Document Detail


Carotid atherosclerosis predicts incident acute coronary syndromes in rheumatoid arthritis.
MedLine Citation:
PMID:  21305526     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: The role of atherosclerosis in the acute coronary syndromes (ACS) that occur in patients with rheumatoid arthritis (RA) has not been quantified in detail. We undertook this study to determine the extent to which ACS are associated with carotid atherosclerosis in RA.
METHODS: We prospectively ascertained ACS, defined as myocardial infarction, unstable angina, cardiac arrest, or death due to ischemic heart disease, in an RA cohort. We measured carotid atherosclerosis using high-resolution ultrasound. We used Cox proportional hazards models to estimate the association between ACS and atherosclerosis, adjusting for demographic features, cardiovascular (CV) risk factors, and RA manifestations.
RESULTS: We performed carotid ultrasound on 636 patients whom we followed up for 3,402 person-years. During this time, 84 patients experienced 121 new or recurrent ACS events, a rate of 3.5 ACS events per 100 patient-years (95% confidence interval [95% CI] 3.0-4.3). Among the 599 patients without a history of ACS, 66 incident ACS events occurred over 3,085 person-years, an incidence of 2.1 ACS events per 100 person-years (95% CI 1.7-2.7). The incidence of new ACS events per 100 patient-years was 1.1 (95% CI 0.6-1.7) among patients without plaque, 2.5 (95% CI 1.7-3.8) among patients with unilateral plaque, and 4.3 (95% CI 2.9-6.3) among patients with bilateral plaque. Covariates associated with incident ACS events independent of atherosclerosis included male sex, diabetes mellitus, and a cumulative glucocorticoid dose of ≥ 20 gm.
CONCLUSION: Atherosclerosis is strongly associated with ACS in RA. RA patients with carotid plaque, multiple CV risk factors (particularly diabetes mellitus or hypertension), many swollen joints, and a high cumulative dose of glucocorticoids, as well as RA patients who are men, are at high risk of ACS.
Authors:
Matthew R Evans; Agustín Escalante; Daniel F Battafarano; Gregory L Freeman; Daniel H O'Leary; Inmaculada del Rincón
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural    
Journal Detail:
Title:  Arthritis and rheumatism     Volume:  63     ISSN:  1529-0131     ISO Abbreviation:  Arthritis Rheum.     Publication Date:  2011 May 
Date Detail:
Created Date:  2011-05-03     Completed Date:  2011-08-05     Revised Date:  2013-06-30    
Medline Journal Info:
Nlm Unique ID:  0370605     Medline TA:  Arthritis Rheum     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1211-20     Citation Subset:  AIM; IM    
Copyright Information:
Copyright © 2011 by the American College of Rheumatology.
Affiliation:
Brooke Army Medical Center, Fort Sam Houston, Texas, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Coronary Syndrome / epidemiology,  etiology*,  ultrasonography
Adult
Aged
Arthritis, Rheumatoid / complications*,  epidemiology,  ultrasonography
Atherosclerosis / complications*,  epidemiology,  ultrasonography
Carotid Arteries / ultrasonography*
Carotid Artery Diseases / complications*,  epidemiology,  ultrasonography
Female
Humans
Incidence
Male
Middle Aged
Prospective Studies
Risk Factors
Severity of Illness Index
Grant Support
ID/Acronym/Agency:
K23 HL004481-05/HL/NHLBI NIH HHS; K23-HL-004481/HL/NHLBI NIH HHS; R01 HD037151-10/HD/NICHD NIH HHS; R01 HL085742-02/HL/NHLBI NIH HHS; R01-HD-037151/HD/NICHD NIH HHS; R01-HL-085742/HL/NHLBI NIH HHS; UL1 RR025767/RR/NCRR NIH HHS; UL1 RR025767-01/RR/NCRR NIH HHS; UL1 TR000149/TR/NCATS NIH HHS; UL1-RR-025767/RR/NCRR NIH HHS
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