Int J Rheum Dis. 2019;00:1–16. wileyonlinelibrary.com/journal/apl | 1 © 2019 Asia Pacific League of Associations for Rheumatology and John Wiley & Sons Australia, Ltd Received: 17 September 2017 | Revised: 2 June 2019 | Accepted: 5 August 2019 DOI: 10.1111/1756-185X.13685 ORIGINAL ARTICLE Coronary artery calcium score in female rheumatoid arthritis patients: Associations with apolipoproteins and disease biomarkers Miguel Bernardes 1,2 | António Madureira 2,3 | Ana Oliveira 4 | Maria João Martins 5,6 | Raquel Lucas 7,8 | Lúcia Costa 1 | Jorge G. Pereira 4 | Francisco Ventura 9 | Isabel Ramos 2,3 | Elisabete Martins 2,6,10 1 Department of Rheumatology, São João Hospital Center, Porto, Portugal 2 Department of Medicine, Faculty of Medicine, University of Porto, Porto, Portugal 3 Department of Radiology, São João Hospital Center, Porto, Portugal 4 Department of Nuclear Medicine, São João Hospital Center, Porto, Portugal 5 Departamento de Biomedicina, Unidade de Bioquímica, Faculdade de Medicina, Universidade do Porto, Porto, Portugal 6 Instituto de Investigação e Inovação em Saúde (i3s), Universidade do Porto, Porto, Portugal 7 EPI Unit-Institute of Public Health, University of Porto, Porto, Portugal 8 Department of Clinical Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal 9 Faculty of Medicine, University of Porto, Porto, Portugal 10 Department of Cardiology, São João Hospital Center, Porto, Portugal Correspondence Miguel Bernardes, Department of Rheumatology, São João Hospital Center, Porto, Portugal; Department of Medicine, Faculty of Medicine, University of Porto, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal. Email: mbernardes09@gmail.com Funding information This study was supported by Associação Nacional de Reumatologia, Portugal. Abstract Aims and methods: In rheumatoid arthritis (RA), cardiovascular (CV) comorbidities are a major cause of mortality. Coronary Calcium Score (CCS) assessed by computed tomography has been associated with RA prognosis. In this work, we aimed to as- sess CCS in female RA patients and determine CCS association with different clinical, laboratory and imaging disease parameters. Results: We evaluated 60 female patients, with a mean age of 53.6 ± 10.4 years, a mean Disease Activity Score of 28 joints (DAS28) (4v) and Health Assessment Questionnaire (HAQ) of 4.542 ± 1.317 and 1.488 ± 0.631, respectively, and a disease duration of 14.7 ± 10.3 years. Mean CCS value was 35.192 ± 117.786. CCS > 10 was significantly associated with CV risk factors (age: odds ratio [OR] = 1.120; P = .002, body mass index [BMI] ≥ 25 kg/m 2 : OR = 0.271; P = .025, high-density lipoprotein [HDL]: OR = 0.011; P = .025, low-density lipoprotein/ HDL ratio: OR = 2.084; P = .030, apolipoprotein A1 [ApoA1]: OR = 0.965; P = .014, apolipoprotein B/ApoA1 [ApoB/ ApoA1] ratio: OR = 59.834; P = .011, homocysteine: OR = 1.287; P = .045, diabetes: OR = 10.400; P = .043, and anti-diabetic therapy: OR = 10.667, P = .041), disease parameters (C-reactive protein [CRP]: OR = 1.038; P = .046, DAS[4v]: OR = 1.900; P = .009, DAS28[4v; CRP]: OR = 1.700; P = .019, DAS[3v]: OR = 1.947; P = .010, DAS28[3v; CRP]: OR = 1.696; P = .022, HAQ: OR = 3.299; P = .023, erosion score: OR = 1.015; P = .012, and total modified Sharp/van der Heijde Score: OR = 1.008; P = .035), biomarkers (osteoprotegerin: OR = 1.505; P = .022), and bone mineral den- sity (femoral: OR = 0.005; P = .018, lumbar spine: OR = 0.001; P = .002, left hand: OR = 7.9 × 10 −9 ; P = .005, and osteoporosis: OR = 6.628; P = .007). After adjustment for age and BMI, significant associations were maintained with ApoA1, ApoB/ApoA1 ratio, homocysteine, CRP, DAS(4v), DAS(4v; CRP), DAS(3v) and DAS(3v; CRP). A sen- sitivity analysis undertaken after excluding the 6 diabetics yielded similar results. Conclusions: Our work reinforces the hypothesis that in RA, CCS may be a useful tool in CV risk assessment, particularly valuable in poorer controlled patients with certain lipoprotein profiles.