Metabolic cardiovascular risk burden and atherosclerosis in African black and Caucasian women with rheumatoid arthritis: a cross-sectional study.

OBJECTIVES: The impact of metabolic risk factors on atherosclerotic cardiovascular disease (ACVD) in patients with rheumatoid arthritis (RA) from developing populations is currently unknown. We examined the relationships of the metabolic syndrome (MetS) and its components with carotid artery atherosclerosis in African women with rheumatoid arthritis (RA) from a developing black and developed Caucasian population. METHODS: We assessed the associations of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) defined MetS and its criteria with high resolution B-mode ultrasound determined common carotid artery intima-media thickness (cIMT) and carotid artery plaque in multivariable regression models in 104 black and 93 Caucasian women with RA. RESULTS: The MetS prevalence was 30.8% in black compared to 9.7% in Caucasian women with RA (adjusted odds ratio [95% confidence interval]=10.11 [1.76-58.03] [p=0.009]). Population origin impacted on the relationships of metabolic risk factors with atherosclerosis. In Caucasian women, the MetS was associated with cIMT (p=0.036) and MetS triglycerides and the number of MetS criteria were each associated with both cIMT (p=0.01 and p=0.028, respectively) and plaque (p=0.049 and p=0.02, respectively); by contrast, in black women, MetS blood pressure was related to cIMT (p=0.04). CONCLUSIONS: A high overall metabolic cardiovascular risk burden as disclosed by markedly prevalent MetS in women with RA from developing groups of black African descent was not associated with atherosclerosis. This calls for systematic rigorous cardiovascular risk management irrespective of metabolic risk factor profiles in African black women with RA.

The carotid artery atherosclerosis burden and its relation to cardiovascular risk factors in black and white Africans with established rheumatoid arthritis: a cross-sectional study.

OBJECTIVE: Black Africans currently experience a distinctly low frequency of atherosclerotic cardiovascular disease. Whether this protection persists in those with rheumatoid arthritis (RA) is unknown. We compared the carotid atherosclerosis burden and its relationships with cardiovascular (CV) risk factors between Africans with RA from a developing black and developed CV population. METHODS: We performed high resolution B-mode ultrasonography and assessed CV risk factors in 243 patients with established RA, of whom 121 were black and 122 white. Data were analyzed in age, sex, and healthcare center-adjusted regression models. RESULTS: The mean±SD common carotid intima-media thickness (cIMT) was 0.694±0.097 mm in black and 0.712±0.136 mm in white patients (adjusted p=0.8). Plaque prevalence was also similar in black compared to white cases (35.5% and 44.3%, respectively; adjusted OR 0.83, 95% CI 0.32-2.20, p=0.7). Interactions between population grouping and several CV risk factors were independently associated with cIMT and plaque. In stratified analysis, that is, in each population group separately, risk factors associated with cIMT or/and plaque comprised the systolic blood pressure (p=0.02), serum cholesterol/high-density lipoprotein cholesterol ratio (p=0.004), C-reactive protein concentrations (p=0.01), and the presence of extraarticular manifestations (p=0.01) in whites but, contrastingly, the Arthritis Impact Measurement Scales tension score (p=0.04) and use of nonsteroidal antiinflammatory agent (p=0.03) in black patients. The Framingham score was significantly associated with atherosclerosis only in whites (p<0.0001). CONCLUSION: The carotid atherosclerosis burden is similar in black compared to white Africans with RA, but relationships between modifiable CV risk factors and atherosclerosis vary substantially among Africans with RA.