Cardiovascular Disease Risk amongst African Black Patients with Rheumatoid Arthritis: The Need for Population Specific Stratification

Abstract

Rheumatoid arthritis (RA) enhances the risk of cardiovascular disease to a similar extent as diabetes. Whereas atherogenesis remains poorly elucidated in RA, traditional and nontraditional risk factors associate similarly and additively with CVD in RA. Current recommendations on CVD risk stratification reportedly have important limitations. Further, reported data on CVD and its risk factors derive mostly from data obtained in the developed world. An earlier epidemiological health transition is intrinsic to persons living in rural areas and those undergoing urbanization. It is therefore conceivable that optimal CVD risk stratification differs amongst patients with RA from developing populations compared to those from developed populations. Herein, we briefly describe current CVD and its risk factor profiles in the African black population at large. Against this background, we review reported data on CVD risk and its potential stratification amongst African black compared to white patients with RA. Routinely assessed traditional and nontraditional CVD risk factors were consistently and independently related to atherosclerosis in African white but not black patients with RA. Circulating concentrations of novel CVD risk biomarkers including interleukin-6 and interleukin-5 adipokines were mostly similarly associated with both endothelial activation and atherosclerosis amongst African black and white RA patients.

Cardiovascular Disease Risk Associated to Chronic Inflammatory Rheumatic Diseases in Patients Seen in Rheumatology Unit in Yaounde, Cameroon

“…A Dutch study including 3356 CIRD patients and 6708 matched controls similarly reported a significantly higher prevalence of hypertension in the group of CIRD patients compared with controls (12% vs 9%, "Hazard ratio 1.3, 95% CI (1.1 -1.5), p = 0.001" [24]. Furthermore, excess adiposity has also been previously reported in Black African RA patients and could be a risk factor for arthritis development and progression [8] [25]. Like in the general population [26], excess adiposity and most importantly increased age might substantially favor the development of hypertension in the context of CIRD.…”

“…However, when estimating the cardiovascular risk with the WHO/ISH risk charts, CIRD patients did not significantly differ from their non-CIRD counterparts, and similarly had a broadly reduced cardiovascular risk. Remarkably, many cardiovascular risk calculators appropriate for the general population have been tested in RA patients [8] [27] [32] [33], but not in the other CIRD populations. Almost all of those studies have reported a low CVD risk and substantial underestimation of the CVD risk when using those calculators.…”

“…Despite the increasing burden of both CIRD and CVD in Sub-Saharan Africa collectively with extensive assessment of their relationships in temperate regions [1] [3] [5]- [7], no published study has yet addressed the issue of CVD in a group of multiple CIRD in Black African patients to the best of our knowledge. The only reports investigating the link between CIRD and CVD in Sub-Saharan Africa focused on RA [8] [9]. Moreover, their results are discrepant.…”

“…Moreover, their results are discrepant. In this regard and considering the need for population specific stratification [8], the potential link between various CIRD and CVD might appear theoretical in Sub-Saharan Africa and thus deserve rigorous exploration in this region. Hence, we carried out a study aiming to investigate the association between CIRD and cardiovascular risk in a Cameroonian population based on the World Health Organization (WHO) and International Society for Hypertension (ISH) risk charts.…”

Relationship of rheumatoid arthritis and coronary artery disease in the Korean population: a nationwide cross-sectional study

“…Unfortunately, the association between RA and CAD were reported mainly in non-Asian groups and no data in South Korea have been reported yet [1,2,14]. Since some Asians appeared to have a higher risk for CAD, it is necessary to investigate whether CAD is more common in Korean RA patients than in non-RA patients [15]. We, therefore, investigated the prevalence of RA and the association between RA and CAD in South Korea using nationwide data.…”