Background Reported findings on the relationship between adiposity and atherosclerotic cardiovascular disease (ACVD) risk in rheumatoid arthritis (RA) are contradictory and originate in developed populations [1-4], whereas approximately 80% of ACVD now occurs in developing countries .
Objectives To ascertain the associations of anthropometric measures with metabolic cardiovascular risk and atherosclerosis in African women with RA from a developing black and developed Caucasian population.
Methods The associations of body mass index (BMI) as an indicator of overall adiposity and waist circumference and waist-to-height and waist-to-hip ratios as abdominal obesity indices with metabolic risk factors and high resolution B-mode ultrasound determined carotid artery atherosclerosis were assessed in multivariable regression models in 203 African women with established RA; 108 were black and 95 Caucasian.
Results The mean (SD) BMI and waist-to-height ratio were higher in African black compared to Caucasian women with RA (29.9 (6.6) versus 25.3 (4.9) kg/m2, p=0.002 and 0.59 (0.09) versus 0.53 (0.08), p=0.01, respectively). Interactions between population origin and anthropometric measures were not related to metabolic risk factors but were associated with atherosclerosis, independent of confounders and individual terms. In all patients, BMI was related to systolic and diastolic blood pressure but not to serum lipid concentrations whereas abdominal obesity indices were associated with serum lipid concentrations but not with blood pressure values; anthropometric measures that were associated with plasma glucose concentrations comprised BMI, waist circumference and waist-to-height ratio (p<0.05 in multiple confounder adjusted analysis). In African Caucasian women, BMI was independently associated with common carotid artery intima-media thickness (standardized beta (95% CI)=0.21 (0.03 to 0.38)) and waist-to-hip ratio with plaque (OR (95% CI)=1.83 (1.03 to 3.25) for 1 SD increase). These relationships were independent of multiple non-metabolic risk factors but explained by metabolic risk factors. In African black women with RA, none of the anthropometric measures was related to atherosclerosis.
Conclusions Obesity in women with RA from developing groups of black African descent does not as yet translate into atherosclerosis. In Caucasian women with RA that belong to developed populations, BMI and waist-to-hip ratio should be considered in ACVD risk assessment.
Stavropoulos-Kalinoglou A et al. Ann Rheum Dis 2009,68:242-5.
Dessein PH et al. Arthritis Rheum 2006;54:2765-75.
Maradit Kremers H et al. Arthritis Rheum 2004;50:3450-7.
Stavropoulos-Kaniloglou A et al; Rheumatology 2011;50:450-62.
Yusuf S et al. Lancet 2004;364:937-52.
Disclosure of Interest P. Dessein Grant/Research support from: Medical Research Grant, G. Norton: None Declared, A. Woodiwiss: None Declared, A. Solomon: None Declared