Background Compared to persons from developed populations, those that belong to developing populations are at an earlier epidemiological health transition stage [1-3]. Accordingly, black Africans still experience a distinctly low prevalence of atherosclerotic cardiovascular disease [2-3]. It is unknown whether this protection is present in patients with established rheumatoid arthritis (RA) from developing populations [4].

Objectives To compare the carotid atherosclerosis burden and its relationships with cardiovascular risk and predisposing factors between Africans with RA from a developing black and developed Caucasian population.

Methods We assessed cardiovascular risk factors and the carotid intima-media thickness (cIMT) and plaque by high resolution B-mode ultrasound in 243 patients with established RA of whom 121 were black and 122 Caucasian. Data were analyzed in multivariable regression models.

Results The mean (SD) cIMT was 0.694 (0.097) and 0.712 (0.136) mm in black and Caucasian patients (adjusted p=0.8), respectively. Plaque prevalence was also similar in black compared to Caucasian cases (35.5 and 44.3%, respectively; adjusted OR [95% CI]=0.83 [0.32-2.20], p=0.7). Compared to their Caucasian counterparts, black patients with RA had more prevalent hypertension, a smaller pack-year history of smoking, higher body mass index, less years of education and less frequent extraarticular manifestations (p<0.02), serum total cholesterol$÷ $HDL cholesterol ratio (p=0.004), C-reactive protein concentrations (p=0.01) and the presence of extraarticular manifestations (p=0.01) in Caucasians but, contrastingly, the Arthritis Impact Measurement Scales tension score (p≤0.04) and use of non-steroidal anti-inflammatory agents (p=0.03) in black patients. The Framingham score was significantly associated with atherosclerosis in Caucasians (p

Conclusions In keeping with existing disparate epidemiological transition stages, cardiovascular risk factor profiles and their relationships with atherosclerosis vary substantially amongst Africans with RA. However, the carotid atherosclerosis burden is similar in black compared to Caucasian Africans with RA. Conventional cardiovascular risk factors and systemic inflammation may be insufficient in atherosclerosis risk assessment in patients with RA from developing groups of black African descent.

1. Yusuf S et al. Circulation 2001;104:3554-61.

2. Steyn K et al. Circulation 2005;112:3554-61.

3. Mayosi BM et al. Lancet 2009;374:934-47.

4. Solomon A et al. J Rheumatol 2010;37:953-60.

Disclosure of Interest P. Dessein Grant/Research support from: Medical Research Council, A. Woodiwiss: None Declared, A. Abdool-Carrim: None Declared, B. Stevens: None Declared, G. Norton: None Declared, A. Solomon: None Declared