The Carotid Artery Atherosclerosis Burden and Its Relation to Cardiovascular Risk Factors in Black and White Africans with Established Rheumatoid Arthritis: A Cross-sectional Study

Solomon, Ahmed; Woodiwiss, Angela J.; Abdool-Carrim, Abu T; Stevens, Belinda; Norton, Gavin R.; Dessein, Patrick H

doi:10.3899/jrheum.120073

Cited by 24 publications

(39 citation statements)

References 59 publications

(75 reference statements)

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“…Participants gave informed, written consent. The present study design has previously been described [38,50-52,56,59-61]. Briefly, 115 African black patients who met the 1988 American College of Rheumatology criteria for RA [62] were enrolled at the Charlotte Maxeke Johannesburg Academic Hospital.…”

Section: Methodsmentioning

confidence: 99%

“…In this regard, we recently documented consistent disparities in individual cardiovascular risk factor profiles including more marked overall adiposity, an increased prevalence of hypertension and less frequent alcohol consumption in patients with RA from developing groups of black African descent compared to their white counterparts from a developed population, as well as risk factor-atherosclerosis relationships amongst both groups [38,51,52]. Non-RA black African subjects experience not only a very large prevalence of obesity [53] and hypertension [54,55], but also a strikingly large systemic inflammation burden [56-58], whereas serum C-reactive protein concentrations are not increased in black Africans compared to white patients with RA [52]. Further, cumulative inflammation as estimated by the number of deformed joints, is independently associated with decreased overall and abdominal obesity in African black but not white women with RA [38].…”

Section: Introductionmentioning

confidence: 99%

“…As applies to the general population, available data on atherogenesis in RA were generally obtained in subjects that belong to developed populations, whereas 80% of CVD now occurs in low income or developing countries [38,48-52]. In this regard, we recently documented consistent disparities in individual cardiovascular risk factor profiles including more marked overall adiposity, an increased prevalence of hypertension and less frequent alcohol consumption in patients with RA from developing groups of black African descent compared to their white counterparts from a developed population, as well as risk factor-atherosclerosis relationships amongst both groups [38,51,52].…”

Section: Introductionmentioning

confidence: 99%

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Rheumatoid arthritis is associated with reduced adiposity but not with unfavorable major cardiovascular risk factor profiles and enhanced carotid atherosclerosis in black Africans from a developing population: a cross-sectional study

et al. 2013

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IntroductionRheumatoid arthritis (RA) is characterized by inflamed joint-derived cytokine-mediated high-grade systemic inflammation that enhances cardiovascular metabolic risk and disease in developed populations. We investigated the potential impact of RA on cardiovascular risk factors including systemic inflammation and atherosclerosis, and their relationships in black Africans from a developing population.MethodsWe evaluated demographic features, adiposity indices, major traditional cardiovascular risk factors, circulating C-reactive protein and interleukin-6 concentrations and ultrasound determined carotid intima-media thickness (cIMT) in 274 black Africans; 115 had established RA. Data were analyzed in confounder-adjusted mixed regression models.ResultsThe body mass index and waist-height ratio were lower in RA compared to non-RA subjects (29.2 (6.6) versus 33.7 (8.0), P < 0.0001 and 0.58 (0.09) versus 0.62 (0.1), P = 0.0003, respectively). Dyslipidemia was less prevalent in patients with RA (odds ratio (OR) (95% confidence interval (CI) = 0.54 (0.30 to1.00)); this disparity was no longer significant after further adjustment for reduced adiposity and chloroquine use. RA was also not associated with hypertension, current smoking and diabetes. The number of major traditional risk factors did not differ by RA status (1.1 (0.8) versus 1.2 (0.9), P = 0.7). Circulating C-reactive protein concentrations were similar and serum interleukin-6 concentrations reduced in RA (7.2 (3.1) versus 6.7 (3.1) mg/l, P = 0.7 and 3.9 (1.9) versus 6.3 (1.9) pg/ml, P < 0.0001, respectively). The cIMT was 0.700 (0.085) and 0.701 (0.111) mm in RA and non-RA subjects, respectively (P = 0.7). RA disease activity and severity parameters were consistently unrelated to systemic inflammation, despite the presence of clinically active disease in 82.6% of patients. In all participants, adiposity indices, smoking and converting angiotensin inhibitor non-use were associated with increased systemic inflammation, which related to more atherogenic lipid profiles, and circulating low density lipoprotein concentrations were associated with cIMT (partial R = 0.153, P = 0.032); RA did not impact on these relationships (interaction P ≥0.1).ConclusionsAmong black Africans, patients with established RA experience reduced overall and abdominal adiposity but no enhanced major traditional risk factor and atherosclerosis burden. This study further suggests that an absent interleukin-6 release by inflamed RA joints into the circulation may account for this unaltered cardiovascular disease risk.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rheumatoid arthritis is associated with reduced adiposity but not with unfavorable major cardiovascular risk factor profiles and enhanced carotid atherosclerosis in black Africans from a developing population: a cross-sectional study

et al. 2013

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“…The carotid atherosclerosis burden and its relationship with major conventional and nonconventional cardiovascular risk factors between Africans with RA were compared between 121 black and 122 white Africans with RA [52]. The risk factors that were associated with atherosclerosis in African black and white patients with RA are shown in Figure 1.…”

Section: The Atherosclerosis Burden and Its Associations With Convmentioning

confidence: 99%

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

Solomon

Tsang

Woodiwiss

et al. 2014

BioMed Research International

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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.

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“…Indeed, the relation between lipids and CVD is at most inconsistent17 and in one report was in fact paradoxically inverse, in RA 18. A recent investigation disclosed that in contrast to their white counterparts, black Africans with RA experience no major conventional risk factor–atherosclerosis and systemic inflammation–atherosclerosis relations 19. This further argues against the reliance on risk factor profiles as currently recommended in evaluating actual CVD risk.…”

mentioning

confidence: 99%

Could cardiovascular disease risk stratification and management in rheumatoid arthritis be enhanced?

Dessein

Semb

2013

Ann Rheum Dis

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The Carotid Artery Atherosclerosis Burden and Its Relation to Cardiovascular Risk Factors in Black and White Africans with Established Rheumatoid Arthritis: A Cross-sectional Study

Abstract: The carotid atherosclerosis burden is similar in black compared to white Africans with RA, but relationships between modifiable CV risk factors and atherosclerosis vary substantially among Africans with RA.

Cited by 24 publications

References 59 publications

Rheumatoid arthritis is associated with reduced adiposity but not with unfavorable major cardiovascular risk factor profiles and enhanced carotid atherosclerosis in black Africans from a developing population: a cross-sectional study

Rheumatoid arthritis is associated with reduced adiposity but not with unfavorable major cardiovascular risk factor profiles and enhanced carotid atherosclerosis in black Africans from a developing population: a cross-sectional study

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

Could cardiovascular disease risk stratification and management in rheumatoid arthritis be enhanced?

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