Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.


Disease Specific Cardiovascular Risk Factors in Patients with Rheumatic Diseases.

Kleinert2,  Stefan, Breunig1,  Margret, Tony3,  Hans Peter T., Feuchtenberger4,  Martin, Bouma1,  Stefanie, Christiane1,  Angermann E., Ertl1,  Georg

Department of Cardiology, Med. Klinik 1, University of Wuerzburg
Rheumatology / Clinical Immunology, Med. Klinik 2, University of Wuerzburg, Wuerzburg, Germany
Rheumatology / Clinical Immunology, Med. Klinik 2, University of Wuerzburg, Wuerzburg, Germany
Rheumatology/Clinical Immunology, Med. Klinik 2, University of Wuerzburg

Introduction:

The increased cardiovascular risk in patients with rheumatic diseases (RD) may be attributed to traditional cardiovascular (CV) as well as to RD-specific risk factors. We aimed to identify RD-specific correlates of CV risk in patients with RD.

Methods:

628 consecutive patients attending the rheumatology outpatient department of the University Hospital were assessed regarding CV risk factors by structured history taking, questionnaires, ECG and laboratory measurements including natriuretic peptides (NT-proBNP). Screening for increased risk of CV disease was regarded positive (RISK+) if any of the following was present: European CV Risk Score (EURO-Score) >=3% or NTproBNP >200 pg/ml or any pathological ECG pattern.

Results:

Patients had rheumatoid arthritis (RA, n=333), spondylarthropathies (SpA, n=124), connective tissue diseases (CTD, n=145) and no RD (Control, n=73). For details of patients' characteristics see table 1 and 2.

 % femaleMean Age (years)Disease Duration (years)NSAR+Steroids+DMARD+Biologic+
RA (1)79558.742%66%83%20%
SpA (2)37449.355%14%49%29%
CTD (3)86499.215%49%47%1%
Control (4)734827%13%3%0%
"+" indicates use of substance class
 DMpAVKStrokeFamHxHypertHLPSmokerESC >= 3ECGBNP >200RISK +
RA15%12%2%42%38%4719%32%14%18%43%
SpA10%12%1%465%24%39%33%17%16%5%32%
CTD6%16%3%49%35%40%19%18%14%17%34%
Con4%12%3%61%18%32%23%22%18%14%34%
DM=Diabetes mellitus, pAVK=peripheral artery disease, stroke=history of stroke, FamHx = family history of myocardial infarction, Hypert=Arterial Hypertension, HLP=Hyperlipoproteinemia, Smoker (ex)=current smoker, ESC=EURO-Score, ECG=Electrocardiogram, BNP=NTproBNP > 200 pg/ml, RISK+=at least one risk factor positive i.e. EURO-Score >=3% or NTproBNP > 200 pg/ml or pathological ECG.    

Logistic regression (dependent variable RISK+) was performed within the 4 groups using rheumatoid factor, disease duration, sex, haemoglobin, GFR, CRP, LDL-cholesterol, BSG, usage of NSAR, Steroids, DMARDs, or Biologicals, as well as DAS28 in RA. Odds ratio and 95% CI are reported. Positive correlates of RISK+ were in the RA group: use of DMARD 4.1 (1.49–11.30; p=0.006), disease duration 1.05 per year (1.01–1.09, p=0.011), LDL-cholesterol 1.01 per g/dl (1.00–1.03, p=0.017), and CRP 1.27 per mg/dl (1.00–1.61; p=0.048); negative correlates were: male sex 0.16 (0.07–0.39; p<0.001) and renal function (GFR per ml/min/kg 0.98 (0.96–0.99; p=0.007)).

In the SpA group a high CRP 2.25 per mg/dl (1.23–4.10, p=0.008) and haemoglobin 2.20 per g/dl (1.16–4.17, p=0.015) were associated with a worse risk profile.

Screening results in patients with connective tissue diseases were more likely to be positive in patients using DMARDs (3.73, 1.25–11.19, p=0.019) and less likely if patients were male (0.18, 0.04–0.85, p=0.031) and if renal function was good (GFR per ml/min/kg (0.96, 0.94–0.99, p=0.002)). In the control group male sex (0.17, 0.001–0.25; p=0.003) was associated with a reduced and ESR per mm (1.19, 1.003–1.42; p=0.003) with an increased risk profile.

Conclusion:

In different rheumatic conditions disease-specific risk factors indicating an increased cardiovascular risk could be identified, justifying further cardiologic diagnostics and closer long-term follow-up.

To cite this abstract, please use the following information:
Kleinert, Stefan, Breunig, Margret, Tony, Hans Peter T., Feuchtenberger, Martin, Bouma, Stefanie, Christiane, Angermann E., et al; Disease Specific Cardiovascular Risk Factors in Patients with Rheumatic Diseases. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1026
DOI: 10.1002/art.28793

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