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Egyptian Rheumatology and Rehabilitation
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Risk factors for acute coronary events in patients with rheumatoid arthritis

Egyptian Rheumatology and Rehabilitation volume 44, pages 164–171 (2017)Cite this article

Abstract

Objectives

The aim of this study was to assess the role of disease activity, line of treatment, and carotid atherosclerosis in the risk for acute coronary syndrome (ACS) in rheumatoid arthritis (RA) patients.

Patients and methods

In this prospective study, we ascertained ACS on 124 patients with RA. Disease activity score 28 was used for the assessment of RA activity. Insulin resistance was evaluated using homeostasis model assessment-insulin resistance. Carotid atherosclerosis was measured using high-resolution ultrasound. We used Cox’s proportional hazards models to estimate the association between ACS and atherosclerosis, cardiovascular (CV) risk factors, and RA line of treatment.

Results

Among the 124 RA patients without a history of previous ACS, 16 incident ACS events occurred over 30 months. Old age, long RA disease duration, high BMI, and 10-year cardiovascular disease risk were associated with an increased risk for ACS. High mean disease activity score 28, rheumatoid factor, and anticitrullinated peptide antibodies (ACPA) levels were significantly associated with ACS risk. Treatment with disease-modifying antirheumatic drugs or biological disease-modifying antirheumatic drugs (DMARDs) did not alter the ACS risk. Logistic regression analysis showed that carotid plaques were a good predictor for ACS in RA patients.

Conclusion

The main finding of this study was a general tendency toward an association of disease activity, rheumatoid factor, and ACPA with the risk for ACS. In addition, subclinical atherosclerosis detected by means of carotid intima-media thickness and the presence of carotid plaques were good predictors for RA patients with ACS. Treatment with any DMARD or biologic DMARDs was not linked to an altered risk for ACS.

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Author information

Authors and Affiliations

  1. Department of Internal Medicine, Umm Alqura University, Makkah, Saudi Arabia

    Abdulsalam Noorwali

  2. Department of Internal Medicine, Alnoor General Hospital, Makkah, Saudi Arabia

    Narges Omran

  3. Department of Rheumatology and Rehabilitation, Faculty of Medicine, Tanta University, El-Geish Street, 31511, Tanta, Gharbia, Egypt

    Samah H. Elmedany & Amal M. El-Barbary (MD)

Authors
  1. Abdulsalam Noorwali
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  2. Narges Omran
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  3. Samah H. Elmedany
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  4. Amal M. El-Barbary
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Corresponding author

Correspondence to Amal M. El-Barbary.

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Noorwali, A., Omran, N., Elmedany, S.H. et al. Risk factors for acute coronary events in patients with rheumatoid arthritis. Egypt Rheumatol Rehabil 44, 164–171 (2017). https://doi.org/10.4103/err.err_14_17

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  • DOI: https://doi.org/10.4103/err.err_14_17

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