Objectives To estimate the frequency of atherosclerotic damage of major arteries and coronary artery disease (CAD) in rheumatoid arthritis (RA) patients on the basis of analysis of postmortem examination reports of the Minsk City Clinical Pathologoanatomic Bureau (The Republic of Belarus).
Methods We have estimated atherosclerotic damage of coronary and other major arteries on the basis of autopsy data reports on postmortem and biopsy material microscopic examinations and cases of established clinical diagnosis of CAD in RA patients.
Results The average annual mortality rate in adults was 11.7‰ (CI95 11.6-11.9‰) in Minsk in 2001-2005. The mean number of in-patients dead for the mentioned period was 3464, the mean autopsy number - 2657. Of these, 349 autopsies were performed in patients with rheumatic diseases and 37 - in RA patients. RA was established as the main pathologic diagnosis in 29 (78.4%) and as a concomitant pathologic diagnosis in 8 (21.6%) patients. Cardiovascular diseases (CVDs) associated with the atherosclerosis were diagnosed in 32 (86.5%) RA patients. CAD was diagnosed in 29 (78.4%) patients: 7 (18.9%) cases of acute coronary syndromes and 22 (59.5%) - chronic CAD; arrhythmias due to CAD were revealed in 10 (27.0%) patients. CVDs were considered as the principal cause of death in 8 (21.6%) RA patients with 3 myocardial infarction cases complicated with acute heart failure (HF) and 3 CADs with congestive HF, 1 ischemic brain stem infarction and 1 infective endocarditis with acute HF.
According to the autopsy reports atherosclerotic damage of aorta was quite a common pathology revealed in 34 (91.9%) RA patients, and varied from lipid stains and bands to atheromatosis and calcinosis. Multiple atherosclerosis plaques were revealed in 16 (43.2%) and renal artery atherosclerosis – in 11 (29.8%) patients, cerebral artery atherosclerosis - in 16 (51.6%) of 31 patients with an opened skull, abdominal aorta was predominantly affected in 7 (18.9%) patients. Coronary artery atherosclerosis was revealed in majority of autopsies (83.4%). The mean (median) age of RA patients without plaques in coronary arteries was 50.3 (50.5) years, with multiple plaques – 69.9 (71.5), with ≥50% stenosis – 69.2 (71.5) and with <50% stenosis – 55.0 (54.0). These findings conformed the clinical diagnosis of CAD. The mean (median) age of RA patients without CAD (8/37) according to the clinical data and with CAD as the main postmortem clinical diagnosis was 52.9 years (51.0) and 70.1 years (73.0) correspondingly. We have revealed a close connection between the age of dead patients and intensity of coronary atherosclerosis (multiple plaques and stenosis ≥50%) with biserial correlation coefficient (Rbs) which was 0.47 (p<0.001). On the other hand we have revealed no association between RA severity (defined as glucocorticoid dependence status) and coronary atherosclerosis intensity (correlation coefficient Rγ=-0.07, Z=-0.28, p=0.778).
Conclusions Though artery atherosclerotic damage in RA patients is a common pathology according to the autopsy data and its frequency is associated with the patient age we have revealed no association between RA severity and coronary atherosclerosis intensity that does not agree with the hypothesis of RA inductive influence on the development of atherosclerosis and CAD [1, 2].
Doran, M.F. et al. // Arthr. Rheum. 2002;46:625-631.
Mazurov, V.I. // Nauchno-pract. revm. 2006;4:28-34.
Disclosure of Interest None Declared