Cardiovascular disease risk factors in newly diagnosed rheumatoid arthritis: A retrospective cohort study

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

American journal of preventive cardiology Pub Date : 2025-05-01 DOI:10.1016/j.ajpc.2025.101002

Avi G. Aronov , Yoo Jin Kim , Salman Zahid , Erin D. Michos , Noreen T. Nazir

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引用次数: 0

Abstract

Background and objectives

Patients with rheumatoid arthritis (RA) face an increased risk of cardiovascular disease (CVD) that traditional risk factors alone cannot fully explain. Chronic inflammation may influence lipid profiles and contribute to this risk. This study evaluates predictors of incident CVD in RA and explores how erythrocyte sedimentation rate (ESR) modifies the relationship between lipid levels and CVD outcomes.

Design, settings, participants, and measurements

This retrospective cohort study included 1,802 RA patients aged 40-79 years, diagnosed between 2015 and 2022, and free of CVD at diagnosis. We evaluated the association between traditional cardiovascular risk factors—including current smoking, diabetes mellitus, systolic blood pressure, body mass index (BMI), HDL cholesterol, and LDL cholesterol—and RA-specific inflammatory markers, including ESR and C-reactive protein (CRP), with the incidence of CVD. Cox proportional hazards models adjusted for age, sex, race/ethnicity, antihypertensive medications, lipid-lowering medications, and antiplatelet medications.

Results

During a median follow-up of 3.5 years, 187 patients (10.4 %) developed CVD. The mean BMI was 32 kg/m² (standard deviation [SD] 10), HDL cholesterol was 53 mg/dL (SD 17), and LDL cholesterol was 104 mg/dL (SD 37). The median ESR was 21 mm/hr (interquartile range [IQR] 11–42) and CRP was 6 mg/L (IQR 3–12). Higher LDL cholesterol was inversely associated with CVD risk (HR 0.77 per SD increase, 95 % CI 0.63–0.94), with this association weakening with increasing ESR levels (interaction term HR 0.84, 95 % CI 0.71–0.99). Elevated HDL cholesterol also showed significantly decreased CVD risk (HR 0.82 per SD increase, 95 % CI 0.68–0.97). Smoking and diabetes were associated with increased risks (HR 1.52, 95 % CI 1.07–2.17 and HR 2.08, 95 % CI 1.39–3.10, respectively).

Conclusion

This study highlights the complex interplay between lipid levels and inflammation in RA, highlighting the nuances of CVD risk assessment in RA.

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新诊断的类风湿性关节炎的心血管疾病危险因素：一项回顾性队列研究

背景和目的类风湿关节炎（RA）患者患心血管疾病（CVD）的风险增加，传统的危险因素不能完全解释这一点。慢性炎症可能影响脂质谱，并导致这种风险。本研究评估类风湿关节炎CVD发生的预测因素，并探讨红细胞沉降率（ESR）如何改变脂质水平与CVD结果之间的关系。设计、设置、参与者和测量本回顾性队列研究包括1802例年龄在40-79岁之间的RA患者，诊断于2015年至2022年之间，诊断时无心血管疾病。我们评估了传统心血管危险因素（包括吸烟、糖尿病、收缩压、体重指数（BMI）、高密度脂蛋白胆固醇和低密度脂蛋白胆固醇）和ra特异性炎症标志物（包括ESR和c反应蛋白（CRP））与心血管疾病发病率之间的关系。Cox比例风险模型校正了年龄、性别、种族/民族、抗高血压药物、降脂药物和抗血小板药物。结果在中位3.5年的随访期间，187例患者（10.4%）发展为CVD。平均BMI为32 kg/m²（标准差[SD] 10）， HDL胆固醇为53 mg/dL (SD 17)， LDL胆固醇为104 mg/dL （SD 37）。中位ESR为21 mm/hr（四分位数范围[IQR] 11-42）， CRP为6 mg/L （IQR 3-12）。较高的LDL胆固醇与CVD风险呈负相关（HR 0.77 / SD升高，95% CI 0.63-0.94），这种关联随着ESR水平的升高而减弱（相互作用项HR 0.84, 95% CI 0.71-0.99）。高密度脂蛋白胆固醇升高也显示心血管疾病风险显著降低（HR 0.82 / SD升高，95% CI 0.68-0.97）。吸烟和糖尿病相关的风险增加（HR 1.52, 95% CI 1.07-2.17, HR 2.08, 95% CI 1.39-3.10）。结论本研究强调了类风湿性关节炎中脂质水平与炎症之间的复杂相互作用，强调了类风湿性关节炎中心血管疾病风险评估的细微差别。

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