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Lipids, myocardial infarction and ischaemic stroke in patients with rheumatoid arthritis in the

A G Semb1, T K Kvien, A H Aastveit

  • 1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. a-semb@diakonsyk.no

Annals of the Rheumatic Diseases
|June 17, 2010
PubMed

Insights

Patients with rheumatoid arthritis (RA) have a 1.6 times higher risk of acute myocardial infarction (AMI) and ischaemic stroke (IS). Cholesterol and triglycerides predict cardiovascular events in the general population but not consistently in RA patients.

Area of Science:

  • Cardiovascular epidemiology
  • Rheumatology
  • Lipid metabolism

Background:

  • Rheumatoid arthritis (RA) is associated with increased cardiovascular disease (CVD) risk.
  • The predictive value of lipid profiles for CVD events in RA patients remains incompletely understood.

Purpose of the Study:

  • To investigate the incidence of acute myocardial infarction (AMI) and ischaemic stroke (IS) in individuals with and without RA.
  • To assess the predictive capacity of total cholesterol (TC) and triglycerides (TG) for AMI and IS in both RA patients and controls.

Main Methods:

  • The Apolipoprotein MOrtality RISk (AMORIS) Study cohort of 480,406 individuals, including 1,779 with RA, was followed for a median of 11.8 years.
  • Cox regression analysis was employed to calculate hazard ratios (HR) per standard deviation (SD) increase in TC or TG, adjusted for age, diabetes, and hypertension.

Main Results:

  • Individuals with RA exhibited significantly lower TC and TG levels compared to those without RA.
  • Despite lower lipid levels, RA patients had a 1.6-fold higher rate of AMI and IS.
  • TC was a significant predictor of IS in RA patients (HR/SD 1.20, p=0.02) and nearly significant for AMI (HR/SD 1.13, p=0.07).
  • TG showed a weak association with IS (HR/SD 1.13, p=0.06) but not AMI.
  • In contrast, both TC and TG were significant predictors of AMI and IS in individuals without RA.

Conclusions:

  • Patients with RA experience a substantially higher incidence of AMI and IS compared to the general population.
  • While TC and TG are established predictors of cardiovascular events in non-RA individuals, their predictive utility in RA patients is inconsistent.
  • Further research is warranted to elucidate the specific mechanisms driving cardiovascular risk in RA.
Abstract

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