Aim: To ascertain prevalence and prognostic implication of painless myocardial ischemia (PMI) in patients with rheumatoid arthritis (RA) in respect to stage, severity of inflammation and characteristics of the lipid profile.
Material and methods: A 24-h Holter ECG monitoring, tests for total cholesterol, triglycerides and lipid spectrum were made in 94 patients with a documented rheumatoid arthritis (RA) aged 36-68 years (mean age 54.8 +/- 8.0 years, 13 males and 81 females) admitted to Toliatti municipal hospital N 4. The control group consisted of 20 patients with a history of myocardial infarction. Forty RA patients were followed up for mean 1.1 year after basic therapy.
Results: Holter ECG monitoring detected ischemic depression of ST segment in 46 (48.9%) RA patients and 9 (45%) patients with coronary heart disease. RA patients with PMI had changes in the lipid profile in the direction of elevation of atherogenic components and C-reactive protein characterizing severity of inflammation. Basic treatment of RA eliminated PMI symptoms in some patients. This correlated with attenuation of inflammation. Some RA patients had first symptoms of PMI, on the average, on follow-up year 1.1 and higher plasmic atherogenicity.
Conclusion: About 50% RA patients free of clinical symptoms of coronary heart disease had PMI caused by both coronarogenic (atherosclerotic) factors and non-coronarogenic (immunocomplex inflammation) mechanisms.