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Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration
  1. Iris Navarro-Millán1,2,
  2. Shuo Yang1,2,
  3. Scott L DuVall3,
  4. Lang Chen1,2,
  5. John Baddley1,2,
  6. Grant W Cannon3,
  7. Elizabeth S Delzell2,
  8. Jie Zhang2,
  9. Monika M Safford2,
  10. Nivedita M Patkar2,
  11. Ted R Mikuls4,
  12. Jasvinder A Singh1,2,
  13. Jeffrey R Curtis1,2
  1. 1Birmingham VA Medical Center, Birmingham, Alabama, USA
  2. 2University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA
  3. 3VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, Utah, USA
  4. 4Omaha VA and University of Nebraska Medical Center, Omaha, Nebraska, USA
  1. Correspondence to
    Dr Jeffrey R Curtis, University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, 510 20th Street South, Faculty Office Tower 802D, Birmingham, AL 35294, USA; jcurtis{at}uab.edu

Abstract

Objective To examine the association of serum lipids, inflammation and seropositivity on coronary heart disease (CHD) and stroke in patients with rheumatoid arthritis (RA).

Methods The incidence of hospitalised myocardial infarction (MI) or stroke was calculated in a cohort of patients with RA receiving care within the national Veterans Health Administration from 1998 to 2011. Cox proportional hazard models were used to examine the association between these outcomes and low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as time-varying variables, divided into quintiles.

Results There were 37 568 patients with RA in the cohort with mean age of 63 years (SD 12.1); 90% were men. There was a no clear association between LDL-C and CHD/stroke. Compared with lower HDL-C (<34 mg/dL), higher HDL-C (≥54 mg/dL) was inversely associated with MI (hazard ratio (HR)=0.68, 95% CI 0.55 to 0.85) and stroke (HR=0.69, 95% CI 0.50 to 0.96). Higher CRP >2.17 mg/dL (vs CRP <0.26 mg/dL) was associated with increased risk (HR=2.43, 95% CI 1.77 to 3.33) for MI and 2.02 (95% CI 1.32 to 3.08) for stroke. ESR >47 mm/h compared with <8 mm/h had an HR 1.87 (95% CI 1.39 to 2.52) for MI and 2.00 (95% CI 1.26 to 3.18) for stroke. The association between MI was significant for RA seropositivity (HR=1.23, 95% CI 1.03 to 1.48).

Conclusions In this predominantly older male RA cohort, there was no clear association between LDL-C and CHD, whereas higher HDL-C was inversely associated with MI and stroke. CRP and ESR were similarly associated with increase MI risk and stroke, reflecting the prominent role of inflammation in CHD risk in RA.

  • Rheumatoid Arthritis
  • Cardiovascular Disease
  • Inflammation

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