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Cardiovascular disease risk amongst African black patients with rheumatoid arthritis: the need for population
Ahmed Solomon1, Linda Tsang2, Angela J Woodiwiss2
1Department of Rheumatology, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Parktown 2193, Johannesburg, South Africa.
Insights
Rheumatoid arthritis (RA) increases cardiovascular disease (CVD) risk. Risk factor assessment for CVD in African RA patients differs from white patients, necessitating tailored risk stratification strategies.
Area of Science:
- Rheumatology
- Cardiology
- Epidemiology
Background:
- Rheumatoid arthritis (RA) significantly elevates cardiovascular disease (CVD) risk, comparable to diabetes.
- Traditional and nontraditional CVD risk factors are associated with CVD in RA, but current risk stratification guidelines have limitations.
- Most CVD research in RA originates from developed nations, potentially overlooking differences in developing populations.
Purpose of the Study:
- To review CVD risk and stratification in African black RA patients compared to white RA patients.
- To describe CVD and risk factor profiles in the general African black population.
- To investigate the association of traditional and novel CVD risk factors with atherosclerosis in diverse RA populations.
Main Methods:
- Review of epidemiological data on CVD and risk factors in African populations.
- Comparative analysis of CVD risk factors in African black versus white RA patients.
- Assessment of associations between traditional/nontraditional CVD risk factors and novel biomarkers with atherosclerosis and endothelial activation.
Main Results:
- Traditional and nontraditional CVD risk factors were linked to atherosclerosis in African white RA patients but not in African black RA patients.
- Novel CVD risk biomarkers, including interleukin-6 and adipokines, showed similar associations with endothelial activation and atherosclerosis in both African black and white RA patients.
- Significant differences exist in CVD risk factor associations within RA populations across different ethnicities and geographic settings.
Conclusions:
- CVD risk stratification in RA patients from developing populations may require different approaches compared to developed populations.
- The predictive value of traditional CVD risk factors for atherosclerosis differs between African black and white RA patients.
- Novel biomarkers may offer a more consistent approach to assessing CVD risk in diverse RA populations.
Abstract:
Rheumatoid arthritis (RA) enhances the risk of cardiovascular disease to a similar extent as diabetes. Whereas atherogenesis remains poorly elucidated in RA, traditional and nontraditional risk factors associate similarly and additively with CVD in RA. Current recommendations on CVD risk stratification reportedly have important limitations. Further, reported data on CVD and its risk factors derive mostly from data obtained in the developed world. An earlier epidemiological health transition is intrinsic to persons living in rural areas and those undergoing urbanization. It is therefore conceivable that optimal CVD risk stratification differs amongst patients with RA from developing populations compared to those from developed populations. Herein, we briefly describe current CVD and its risk factor profiles in the African black population at large. Against this background, we review reported data on CVD risk and its potential stratification amongst African black compared to white patients with RA. Routinely assessed traditional and nontraditional CVD risk factors were consistently and independently related to atherosclerosis in African white but not black patients with RA. Circulating concentrations of novel CVD risk biomarkers including interleukin-6 and interleukin-5 adipokines were mostly similarly associated with both endothelial activation and atherosclerosis amongst African black and white RA patients.
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