Rheumatoid Arthritis as a Risk Factor for Coronary Artery Calcification and Obstructive Coronary Artery Disease in Patients with Chest Pain: A Registry Based Cross-Sectional Study

Figures & data

Figure 1 Flowchart of the patient inclusion.

Abbreviations: CT, computed tomography; WDHR, Western Denmark Heart Registry; CPR, personal identification number; CAD, coronary artery disease; MI, myocardial infarction; PCI, percutaneous coronary intervention; CABG, coronary artery bypass grafting; CACS, coronary artery calcium score; RA, rheumatoid arthritis.

Table 1 Demographics, Rheumatoid Arthritis Subgroups, Comorbidities and Traditional Cardiovascular Risk Factors of the Study Population Combined with Computed Tomography Angiography Data of the Study Population

Number of patients	Non-RA Patients	RA Patients
	45,815	395
Serology
Other RA		78 (19.7%)
Seropositive RA		317 (80.3%)
DMARD treatment
csDMARD		274 (69.4%)
bDMARD		121 (30.6%)
Relapse/flare treatment
0 injections		242 (61.3%)
≥ 1 injections		153 (38.7%)
Sex, men	21,080 (46.0%)	106 (26.8%)
Age, median (Q1;Q3)	58.1 (50.1;65.8)	63.4 (56.5;69.8)
BMI
<18.5	486 (1.1%)	7 (1.8%)
18.5–25	14,609 (31.9%)	141 (35.7%)
25–30	16,047 (35.0%)	135 (34.2%)
≥30	8245 (18.0%)	71 (18.0%)
Missing	6428 (14.0%)	41 (10.4%)
Smoking
Current	9631 (21.0%)	59 (14.9%)
Never	17,703 (38.6%)	125 (31.6%)
Former	15,093 (32.9%)	177 (44.8%)
Missing	3388 (7.4%)	34 (8.6%)
Comorbidity
No comorbidity (0)	33,688 (73.5%)	221 (55.9%)
Moderate comorbidity (1)	6858 (15.0%)	92 (23.3%)
Severe comorbidity (2+)	5269 (11.5%)	82 (20.8%)
Hypertension	21,381 (46.7%)	227 (57.5%)
Dyslipidemia	16,006 (34.9%)	169 (42.8%)
Familiar history of CVD	18,397 (40.2%)	162 (41.0%)
Diabetes	3767 (8.2%)	36 (9.1%)
CACS >0	22,915 (50.0%)	236 (59.7%)
CACS ≥400	4741 (10.3%)	59 (14.9%)
CACS
0	22,900 (50.0%)	159 (40.3%)
1–99	12,147 (26.5%)	116 (29.4%)
100–399	6027 (13.2%)	61 (15.4%)
≥400	4741 (10.3%)	59 (14.9%)
CAD
Non-obstructive CAD	35,054 (76.5%)	283 (71.6%)
Obstructive CAD	7515 (16.4%)	70 (17.7%)
Missing	3246 (7.1%)	42 (10.6%)
CAD
No CAD	20,298 (44.3%)	143 (36.2%)
Non-obstructive CAD	14,756 (32.2%)	140 (35.4%)
1 VD	5331 (11.6%)	44 (11.1%)
2 VD	1591 (3.5%)	18 (4.6%)
3 VD	593 (1.3%)	8 (2.0%)
Terminated after CACS	3128 (6.8%)	41 (10.4%)
Missing	118 (0.3%)	1 (0.3%)
Referral symptoms
Typical angina	4850 (10.6%)	47 (11.9%)
Atypical angina	19,405 (42.4%)	168 (42.5%)
Non-anginal chest pain	12,172 (26.6%)	101 (25.6%)
Shortness of breath	3036 (6.6%)	33 (8.4%)
Missing	6352 (13.9%)	46 (11.6%)

Abbreviations: RA, rheumatoid arthritis; csDMARD, conventional synthetic disease-modifying antirheumatic drugs; bDMARD, biological disease-modifying antirheumatic drugs; BMI, body mass index; CVD, cardiovascular disease; CACS, coronary artery calcium score; CAD, coronary artery disease; VD, vessel disease.

