Silent Coronary Artery Disease in Patients with Rheumatoid Arthritis in Kurdistan, Iraq: A cross-sectional study
Keywords:Coronary Artery Disease, Arthritis, Rheumatoid, Coronary Vessels
Objectives: This study attempts to determine the silent coronary artery disease (CAD) in a sample of Iraqi Kurdish patients diagnosed with rheumatoid arthritis (RA).
Methods: A total of 50 such patients from Duhok, Kurdistan region of Iraq, underwent multi slices computed tomography (MSCT) coronary angiography 64 slices to determine coronary artery calcium (CAC) scores and coronary stenoses.
Results: 62% of cases had a (CAC) score > zero on non-contrast MSCT scans. Coronary angiograms showed that 26 (52%) of the cases had variable coronary artery stenosis; 17(34%) of them were obstructive (>50% luminal narrowing). The study demonstrated that Inflammatory markers (rheumatoid factor, Anti- cyclic citrullinated peptides, and some cardiovascular risk factors, namely (hypertension and type 2 diabetes mellitus) were significantly related to the presence of CAD in these patients.
Conclusions: Patients with rheumatoid arthritis are at increased risk of CAD. This risk is higher in the presence of inflammatory and cardiovascular risk factors.
Bullock J, Rizvi SA, Saleh AM, Ahmed SS, Do DP, Ansari RA, et al. Rheumatoid arthritis: a brief overview of the treatment. Medical Principles and Practice. 2018;27(6):501-7.
Jeong H, Baek SY, Kim SW, Eun YH, Kim IY, Kim H, et al. Comorbidities of rheumatoid arthritis: results from the Korean National Health and Nutrition Examination Survey. PLoS One. 2017;12(4):e0176260.
Mohammad AM, Jehangeer HI, Shaikhow SK. Prevalence and risk factors of premature coronary artery disease in patients undergoing coronary angiography in Kurdistan, Iraq. BMC Cardiovascular Disorders. 2015;15(1):155.
Mohammad AM, Othman GO, Saeed CH, Al Allawi S, Gedeon GS, Qadir SM, et al. Genetic polymorphisms in early-onset myocardial infarction in a sample of Iraqi patients: a pilot study. BMC Research Notes. 2020;13(1):541.
Gabriel SE. Why do people with rheumatoid arthritis still die prematurely? Annals of the rheumatic diseases. 2008;67(Suppl 3):iii30-iii4.
Mohammad AM, Hasan Yousif A, Ahmed Qasim B, Aziz Joma J, Saeed SY. Estimation of apolipoprotein A in early onset ST-segment elevation myocardial infarction. Cardiovasc Endocrinol Metab. 2019;8(4):106-8.
Gabriel SE. Cardiovascular morbidity and mortality in rheumatoid arthritis. The American journal of medicine. 2008;121(10):S9-S14.
Solomon DH, Karlson EW, Rimm EB, Cannuscio CC, Mandl LA, Manson JE, et al. Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis. Circulation. 2003;107(9):1303-7.
Mohammad A, Othman G, Saeed C, Allawi N. TCT-441 Traditional and genetic risk factors in young patients with myocardial infarction in Iraq. Journal of the American College of Cardiology. 2017 Oct 31;70(18S):B181-.
Turesson C, Jarenros A, Jacobsson L. Increased incidence of cardiovascular disease in patients with rheumatoid arthritis: results from a community based study. Annals of the rheumatic diseases. 2004;63(8):952-5.
Mohammad AM, Al-Allawi NAS. CYP2C19 Genotype is an Independent Predictor of Adverse Cardiovascular Outcome in Iraqi Patients on Clopidogrel After Percutaneous Coronary Intervention. Journal of Cardiovascular Pharmacology. 2018;71(6):347-51.
DeMizio DJ, Geraldino-Pardilla LB. Autoimmunity and inflammation link to cardiovascular disease risk in rheumatoid arthritis. Rheumatology and therapy. 2020;7(1):19-33.
Lee TH, Song GG, Choi SJ, Seok H, Jung JH. Relationship of rheumatoid arthritis and coronary artery disease in the Korean population: a nationwide cross-sectional study. Advances in Rheumatology. 2019;59.
Sarmiento-Monroy JC, Amaya-Amaya J, Espinosa-Serna JS, Herrera-Díaz C, Anaya J-M, Rojas-Villarraga A. Cardiovascular disease in rheumatoid arthritis: a systematic literature review in Latin America. Arthritis. 2012;2012.
