The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis.

Abstract

OBJECTIVE:

To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients.

METHODS:

We conducted a retrospective cohort study using 2005-2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess non-linear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes.

RESULTS:

We identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol ≥60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS.

CONCLUSIONS:

This study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.

• Authors: Jie Zhang, Lang Chen, Elizabeth Delzell, Paul Muntner, William B Hillegass, Monika M Safford, Iris Yolanda Navarro Millan, Cynthia S Crowson, Jeffrey R Curtis
• Journal: Annals of the rheumatic diseases (Ann Rheum Dis) Vol. 73 Issue 7 Pg. 1301-8 (Jul 2014) ISSN: 1468-2060 [Electronic] England
• PMID: 24796336 (Publication Type: Journal Article, Research Support, N.I.H., Extramural, Research Support, Non-U.S. Gov't)
• Copyright: Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Chemical References

• Biomarkers
• Cholesterol, HDL
• Cholesterol, LDL
• C-Reactive Protein

Topics

• Adult
• Arthritis, Rheumatoid (blood, complications, metabolism)
• Biomarkers (blood, metabolism)
• Blood Sedimentation
• Brain Ischemia (blood, complications, metabolism)
• C-Reactive Protein (metabolism)
• Cholesterol, HDL (blood)
• Cholesterol, LDL (blood)
• Cohort Studies
• Female
• Humans
• Inflammation (blood, complications, metabolism)
• Male
• Middle Aged
• Multivariate Analysis
• Myocardial Infarction (blood, complications, metabolism)
• Proportional Hazards Models
• Retrospective Studies
• Risk Factors
• Stroke (blood, etiology, metabolism)