title: Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease.
abstract: OBJECTIVE
  Accelerated cardiovascular morbidity and mortality occur in patients with rheumatoid arthritis (RA). We evaluated the presence, burden and compositional differences of coronary plaque in patients with RA without symptoms or diagnosis of coronary artery disease (CAD) compared against controls.
  
  
  METHODS
  One hundred and fifty patients with RA and 150 matched controls underwent 64-slice CT angiography (CTA) for evaluation of coronary plaque. Numbers of segments with plaque per patient (Segment involvement score (SIS)), degree of segment stenosis (stenosis severity score (SSS)), plaque size (plaque burden score (PBS)), and composition were assessed using a standardised American Heart Association 15-segment model. Lesions were classified as non-calcified plaque (NCP), mixed (MP), and fully calcified plaque (CP).
  
  
  RESULTS
  Higher proportion of patients with RA had plaque when compared with controls (71% vs 45%, p<0.0001); 13.5% of total RA segments harboured plaque compared with 6% in controls (p<0.0001), and all plaque types were higher (p<0.001). Multivessel disease, both non-obstructive and obstructive, was more prevalent, and quantitative measures of stenotic plaque severity (SSS) and extent (PBS) were higher in RA, even after adjustments for cardiac risk factors (p<0.01 for all). A steeper progression of plaque with age was seen in RA. Disease activity associated only with presence of NCP and MP, whereas patient age was the only predictor of fully CP.
  
  
  CONCLUSIONS
  RA patients without CAD have higher prevalence, extent, and severity of all types of coronary plaque. Residual disease activity associates with presence of higher risk NCP and MP potentially contributing to future adverse cardiac events.
authors.affiliation: Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA.
authors.forename: George A
authors.initials: GA
authors.lastname: Karpouzas
authors.affiliation: Division of Cardiology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Malpeso
authors.affiliation: Division of Cardiology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA.
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Choi
authors.affiliation: Division of Cardiology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA.
authors.forename: Dong
authors.initials: D
authors.lastname: Li
authors.affiliation: Division of Rheumatology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA.
authors.forename: Silvia
authors.initials: S
authors.lastname: Munoz
authors.affiliation: Division of Cardiology, Harbor-UCLA Medical Center and Los Angeles Biomedical Research Institute, Torrance, California, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Budoff
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D015995:Prevalence; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed; D061205:Vascular Calcification / Q000000981:diagnostic imaging / Q000209:etiology / Q000473:pathology
keywords: Atherosclerosis; Cardiovascular Disease; Rheumatoid Arthritis