Rheumatoid Arthritis as a Risk Factor for Coronary Artery Calcification and Obstructive Coronary Artery Disease in Patients with Chest Pain: A Registry Based Cross-Sectional Study

PURPOSE: To examine the occurrence and severity of coronary artery disease (CAD) in patients with rheumatoid arthritis (RA) compared to non-RA patients in a population referred for coronary computed tomography angiography (CTA) due to chest pain. PATIENTS AND METHODS: In this cross-sectional study, 46,210 patients from a national CTA database were included. Patients with RA were stratified on serology, treatment with conventional synthetic or biological disease-modifying antirheumatic drugs (DMARDs), and the need for relapse or flare treatment with intraarticular or -muscular glucocorticoid injections (GCIs). Primary outcomes were coronary artery calcium score (CACS) >0 and CACS ≥400, and secondary outcome was obstructive CAD. Associations between RA and outcomes were examined using logistic regression and results were adjusted for age, sex, cardiovascular risk factors and comorbidities. RESULTS: A total of 395 (0.9%) RA patients were identified. In overall RA, crude odds ratio (OR) for having CACS >0 was 1.48 (1.21–1.82) and 1.52 (1.15–2.01) for CACS ≥400, whereas adjusted ORs were 1.08 (0.86–1.36) and 1.21 (0.89–1.65), respectively. Seropositive RA patients had adjusted OR of 1.16 (0.89–1.50) for CACS >0 and 1.37 (0.98–1.90) for CACS ≥400. Patients who had received ≥1 GCI in the period of 3 years prior to the CTA had an adjusted OR of 1.37 (0.94–2.00) for having CACS >0 and 1.46 (0.92–2.31) for CACS ≥400. CONCLUSION: This is the first large-scale, CTA-based study examining the occurrence and severity of CAD in RA patients with symptoms suggestive of cardiovascular disease. A higher prevalence of coronary artery calcification was found in RA patients. After adjusting for age, sex, cardiovascular risk factors and comorbidities, the tendency was less pronounced. We found a trend for increased coronary calcification in RA patients being seropositive or needing treatment with GCI for a relapse or flare.