Mohammad AM, Abdulhaleem BH, Habeeb QS. First 24 h’outcomes of acute coronary syndrome in Iraq. Medical Journal of Babylon. 2020;17(2):154.
Maradit‐Kremers H, Crowson CS, Nicola PJ, Ballman KV, Roger VL, Jacobsen SJ, et al. Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population‐based cohort study. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2005;52(2):402-11.
Tournadre A, Mathieu S, Soubrier M. Managing cardiovascular risk in patients with inflammatory arthritis: practical considerations. Therapeutic Advances in Musculoskeletal Disease. 2016;8(5):180-91.
Baillet A, Gossec L, Carmona L, de Wit M, van Eijk-Hustings Y, Bertheussen H, et al. Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: a EULAR initiative. Annals of the rheumatic diseases. 2016;75(6):965-73.
van der Bijl N, Joemai RM, Geleijns J, Bax JJ, Schuijf JD, de Roos A, et al. Assessment of Agatston coronary artery calcium score using contrast-enhanced CT coronary angiography. AJR Am J Roentgenol. 2010;195(6):1299-305.
Ridker PM, Hennekens CH, Buring JE, Rifai N. C-reactive protein and other markers of inflammation in the prediction of cardiovascular disease in women. New England journal of medicine. 2000;342(12):836-43.
Pope JE, Choy EH. C-reactive protein and implications in rheumatoid arthritis and associated comorbidities. Seminars in Arthritis and Rheumatism. 2021;51(1):219-29.
Mohammad AM, Sheikho SK, Tayib JM. Relation of cardiovascular risk factors with coronary angiographic findings in Iraqi patients with ischemic heart disease. Am J Cardiovasc Dis Res. 2013;1(1):25-9.
Wang TJ, Larson MG, Levy D, Benjamin EJ, Kupka MJ, Manning WJ, et al. C-reactive protein is associated with subclinical epicardial coronary calcification in men and women: the Framingham Heart Study. Circulation. 2002;106(10):1189-91.
Ross R. Atherosclerosis—an inflammatory disease. New England journal of medicine. 1999;340(2):115-26.
Chung CP, Oeser A, Raggi P, Gebretsadik T, Shintani AK, Sokka T, et al. Increased coronary‐artery atherosclerosis in rheumatoid arthritis: relationship to disease duration and cardiovascular risk factors. Arthritis & Rheumatism: Official Journal of the American College of Rheumatology. 2005;52(10):3045-53.
Douglas KM, Pace AV, Treharne GJ, Saratzis A, Nightingale P, Erb N, et al. Excess recurrent cardiac events in rheumatoid arthritis patients with acute coronary syndrome. Annals of the rheumatic diseases. 2006;65(3):348-53.
Rinehart S, Vazquez G, Qian Z, Voros S. Coronary plaque imaging with multi-slice computed tomographic angiography and intravascular ultrasound: a close look inside and out. The Journal of invasive cardiology. 2009;21(7):367-72.
Karpouzas GA, Malpeso J, Choi T-Y, Li D, Munoz S, Budoff MJ. Prevalence, extent and composition of coronary plaque in patients with rheumatoid arthritis without symptoms or prior diagnosis of coronary artery disease. Annals of the Rheumatic Diseases. 2014;73(10):1797-804.
Hou Z-h, Lu B, Gao Y, Jiang S-l, Wang Y, Li W, et al. Prognostic value of coronary CT angiography and calcium score for major adverse cardiac events in outpatients. JACC: Cardiovascular Imaging. 2012;5(10):990-9.
Sokolove J, Johnson DS, Lahey LJ, Wagner CA, Cheng D, Thiele GM, et al. Rheumatoid factor as a potentiator of anti–citrullinated protein antibody–mediated inflammation in rheumatoid arthritis. Arthritis & rheumatology. 2014;66(4):813-21.
Mohammad AM, Shammo NA, Jasem JA. Vitamin D status in acute myocardial infarction: a case-control study. Cardiovasc Endocrinol Metab. 2018 Nov 14;7(4):93-96. doi: 10.1097/XCE.0000000000000160. PMID: 31646291; PMCID: PMC6739859.
Fazeli MS, Khaychuk V, Wittstock K, Breznen B, Crocket G, Pourrahmat M-M, et al. Cardiovascular Disease in Rheumatoid Arthritis: Risk Factors, Autoantibodies, and the Effect of Antirheumatic Therapies. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders. 2021;14:11795441211028751.
Choi HK, Hernán MA, Seeger JD, Robins JM, Wolfe F. Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study. The Lancet. 2002;359(9313):1173-7.
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