Cardiovascular risk in persons at risk of developing rheumatoid arthritis

Laurette van Boheemen; Marian H van Beers-Tas; Johanna M Kroese; Lotte A van de Stadt; Dirkjan van Schaardenburg; Michael T Nurmohamed

doi:10.1371/journal.pone.0237072

Cardiovascular risk in persons at risk of developing rheumatoid arthritis

Laurette van Boheemen, Marian H van Beers-Tas, Johanna M Kroese, Lotte A van de Stadt, Dirkjan van Schaardenburg, Michael T Nurmohamed

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

BACKGROUND: Rheumatoid arthritis (RA) is associated with an increased cardiovascular disease (CVD) risk which may start even before diagnosis. To explore this CVD risk prior to RA, we determined multiple risk factors and two 10-year clinical risk scores in a cohort of individuals at-risk of RA. We also analyzed associations with arthritis development and autoantibody status and compared a subset of at-risk individuals to an age and sex matched seronegative control group.

METHODS: In a cohort of 555 consecutive arthralgia patients positive for rheumatoid factor (RF) and / or anti-citrullinated protein antibody (ACPA) we retrospectively identified patients with preclinical arthritis (i.e. those who developed arthritis), and non-arthritis patients (those without arthritis development during maximum 5 years follow up). Demographics, CVD risk factors and the 10-year cardiovascular risk according to the SCORE and QRISK3 system were determined at baseline.

RESULTS: Preclinical arthritis patients (n = 188) had a higher heart rate (68 vs 63 bpm, p = 0.048) and lower cholesterol (5.2 mmol/l vs 5.5, p = 0.006), HDL (1.0 mmol/l vs 1.1, p0.003) and ApoB (0.85 g/l vs 0.91, p = 0.011) compared to non-arthritis patients (n = 367). Lipid levels were associated with ACPA status in both the preclinical arthritis and non-arthritis group. Ten-year CVD risk scores did not differ between preclinical arthritis and non-arthritis patients, in total, 7% (SCORE) and 8% (QRISK3) of seropositive arthralgia patients were classified as high risk. Seropositive at-risk patients (n = 71) had higher total cholesterol (5.4 vs 4.9, p<0.001), TC/HDL ratio (4.0 vs 3.0, p<0.001), triglycerides (1.4 vs 1.0, p = 0.001), ApoB (1.0 vs 0.9, p = 0.019) and 10-year risk scores (median SCORE 1.0 vs 0.0, p = 0.030 and median QRISK3 4.4 vs 3.1, p<0.001) compared to seronegative controls.

CONCLUSION: Our results suggest that lipid changes commence prior to RA diagnosis and that ACPAs might play a role.

Original language	English
Article number	e0237072
Pages (from-to)	1-11
Number of pages	11
Journal	PLoS ONE
Volume	15
Issue number	8
Early online date	3 Aug 2020
DOIs	https://doi.org/10.1371/journal.pone.0237072
Publication status	Published - Aug 2020

Keywords

Adult
Anti-Citrullinated Protein Antibodies
Arthralgia
Arthritis, Rheumatoid/complications
Autoantibodies/immunology
Cardiovascular Diseases/complications
Cohort Studies
Disease Progression
Female
Humans
Male
Middle Aged
Retrospective Studies
Rheumatoid Factor/immunology
Risk Factors

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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@article{1162f7d9afff409392717e2c183ccf18,

title = "Cardiovascular risk in persons at risk of developing rheumatoid arthritis",

