The prevalence of coronary artery disease in rheumatoid arthritis patients in Palestine: a cross-sectional study

TL;DR

This study found that 25.5% of Palestinian rheumatoid arthritis patients have coronary artery disease, driven by traditional risk factors and inflammation.

Contribution

The study provides the first data on CAD prevalence in Palestinian RA patients and identifies novel predictors like low-positive anti-CCP titers.

Findings

25.5% of RA patients in the study had coronary artery disease.

Higher disease activity and elevated CRP levels were strong predictors of CAD.

Low-positive anti-CCP antibody titers were associated with the highest CAD risk.

Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disorder associated with a significantly increased risk of cardiovascular events. This study aims to assess the prevalence of coronary artery disease (CAD) and its associated risk factors among Palestinian patients with RA, a population for which this data has been lacking.

A cross-sectional study was conducted from March to September 2024 at multiple rheumatology clinics in the West Bank, Palestine. The study included 384 patients with a confirmed RA diagnosis based on the American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria. Data were collected on demographic characteristics, traditional cardiovascular risk factors, and RA-specific factors, including disease activity measured by the Disease Activity Score 28 (DAS28) and C-reactive protein (CRP) levels. Multivariable analysis was used to identify independent predictors of CAD.

The prevalence of CAD in this cohort was 25.5%. Multivariable analysis revealed that CAD was independently predicted by increasing age, dyslipidemia, and a first-degree family history of CAD. Markers of systemic inflammation, specifically higher disease activity (DAS28 Prevalence Ratio = 1.309) and elevated CRP levels (PR up to 2.108 for levels > 10 mg/L), also emerged as potent and independent predictors. Furthermore, a paradoxical, non-linear association was observed with anti-CCP antibody status, where low-positive titers conferred the highest risk (PR = 1.811), and a modest inverse association with BMI was noted (PR = 0.992), consistent with the ‘obesity paradox’.

This study reveals a high prevalence of CAD among Palestinian patients with RA, driven by both traditional metabolic risk factors and RA-related systemic inflammation. The findings highlight an urgent need to integrate proactive cardiovascular disease prevention into the standard of care for RA in Palestine, recognizing RA as a cardiovascular risk-equivalent condition.

The online version contains supplementary material available at 10.1186/s41927-026-00613-3.

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