Correlative Study Of Rheumatoid Arthritis With Coronary Heart Disease

Part Ⅰ:Association between rheumatoid arthritis and myocardial infarctionObjective To evaluate the clinical differences between patients with rheumatoid arthritis (RA) and coronary atherosclerotic heart disease (CAD) and those CAD patients without RA. To expore whether RA was a risk factor for myocardial infarction (MI).Methods This study included 50 consecutive patients with RA and 50 free of RA in Fuwai cardiovascular disease hospital. The characteristics of both groups were compared. Multivariate model were used to explore the relationship between RA and MI.Results There were no significant differences about demographics, traditional cardiovascular factors between RA group and control group except for the level of body mass index (p=0.025) and percentage of dyslipidemia (p=0.025), which were much lower in RA group. The percentage of MI (p=0.000) was significantly higher in RA group than control group. The result of multivariate logistic’s regression showed that RA was an independent risk factor for MI (P=0.002) in CAD patient. Conclusion RA is an independent risk factor for MI.Part Ⅱ:Red Cell Distribution in Rheumatoid Arthritis Patients with Coronary Atherosclerotic Heart DiseaseObjective:Inflammatory response has observed in myocardial infarction (MI). Rheumatoid arthritis (RA) is a kind of systemic inflammatory disease and our study have proved MI happened more frequently in RA patients than general people. This research had been done to explore the risk factors related to MI in RA patients, and the influence of the potential factors on the prognosis of RA patients with CHD after coronary revascularization.Methods:This retrospective study included 106 consecutive patients with RA in Fuwai cardiovascular disease hospital between January 2010 and December 2012, all of them had been confirmed as coronary disease by coronary angiography. At this sampling 46 RA patients were developed MI. The control group includes 60 subjects who were free of MI. The characteristics of both groups were compared including demographics, traditional cardiovascular risks and laboratory findings. Cases of MI and controls were compared by disease activity variables and risk factors using the student’s t test or Mann-Whitney U test(for continuous variables) or the chi-squaretest (for dichotomous variables). Variables that had a p value of<0.1 in the single factor logistic regression were entered into a multivariate model. Among 106 patients,76 cases with completely follow-up were included in further study. They were divided into two groups (RDW≥13.8%, RDW<13.8%). The association between RDW and adverse outcome of RA patients with CHD was assessed using Cox proportional hazards analysis.Results:There were no significant differences about demographics, traditional cardiovascular risk factors between MI group and control group, such as age, gender, body mass index (BMI), the percentage of hypertension (HT), diabetes mellitus (DM), hyperlipidaemia (HLP) and Smoking. MI group showed increased erythrocyte sedimentation rate (ESR)(p=0.014),red blood cell distribution width (RDW)(p=0.007) C-reactive protein (CRP) (p=0.000) and creatinine (p=0.024) levels than control group. The result of univariate logistic’s regression demonstrated that ESR(p=0.009), CRP (p=0.022),CR(p=0.030), lipoproteins(LP-a) (p=0.097)and high-sensitivity C-reactive protein (Hs-CRP) (p=0.009) are associated with increased risk of MI in RA. The result of analysis of multivariate logistic’s regression showed that RDW (p=0.039) [OR (95% CI) 1.492 (1.020-2.185)] was an independent risk factor of MI in RA patients.RDW>13.8% was also associated with increased risk of adverse outcome in RA patients with CHD after coronary revascularization (p=0.000). In multivariate analysis, RDW>13.8 remained significantly associated with increased risk for adverse outcome in RA patients with CHD (HR(CI 95%)=1.061(1.033-1.089), p=0.000).Conclusions:Our findings suggest that RDW was associated with MI in RA patients with CHD and may be a novel prognostic biomarker in those patients.