WASHINGTON — Treatment with glucocorticoids was strongly associated with the presence of coronary calcification among patients with rheumatoid arthritis in a cross-sectional analysis, Dr. Jon T. Giles reported at the annual meeting of the American College of Rheumatology.
Coronary artery calcification, as measured by high-resolution computed tomography, is a quantifiable representation of coronary atherosclerotic burden and is predictive of future cardiovascular events in patients with subclinical atherosclerosis, according to Dr. Giles of Johns Hopkins University, Baltimore.
A group of 187 patients (115 women), underwent multidetector-row computed tomography of the chest with quantification of coronary artery calcification using the Agatston scoring method. The overall prevalence of calcification was 53%, and among men of all ages, it was 75% and among women, 39%.
Patients also underwent laboratory assessments including those for fasting glucose, cholesterol, triglycerides, C-reactive protein, and homocysteine. Data were collected on demographics, body composition, and medication history, and functional status was evaluated on the health assessment questionnaire (HAQ). Depression was rated on the basis of a Center for Epidemiologic Study depression score. A multivariate logistic regression analysis determined the association of individual characteristics with the presence of coronary artery calcification.
After controlling for demographic and conventional risk factors, the presence of any coronary artery calcification was significantly associated with increased levels of clinical depression (odds ratio 1.05), HAQ score (OR 1.71), and high waist:hip ratio (OR 1.21). Most notable was that when compared with no exposure, any history of glucocorticoid exposure was associated with an odds ratio of 2.98 for calcification, even after adjusting for demographic and cardiovascular risk factors, Dr. Giles wrote in a poster session.
Rheumatoid arthritis disease duration and current disease activity such as C-reactive protein were not associated with calcification, while increased education was associated with a decreased odds ratio of 0.71.
“These data would suggest that careful [use] of glucocorticoids in the clinical setting, avoidance of central obesity, and efforts to improve physical functioning and to promote psychological well-being … may be effective strategies in reducing the burden of atherosclerosis in RA patients,” he concluded.