# 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.

## Key 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.