Cardiovascular risk factors in women with and without rheumatoid arthritis
Daniel H Solomon1, Gary C Curhan, Eric B Rimm
1Division of Pharmacoepidemiology, Brigham and Women's Hospital, Harvard Medical School, 1620 Tremont Street, Boston, MA 02120, USA. dhsolomon@partners.org
Insights
Women with rheumatoid arthritis (RA) show similar traditional cardiovascular disease (CVD) risk factors but elevated inflammatory biomarkers linked to CVD compared to women without RA. This highlights the inflammatory component of CVD risk in RA patients.
Area of Science:
- Rheumatology
- Cardiovascular Medicine
- Epidemiology
Background:
- Rheumatoid arthritis (RA) is associated with an increased risk of cardiovascular disease (CVD).
- Understanding the distribution of CVD risk factors and biomarkers in RA patients is crucial for risk stratification and management.
- This study investigates CVD risk profiles in women with and without RA.
Purpose of the Study:
- To compare traditional cardiovascular disease (CVD) risk factors between women with and without rheumatoid arthritis (RA).
- To analyze biomarkers of CVD in women with and without RA.
- To identify specific risk factor profiles associated with RA in relation to CVD.
Main Methods:
- Utilized data from the Nurses' Health Study, a prospective longitudinal cohort.
- Examined clinical CVD risk factors via mailed questionnaire in 1990.
- Analyzed CVD biomarkers in a biospecimen cohort (blood samples from 1989), adjusting for age, BMI, smoking, and menopause status.
Main Results:
- Women with RA reported higher rates of no alcohol use and past smoking but similar current smoking status, BMI, and other traditional risk factors.
- Elevated levels of inflammatory biomarkers (CRP, fibrinogen, sICAM-1, sTNFRI, sTNFRII, osteoprotegerin) were observed in women with RA.
- Lipid profiles and homocysteine levels were similar, while vitamin B12 was higher in women with RA.
Conclusions:
- Most traditional CVD risk factors were comparable between women with and without RA.
- Biomarkers of inflammation associated with CVD were generally elevated in women with RA.
- Findings underscore the role of inflammation in CVD risk among RA patients.
Objective:
The risk of cardiovascular disease (CVD) is increased in patients with rheumatoid arthritis (RA). The objective of this study was to examine the distribution of known CVD risk factors and biomarkers of CVD in women with and without RA.
Methods:
This study included two components: an examination of clinical CVD risk factors among women participating in the Nurses' Health Study, a prospective longitudinal cohort, and an analysis of CVD biomarkers among a subgroup of women from this cohort who provided a blood specimen in 1989 (biospecimen cohort). Data regarding clinical risk factors for CVD were collected in 1990 by mailed questionnaire. The diagnosis of RA was confirmed through a structured medical record abstraction. We compared clinical risk factors for CVD and biomarkers of CVD between women with and without RA, adjusting for age, body mass index (BMI), smoking status, and menopause status.
Results:
Women with RA (n = 287) were significantly more likely than women without RA (n = 87,019) to report no alcohol use (48.2% versus 39.4%) and past cigarette smoking (47.8% versus 38.0%). No significant differences between these groups were observed for current smoker status, BMI, regular aspirin use, diabetes, hypertension, physical activity, and family history of early myocardial infarction. In the biospecimen cohort (69 RA cases and 491 controls), the levels of several inflammatory biomarkers linked to CVD were significantly elevated in women with RA, including CRP, fibrinogen, sICAM-1, sTNFRI, sTNFRII, and osteoprotegerin. Levels of total cholesterol, low-density lipoprotein, triglycerides, apolipoprotein B, and Lp(a) were similar between groups. Levels of homocysteine were similar, but vitamin B(12) was significantly higher among women with RA than among the controls.
Conclusion:
In women participating in the Nurses' Health Study, most traditional CVD risk factors were similar between those who had RA and those who did not. However, as expected, biomarkers of inflammation associated with CVD were generally elevated in women with RA.
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