence and extent of CAC as well as significantly increased odds of having any CAC (odds ratio 1.87, 95% confidence interval 1.09 to 3.21) and more extensive CAC (odds ratio 4.04, 95% confidence interval 1.42 to 11.56 for CAC score >100) compared with healthy controls. After controlling for differences in cardiovascular risk factors, including insulin resistance and hypertension, the results remained statistically significant. After adjustment for differences in levels of C-reactive protein and/or soluble intercellular adhesion molecule-1, however, women with chronic inflammatory diseases no longer had significantly increased odds of having any CAC or more extensive CAC compared with controls. In conclusion, asymptomatic and nondiabetic women with chronic inflammatory diseases had significantly increased odds of having CAC and more extensive CAC compared with age- and race-matched healthy controls. The increased odds for CAC may in part result from higher levels of inflammation and endothelial activation in these patients.
authors.affiliation: Department of Medicine, Division of Rheumatology and Clinical Immunology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA. ahk7@pitt.edu
authors.forename: Amy H
authors.initials: AH
authors.lastname: Kao
authors.forename: Mary Chester M
authors.initials: MC
authors.lastname: Wasko
authors.forename: Shanthi
authors.initials: S
authors.lastname: Krishnaswami
authors.forename: Joseph
authors.initials: J
authors.lastname: Wagner
authors.forename: Daniel
authors.initials: D
authors.lastname: Edmundowicz
authors.forename: Penny
authors.initials: P
authors.lastname: Shaw
authors.forename: Amy Lynn
authors.initials: AL
authors.lastname: Cunningham
authors.forename: Natalya
authors.initials: N
authors.lastname: Danchenko
authors.forename: Kim
authors.initials: K
authors.lastname: Sutton-Tyrrell
authors.forename: Russell P
authors.initials: RP
authors.lastname: Tracy
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Susan
authors.initials: S
authors.lastname: Manzi
mesh_terms: D001172:Arthritis, Rheumatoid / Q000097:blood / Q000453:epidemiology*; D015992:Body Mass Index; D002097:C-Reactive Protein / Q000032:analysis*; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D018799:Intercellular Adhesion Molecule-1 / Q000097:blood; D008180:Lupus Erythematosus, Systemic / Q000097:blood / Q000453:epidemiology*; D008875:Middle Aged; D015999:Multivariate Analysis; D014057:Tomography, X-Ray Computed
chemical_list: D018799:Intercellular Adhesion Molecule-1; D002097:C-Reactive Protein
references.citation: Hypertension. 2005 Jul;46(1):194-9
references.pmid: 15911740
references.citation: Circulation. 1997 Dec 16;96(12):4219-25
references.pmid: 9416885
references.citation: Am Heart J. 1998 Nov;136(5):884-93
references.pmid: 9812085
references.citation: J Am Geriatr Soc. 2000 Mar;48(3):256-63
references.pmid: 10733050
references.citation: N Engl J Med. 1997 Apr 3;336(14):1014-6
references.pmid: 9077383
references.citation: Mayo Clin Proc. 1999 Mar;74(3):243-52
references.pmid: 10089993
references.citation: Arthritis Rheum. 1988 Mar;31(3):315-24
references.pmid: 3358796
references.citation: N Engl J Med. 2003 Dec 18;349(25):2407-15
references.pmid: 14681506
references.citation: Eur Heart J. 1998 Jan;19(1):1-3
references.pmid: 9503166
references.citation: Eur Heart J. 2001 Jul;22(14):1226-34
references.pmid: 11440495
references.citation: Eur J Clin Invest. 2004 Dec;34(12):803-10
references.pmid: 15606722
references.citation: Atherosclerosis. 2006 Dec;189(2):464-9
references.pmid: 16466728
references.citation: Arthritis Rheum. 2006 Jul;54(7):2220-7
references.pmid: 16802358
references.citation: J Rheumatol. 2007 Apr;34(4):726-30
references.pmid: 17309130
references.citation: Circulation. 2002 Sep 3;106(10):1189-91
references.pmid: 12208790
references.citation: Arthritis Rheum. 2006 Sep;54(9):2765-75
references.pmid: 16947779
references.citation: Am J Cardiol. 2003 Feb 1;91(3):287-92
references.pmid: 12565084
references.citation: Circulation. 2006 Jan 3;113(1):38-43
references.pmid: 16380546
references.citation: Clin Chem. 1972 Jun;18(6):499-502
references.pmid: 4337382
references.citation: J Am Coll Cardiol. 1990 Mar 15;15(4):827-32
references.pmid: 2407762
references.citation: Lancet. 1998 Jan 10;351(9096):88-92
references.pmid: 9439492
references.citation: Circulation. 2003 Oct 7;108(14):1676-8
references.pmid: 14504187
references.citation: Int J Cardiol. 1996 Aug;54 Suppl:S51-60
references.pmid: 9119527
references.citation: Clin Immunol Immunopathol. 1993 Jul;68(1):74-8
references.pmid: 8099860
references.citation: Circulation. 2000 Oct 31;102(18):2165-8
references.pmid: 11056086
references.citation: Am J Med. 1992 Nov;93(5):513-9
references.pmid: 1442853
references.citation: Arthritis Rheum. 2005 Oct;52(10):3045-53
references.pmid: 16200609
references.citation: Atherosclerosis. 1999 Aug;145(2):375-9
references.pmid: 10488966
references.citation: Circulation. 1998 Aug 25;98(8):731-3
references.pmid: 9727541
references.citation: Diabetologia. 1985 Jul;28(7):412-9
references.pmid: 3899825
references.citation: Atherosclerosis. 2008 Mar;197(1):297-302
references.pmid: 17640650
references.citation: Cytokine. 1992 Sep;4(5):361-8
references.pmid: 1420997