abstract = "BACKGROUND: Rheumatoid arthritis (RA) is associated with an increased cardiovascular disease (CVD) risk which may start even before diagnosis. To explore this CVD risk prior to RA, we determined multiple risk factors and two 10-year clinical risk scores in a cohort of individuals at-risk of RA. We also analyzed associations with arthritis development and autoantibody status and compared a subset of at-risk individuals to an age and sex matched seronegative control group.METHODS: In a cohort of 555 consecutive arthralgia patients positive for rheumatoid factor (RF) and / or anti-citrullinated protein antibody (ACPA) we retrospectively identified patients with preclinical arthritis (i.e. those who developed arthritis), and non-arthritis patients (those without arthritis development during maximum 5 years follow up). Demographics, CVD risk factors and the 10-year cardiovascular risk according to the SCORE and QRISK3 system were determined at baseline.RESULTS: Preclinical arthritis patients (n = 188) had a higher heart rate (68 vs 63 bpm, p = 0.048) and lower cholesterol (5.2 mmol/l vs 5.5, p = 0.006), HDL (1.0 mmol/l vs 1.1, p0.003) and ApoB (0.85 g/l vs 0.91, p = 0.011) compared to non-arthritis patients (n = 367). Lipid levels were associated with ACPA status in both the preclinical arthritis and non-arthritis group. Ten-year CVD risk scores did not differ between preclinical arthritis and non-arthritis patients, in total, 7% (SCORE) and 8% (QRISK3) of seropositive arthralgia patients were classified as high risk. Seropositive at-risk patients (n = 71) had higher total cholesterol (5.4 vs 4.9, p<0.001), TC/HDL ratio (4.0 vs 3.0, p<0.001), triglycerides (1.4 vs 1.0, p = 0.001), ApoB (1.0 vs 0.9, p = 0.019) and 10-year risk scores (median SCORE 1.0 vs 0.0, p = 0.030 and median QRISK3 4.4 vs 3.1, p<0.001) compared to seronegative controls.CONCLUSION: Our results suggest that lipid changes commence prior to RA diagnosis and that ACPAs might play a role.",

keywords = "Adult, Anti-Citrullinated Protein Antibodies, Arthralgia, Arthritis, Rheumatoid/complications, Autoantibodies/immunology, Cardiovascular Diseases/complications, Cohort Studies, Disease Progression, Female, Humans, Male, Middle Aged, Retrospective Studies, Rheumatoid Factor/immunology, Risk Factors",

author = "{van Boheemen}, Laurette and {van Beers-Tas}, {Marian H} and Kroese, {Johanna M} and {van de Stadt}, {Lotte A} and {van Schaardenburg}, Dirkjan and Nurmohamed, {Michael T}",

year = "2020",

month = aug,

doi = "10.1371/journal.pone.0237072",

language = "English",

volume = "15",

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issn = "1932-6203",

publisher = "Public Library of Science",

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TY - JOUR

T1 - Cardiovascular risk in persons at risk of developing rheumatoid arthritis

AU - van Boheemen, Laurette

AU - van Beers-Tas, Marian H

AU - Kroese, Johanna M

AU - van de Stadt, Lotte A

AU - van Schaardenburg, Dirkjan

AU - Nurmohamed, Michael T

PY - 2020/8

Y1 - 2020/8

N2 - BACKGROUND: Rheumatoid arthritis (RA) is associated with an increased cardiovascular disease (CVD) risk which may start even before diagnosis. To explore this CVD risk prior to RA, we determined multiple risk factors and two 10-year clinical risk scores in a cohort of individuals at-risk of RA. We also analyzed associations with arthritis development and autoantibody status and compared a subset of at-risk individuals to an age and sex matched seronegative control group.METHODS: In a cohort of 555 consecutive arthralgia patients positive for rheumatoid factor (RF) and / or anti-citrullinated protein antibody (ACPA) we retrospectively identified patients with preclinical arthritis (i.e. those who developed arthritis), and non-arthritis patients (those without arthritis development during maximum 5 years follow up). Demographics, CVD risk factors and the 10-year cardiovascular risk according to the SCORE and QRISK3 system were determined at baseline.RESULTS: Preclinical arthritis patients (n = 188) had a higher heart rate (68 vs 63 bpm, p = 0.048) and lower cholesterol (5.2 mmol/l vs 5.5, p = 0.006), HDL (1.0 mmol/l vs 1.1, p0.003) and ApoB (0.85 g/l vs 0.91, p = 0.011) compared to non-arthritis patients (n = 367). Lipid levels were associated with ACPA status in both the preclinical arthritis and non-arthritis group. Ten-year CVD risk scores did not differ between preclinical arthritis and non-arthritis patients, in total, 7% (SCORE) and 8% (QRISK3) of seropositive arthralgia patients were classified as high risk. Seropositive at-risk patients (n = 71) had higher total cholesterol (5.4 vs 4.9, p<0.001), TC/HDL ratio (4.0 vs 3.0, p<0.001), triglycerides (1.4 vs 1.0, p = 0.001), ApoB (1.0 vs 0.9, p = 0.019) and 10-year risk scores (median SCORE 1.0 vs 0.0, p = 0.030 and median QRISK3 4.4 vs 3.1, p<0.001) compared to seronegative controls.CONCLUSION: Our results suggest that lipid changes commence prior to RA diagnosis and that ACPAs might play a role.

