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Inflammatory arthritis
Original article
Associations between coronary and carotid artery atherosclerosis in patients with inflammatory joint diseases
  1. Mona Svanteson1,2,
  2. Silvia Rollefstad3,
  3. Nils Einar Kløw1,2,
  4. Jonny Hisdal4,
  5. Eirik Ikdahl3,
  6. Anne Grete Semb3 and
  7. Ylva Haig1
  1. 1 Department of Radiology, Oslo University Hospital, Oslo, Norway
  2. 2 Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
  3. 3 Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
  4. 4 Department of Vascular Investigations, Oslo University Hospital, Oslo, Norway
  1. Correspondence to Mona Svanteson; mona.svanteson{at}medisin.uio.no

Abstract

Objective Low association between cardiac symptoms and coronary artery disease (CAD) in patients with inflammatory joint diseases (IJD) demands for objective markers to improve cardiovascular risk stratification. Our main aim was to evaluate the prevalence and characteristics of CAD in patients with IJD with carotid artery plaques. Furthermore, we aimed to assess associations of carotid ultrasonographic findings and coronary plaques.

Methods Eighty-six patients (61% female) with IJD (55 with rheumatoid arthritis, 21 with ankylosing spondylitis and 10 with psoriatic arthritis) and carotid artery plaque were referred to coronary CT angiography (CCTA). CAD was evaluated using the modified 17-segment American Heart Association model. Calcium score, plaque composition, segment involvement score and segment stenosis score were assessed and correlated to the carotid artery plaques and cardiovascular disease risk factors in logistic and linear regression analyses. Risk prediction models were tested with various cut-off values for associating variables.

Results Fifty-five patients (66%) had CAD assessed by CCTA and 36 (43%) of these had coronary plaques defined as either mixed or soft. Eleven patients (13%) had obstructive CAD. The best risk prediction model (area under the curve: 0.832, 95% CI 0.730 to 0.935) included the combination of variables with cut-off values: age ≥55 years (OR: 12.18, 95% CI 2.80 to 53.05), the carotid-intima media thickness ≥0.7 mm (OR: 4.08, 95% CI 1.20 to 13.89) and carotid plaque height ≥1.5 mm (OR: 8.96, 95% CI 1.68 to 47.91), p<0.05.

Conclusion Presence of carotid plaque is alone not sufficient to identify patients at risk for CAD, and a combination of ultrasonographic measurements may be useful in risk stratification of patients with IJD.

Trial registration number NCT01389388, Results.

  • inflammatory joint diseases
  • atherosclerosis
  • plaques
  • computed tomography

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

https://doi.org/10.1136/rmdopen-2017-000544

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    Footnotes

    • Contributors AGS, SR and EI were responsible for the study design. All authors were responsible for the data acquisition. MS, SR, EI, AGS and YH analysed the data. MS wrote the first draft. All authors critically revised the manuscript and approved the final version. AGS and YH share last authorship.

    • Funding This study has received funding from the South-Eastern Regional Health Authority of Norway.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval South-Eastern Regional Ethics Committee, Norway.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement MS, SR and AGS have access to all the data.