ABSTRACT
Cardiovascular event rates are markedly increased in rheumatoid arthritis [RA], and RA atherogenesis remains poorly understood. The relative contributions of traditional and nontraditional risk factors to cardiovascular disease [CVD] in RA await elucidation. To compare traditional and nontraditional cardiovascular risk factors in RA patients Vs age and sex-matched healthy control population and in seropositive Vs seronegative RA patients and to correlate these potential risk factors with the disease duration and activity. Thirty nine active RA women were divided according to the presence or absence of rheumatoid factor into two groups and twenty nine age- and sex-matched apparently healthy control women. After controlling for age and menopausal status, traditional cardiovascular risk factors including body mass index [BMI], waist circumference, hypertension, fasting lipids [Triglycerides [TG], Total cholesterol [TC], Low density lipoprotein cholesterol [LDL-C] and High density lipoprotein cholesterol [HDL-C]], and insulin sensitivity [IS], and nontraditional cardiovascular risk factors, including high-sensitivity C-reactive protein [hs-CRP], IL-1, IL-6 and tumor necrosis factor-a were compared in RA patients versus healthy control individuals and in seropositive versus seronegative RA patients. Insulin sensitivity was determined by the Quantitative Insulin Sensitivity Check Index [QUICKI]. Traditional and nontraditional risk factors for CVD were correlated with disease duration and activity. Rheumatoid factor was positive in twenty six [67%] of RA patients. Significant higher percentage of individuals with hypertension [p<0.05], significant lower levels of HDL-C and QUICKI [p<0.001, <0.05 respectively] and significant higher levels of LDL-C and hs-CRP, IL-1, IL-6 and TNF-a concentrations [p<0.05, 0.001, 0.001, 0.001 and 0.001 respectively] were observed in RA patients Vs controls. Significant lower HDL-C [p<0.05] and higher hs-CRP, and IL-6 concentrations [p<0.01, 0.05 respectively] were observed in seropositive Vs seronegative RA patients. No correlation was found between traditional and nontraditional risk factors for CVD and duration of disease. HDL-cholesterol, hs-CRP, Interleukin -1 and Interleukin -6 correlated significantly with disease activity score [p<0.05, <0.01, <0.05 and <0.02 respectively]. Excess traditional and nontraditional cardiovascular risk factors were observed in RA patients as compared with controls and in seropositive RA patients as compared with seronegative RA patients. This results in a tendency towards increased frequency of CV death in RA patients, more commonly in seropositive patients. Non-traditional risk factors play a more important role than traditional risk factors in cardiovascular disease in RA