AB - BACKGROUND: Rheumatoid arthritis (RA) is associated with an increased cardiovascular disease (CVD) risk which may start even before diagnosis. To explore this CVD risk prior to RA, we determined multiple risk factors and two 10-year clinical risk scores in a cohort of individuals at-risk of RA. We also analyzed associations with arthritis development and autoantibody status and compared a subset of at-risk individuals to an age and sex matched seronegative control group.METHODS: In a cohort of 555 consecutive arthralgia patients positive for rheumatoid factor (RF) and / or anti-citrullinated protein antibody (ACPA) we retrospectively identified patients with preclinical arthritis (i.e. those who developed arthritis), and non-arthritis patients (those without arthritis development during maximum 5 years follow up). Demographics, CVD risk factors and the 10-year cardiovascular risk according to the SCORE and QRISK3 system were determined at baseline.RESULTS: Preclinical arthritis patients (n = 188) had a higher heart rate (68 vs 63 bpm, p = 0.048) and lower cholesterol (5.2 mmol/l vs 5.5, p = 0.006), HDL (1.0 mmol/l vs 1.1, p0.003) and ApoB (0.85 g/l vs 0.91, p = 0.011) compared to non-arthritis patients (n = 367). Lipid levels were associated with ACPA status in both the preclinical arthritis and non-arthritis group. Ten-year CVD risk scores did not differ between preclinical arthritis and non-arthritis patients, in total, 7% (SCORE) and 8% (QRISK3) of seropositive arthralgia patients were classified as high risk. Seropositive at-risk patients (n = 71) had higher total cholesterol (5.4 vs 4.9, p<0.001), TC/HDL ratio (4.0 vs 3.0, p<0.001), triglycerides (1.4 vs 1.0, p = 0.001), ApoB (1.0 vs 0.9, p = 0.019) and 10-year risk scores (median SCORE 1.0 vs 0.0, p = 0.030 and median QRISK3 4.4 vs 3.1, p<0.001) compared to seronegative controls.CONCLUSION: Our results suggest that lipid changes commence prior to RA diagnosis and that ACPAs might play a role.

KW - Adult

KW - Anti-Citrullinated Protein Antibodies

KW - Arthralgia

KW - Arthritis, Rheumatoid/complications

KW - Autoantibodies/immunology

KW - Cardiovascular Diseases/complications

KW - Cohort Studies

KW - Disease Progression

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Retrospective Studies

KW - Rheumatoid Factor/immunology

KW - Risk Factors

U2 - 10.1371/journal.pone.0237072

DO - 10.1371/journal.pone.0237072

M3 - Article

C2 - 32745151

SN - 1932-6203

VL - 15

SP - 1

EP - 11

JO - PLoS ONE

JF - PLoS ONE

IS - 8

M1 - e0237072

ER -

Cardiovascular risk in persons at risk of developing rheumatoid arthritis

Abstract

Keywords

UN SDGs

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