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Metabolic Syndrome and Subclinical Atherosclerosis in Rheumatoid Arthritis
PATRICK H. DESSEIN, MILTON TOBIAS, and MARTIN G. VELLER ABSTRACT. Objective. We assessed whether features of metabolic syndrome (MetSyn) were risk factors for subclinical atherosclerosis independent of previously identified determinants of cardiovascular disease in 74 patients with rheumatoid arthritis (RA). We further evaluated the clinical utility of currently recommended MetSyn definitions in the identification of RA patients with subclinical atherosclerosis. Methods. We investigated the associations of MetSyn features and MetSyn definitions with ultrasonographically determined common carotid artery intima-media thickness (CCA-IMT) and plaque, with adjustment for age, radiographic scores (cumulative inflammation), polymorphonuclear cell counts (current inflammation), or hypothyroidism. Results. The Quantitative Insulin Sensitivity Check Index (QUICKI) (partial R = –0.24 to –0.26, p = 0.04 to 0.02), log triglycerides (partial R = 0.23 to 0.30, p = 0.05 to 0.01), and systolic blood pressure (partial R = 0.22 to 0.30, p = 0.06 to 0.002) were consistently associated with the log CCA-IMT. Log triglycerides (OR 1.04, 95% CI 1.01–1.08, p = 0.02) and the QUICKI (OR 0.22, 95% CI 0.05–0.91, p = 0.03) were associated with plaque after adjusting for cumulative inflammation. Hypertension (blood pressure ≥ 130/85 mm Hg or drug treatment for hypertension) was consistently associated with CCA-IMT (p = 0.05 to 0.0003) and plaque (p = 0.03 to 0.006). The WHO-defined MetSyn was associated with CCA-IMT (p = 0.08 to 0.04) but not with plaque (p ≥ 0.1). The National Cholesterol Education Program-defined MetSyn was not associated with CCA-IMT or plaque (p ≥ 0.3). Conclusion. In this RA cohort, the MetSyn features of hypertension, insulin resistance, and triglycerides were risk factors for subclinical atherosclerosis, independent of previously identified determinants of cardiovascular disease. Individual MetSyn features were more strongly associated with subclinical atherosclerosis than were currently recommended MetSyn definitions. (First Release Oct 15 2006; J Rheumatol 2006;33:2425–32) Key Indexing Terms:
RHEUMATOID ARTHRITIS From the Department of Rheumatology, Department of Radiology, and Department of Surgery, Johannesburg Hospital, Johannesburg, South Africa. Supported in part by the South African Circulatory Disorders Research Fund. P.H. Dessein, MD, FCP(SA), PhD, Department of Rheumatology, Johannesburg Hospital and Milpark Hospital, University of the Witwatersrand; M. Tobias, FFRAD(D)(SA), Department of Radiology, Johannesburg Hospital and Brenthurst Clinic, University of the Witwatersrand; M.G. Veller, FCS(SA), Department of Surgery, Johannesburg Hospital and Donald Gordon Medical Centre, University of the Witwatersrand, Johannesburg. Address reprint requests to Dr. P.H. Dessein, PO Box 1012, Melville 2109, Johannesburg, South Africa. E-mail: Dessein@telkomsa.net Accepted for publication July 31, 2006.
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