Background The metabolic syndrome (MetS) and its components are associated with atherosclerosis in patients with rheumatoid arthritis (RA) that belong to developed populations [1-2]. Whereas approximately 80% of ACVD now occurs in developing countries , the impact of metabolic risk factors on atherosclerotic cardiovascular disease (ACVD) in patients with RA from developing populations is currently unknown.
Objectives To compare the metabolic cardiovascular risk burden and the relationships of the MetS and its components with carotid artery atherosclerosis between African women with rheumatoid arthritis (RA) from a developing black and developed Caucasian population.
Methods We assessed the prevalence of the National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII) defined MetS and its criteria and their relationships 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). Each MetS criterion was most frequently observed in black women and the mean (SD) number of MetS criteria was 2.1 (1.0) and 1.3 (1.1) in black and Caucasian women, respectively (adjusted p=0.03). Population origin impacted independently on the relationships of metabolic risk factors with atherosclerosis. In Caucasian women, the MetS was associated with cIMT (standardized (S) beta (95% confidence interval (CI)=0.19 (0.01-0.35), p=0.036) and MetS triglycerides and the number of MetS criteria were each associated with both cIMT (S beta=0.24 (0.05-0.39), p=0.01 and S beta=0.21 (0.02-0.35), p=0.028, respectively) and plaque (odds ratio (OR) (95%CI)=5.30 (1.00-28.46), p=0.049 and OR (95%CI)=1.89 (1.09-3.26), p=0.02, respectively); by contrast, in black women, an association between MetS blood pressure and cIMT (S beta (95%CI)=0.29 (0.01-0.40), p=0.04) comprised the only relationship between metabolic risk and ultrasound measurements.
Conclusions A large overall metabolic cardiovascular risk burden in women with RA from developing groups of black African descent may not as yet accelerate atherogenesis since their sustained relationship between MetS blood pressure and cIMT likely reflects adaptive responses of arterial media cells rather than atherosclerosis.
Dessein PH et al. J Rheumatol 2006;33:2425-32.
Chung CP et al. Atherosclerosis 2008;196:758-63.
Yusuf S et al. Lancet 2004;364:937-52.
Disclosure of Interest P. Dessein Grant/Research support from: Medical Research Council Grant, G. Norton: None Declared, B. Joffe: None Declared, A. Abdool-Carrim: None Declared, B. Stevens: None Declared, A. Woodiwiss: None Declared, A. Solomon: None Declared