Cardiovascular risk factors in patients with calcium pyrophosphate crystal deposition disease

Calcium pyrophosphate  crystal deposition disease (CPCDD) is among the most common  inflammatory rheumatic diseases; however, studies of cardiovascular risks in CPCDD have not been conducted.

Objective: to stratify a cardiovascular risk in patients with CPCDD according to the systematic coronary risk evaluation (SCORE)  algorithm that allows determination of an individual 10-year risk of cardiovascular death.

Subjects and methods. The one-stage,  single-center  study of a cardiovascular risk enrolled 118 patients (43 men and 75 women) with CPCDD. Laboratory studies included determination of fasting serum glucose, total cholesterol, uric acid, magnesium,  phosphorus,  and total calcium. The level of C-reactive  protein (CRP)  was measured by a highly sensitive method;  CRP >5 mg/L was taken as a high level; parathyroid  hormone  was determined  by chemiluminescence immunoassay.  The SCORE  table was used to assess the total cardiovascular risk in all the patients.

Results and discussion. The patients' mean age was 60.7±12.4 years. According to the SCORE scale, very high and high risks of cardiovascular death were found in 59 (50%) and 6 (5%) patients, respectively; only in 10% of cases this risk was associated exclusively with age (> 65 years); 60 (50.8%) of the 118 patients did not have previous cardiovascular events or atherosclerosis risk factors. Coronary heart disease was detected in 28.8% of the 118 patients; hypertension was identified in 64%; diabetes mellitus (DM)  was found in almost 15%. The mean SCORE values did not significantly differ in men and women. The level of CRP was higher in men than that in women (8.6±4.6 and 7.3±3.5 mg/dL,  respectively; p = 0.04). Glomerular  filtration rate (GFR) <60 ml/min was detected in 11 patients at a very high cardiovascular risk due to the presence of chronic kidney disease; two of them were also diagnosed with DM; two had chronic heart failure, one patient had a history of stroke and another  had that of myocardial infarction.  The patients with GFR  <100 ml/min were more frequently found to be at high risk by the SCORE scale than those with GFR >100 ml/min: 61% (60/98) and 25% (5/20) of patients, respectively (p = 0.003). Hyperparathyroidism (HPT)  was detected in 12 (10%) patients, and 7 of them were at a very high risk by the SCORE scale; however, hypercalcemia was diagnosed in only three cases. The results of the SCORE stratification of the whole group showed that 64 (54.2%) of the 118 patients with CPCDD were at a very high or high risk, the latter was very high in exactly half of the cases (n = 59.

Conclusion. One-half of patients with CPCDD have a very high cardiovascular risk. In addition to the high detection  rate of traditional  cardiovascular risk factors (hypertension, smoking, hypercholesterolemia, and DM),  the presence of chronic microcrystalline  inflammation, concomitant metabolic disorders and diseases (hyperuricemia, HPT,  decreased renal function)  should be taken into account when determining the cardiovascular risk in patients with CPCDD.

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