Table 2 Main Analysis of Rheumatoid Arthritis Patients versus Non-Rheumatoid Arthritis Patients for the Primary Outcomes; CACS > 0 and CACS ≥ 400, and Secondary Outcome; Obstructive CAD. All Results Adjusted for Sex, Age, Smoking, BMI, Family History of Cardiovascular Disease, Dyslipidemia, Hypertension, Diabetes and Comorbidity Score

Primary outcome: CACS> 0
	Patients Total	CACS >0	Crude OR	Adjusted OR
Non-RA	45,815	22,915	Ref.	Ref.
RA	395	236	1.48 (1.21–1.82)	1.08 (0.86–1.36)
Primary outcome: CACS ≥400
	Patients Total	CACS ≥400	Crude OR	Adjusted OR
Non-RA	45,815	4741	Ref.	Ref.
RA	395	59	1.52 (1.15–2.01)	1.21 (0.89–1.65)
Secondary outcome: Obstructive CAD
	Patients Total	Obstructive CAD	Crude OR	Adjusted OR
Non-RA	42,569	7515	Ref.	Ref.
RA	353	70	1.15 (0.89–1.50)	1.05 (0.80–1.37)

Abbreviations: RA, rheumatoid arthritis; CACS, coronary artery calcium score; CAD, coronary artery disease; OR, odds ratio.

Table 3 Secondary Analyses of Rheumatoid Arthritis Subgroups versus Non-Rheumatoid Arthritis Patients for the Primary Outcomes; CACS > 0 and CACS ≥ 400, and Secondary Outcome; Obstructive CAD. All Results Adjusted for Sex, Age, Smoking, BMI, Family History of Cardiovascular Disease, Dyslipidemia, Hypertension, Diabetes and Comorbidity Score

Primary outcome: CACS> 0
	Patients Total	CACS >0	Crude OR	Adjusted OR
Non-RA	45,815	22,915	Ref.	Ref.
Serology
Other RA	78	43	1.23 (0.79–1.92)	0.83 (0.50–1.37)
Seropositive RA	317	193	1.56 (1.24–1.95)	1.16 (0.89–1.50)
DMARD treatment
csDMARD	274	168	1.58 (1.24–2.02)	1.10 (0.83–1.45)
bDMARD	121	68	1.28 (0.89–1.84)	1.05 (0.70–1.59)
Relapse/flare treatment
0 injections	242	136	1.28 (0.99–1.65)	0.93 (0.70–1.25)
≥1 injections	153	100	1.89 (1.35–2.63)	1.37 (0.94–2.00)
Primary outcome: CACS ≥ 400
	Patients Total	CACS ≥400	Crude OR	Adjusted OR
Non-RA	45,815	4741	Ref.	Ref.
Serology
Other RA	78	8	0.99 (0.48–2.06)	0.69 (0.31–1.52)
Seropositive RA	317	51	1.66 (1.23–2.24)	1.37 (0.98–1.90)
DMARD treatment
csDMARD	274	44	1.66 (1.20–2.29)	1.28 (0.90–1.83)
bDMARD	121	15	1.23 (0.71–2.11)	1.04 (0.57–1.89)
Relapse/flare treatment
0 injections	242	33	1.37 (0.95–1.98)	1.06 (0.71–1.59)
≥ 1 injections	153	26	1.77 (1.16–2.71)	1.46 (0.92–2.31)
Secondary outcome: Obstructive CAD
	Patients Total	Obstructive CAD	Crude OR	Adjusted OR
Non-RA	42,569	7515	Ref.	Ref.
Serology
Other RA	75	15	1.17 (0.66–2.05)	1.01 (0.56–1.81)
Seropositive RA	278	55	1.15 (0.86–1.55)	1.06 (0.78–1.43)
DMARD treatment
csDMARD	244	56	1.39 (1.03–1.88)	1.24 (0.91–1.69)
bDMARD	109	14	0.69 (0.39–1.21)	0.64 (0.36–1.14)
Relapse/flare treatment
0 injections	217	42	1.12 (0.80–1.57)	1.01 (0.71–1.43)
≥1 injections	136	28	1.21 (0.80–1.83)	1.11 (0.72–1.70)

Abbreviations: RA, rheumatoid arthritis; CACS, coronary artery calcium score; csDMARD, conventional synthetic disease-modifying antirheumatic drugs; bDMARD, biological disease-modifying antirheumatic drugs; OR, odds ratio; CAD, coronary artery disease.