Treatment with glucocorticoids was strongly associated with the presence of coronary artery 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.
Calcification of the coronary artery, 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 the division of rheumatology in the department of medicine at Johns Hopkins University, Baltimore.
A group of 187 patients, 115 of whom were 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%. Among men of all ages, calcification prevalence 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, while functional status was evaluated on the health assessment questionnaire (HAQ). Depression was rated on the basis of a Center for Epidemiologic Study depression score.
The investigators then performed multivariate logistic regression analysis to determine whether there was an association of individual characteristics with the presence of coronary artery calcification. After controlling for demographic and conventional risk factors, the investigators found that the presence of any coronary artery calcification was significantly associated with increased levels of clinical depression (odds ratio 1.05), HAQ score (odds ratio 1.71), and high waist:hip ratio (odds ratio 1.21).
And most notably, 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 measures of current disease activity such as C-reactive protein were not associated with the presence of calcification, while increased education was associated with a decreased odds ratio of 0.71.
“These data would suggest that careful utilization of glucocorticoids in the clinical setting, avoidance of central obesity, and efforts to improve physical functioning and to promote psychological well-being, in addition to optimizing the control of conventional cardiovascular risk factors, may be effective strategies in reducing the burden of atherosclerosis [in patients with rheumatoid arthritis],” he said.
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