Abstract 014: Predictors of Coronary Heart Disease Risk Among Postmenopausal Women with Rheumatoid Arthritis
Background: Reasons for increased CHD in rheumatoid arthritis (RA) remain unclear. We conducted a prospective CHD nested case-control study among postmenopausal women with RA in the Women's Health Initiative (WHI) to test hypotheses that CHD was associated with: 1) traditional risk factors, including lipoproteins, 2) inflammatory & coagulation markers, and 3) serological (rheumatoid factor, (RF)) and genetic (the HLA-DRB shared epitope (SE)) markers of RA.
Methods: At baseline, of the 161,808 WHI participants aged 50-79, 16,461 (10.2%) reported RA. Chart-review in 2 centers documented that the positive predictive value for probable RA was only 15% for self-reported RA but was 62% when combined with self-reported use of disease-modifying anti-rheumatic drugs (DMARDs). To further improve classification, we measured anti-cyclic citrullinated peptide-2 antibody (anti-CCP2), a marker that is >95% specific for RA, on 9,988 (66%) of white, black, or Hispanic WHI participants with reported RA. Probable RA was defined as self-report plus DMARD use or anti-CCP positivity (+). Among 1423 probable RA cases we sampled 116 CHD cases that occurred during ∼ 10 years of follow-up, and controls matched 1:1 on age, anti-CCP positivity (+/−), and WHI component: Clinical Trial vs. Observational Study. We measured lipoproteins by NMR spectroscopy, sVCAM-1, sICAM-1, CRP, fibrinogen, D-dimer, and RF by immunoassay, and HLA-DRB shared epitope (SE) by Luminex/PCR. Odds ratios were calculated using conditional logistic regression.
Results: Among women with probable RA (Table), in separate models, CHD was associated with hypertension, lipoprotein particles (higher total and small LDL, large VLDL, and lower large HDL), and higher CRP, sICAM-1, sVCAM-1 and fibrinogen; however, only lipoproteins were significant. D-dimer, RF+, and S.E. were not associated with CHD.
Conclusion: Among postmenopausal women with RA, modifiable risk factors, particularly lipoproteins, predicted CHD, emphasizing the potential for CHD prevention in this group.
|Predictor (log unit or indicated)||OR||(95% CI)|
|Hypertension (y/n)||1.45||(0.86, 2.45)|
|Small LDL-P||1.41||(1.10, 1.81)|
|Total LDL-P||5.12||(1.74, 15.00)|
|Large HDL-P||0.47||(0.26, 0.86)|
|Large VLDL-P||1.40||(1.10, 1.77)|
|RF (+/−)||1.18||(0.62, 2.23)|
|#HLA-DRB S.E. (1, 2 vs. 0)||0.74||(0.42, 1.29)|
Models adjusted for hypertension, smoking, lipid-lowering and DMARD use. Predictors log-transformed unless indicated
- © 2012 by American Heart Association, Inc.