Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis

Data from the National Veterans Health Administration

Iris Navarro-Millán, Shuo Yang, Scott L. DuVall, Lang Chen, John Baddley, Grant W. Cannon, Elizabeth S. Delzell, Jie Zhang, Monika M. Safford, Nivedita M. Patkar, Ted R Mikuls, Jasvinder A. Singh, Jeffrey R. Curtis

Research output: Contribution to journalArticle

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Abstract

Objective. To examine the association of serum lipids, inflammation and seropositivity on coronary heart disease (CHD) and stroke in patients with rheumatoid arthritis (RA). Methods. The incidence of hospitalised myocardial infarction (MI) or stroke was calculated in a cohort of patients with RA receiving care within the national Veterans Health Administration from 1998 to 2011. Cox proportional hazard models were used to examine the association between these outcomes and low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as time-varying variables, divided into quintiles. Results. There were 37 568 patients with RA in the cohort with mean age of 63 years (SD 12.1); 90% were men. There was a no clear association between LDL-C and CHD/stroke. Compared with lower HDL-C (<34 mg/dL), higher HDL-C (≥54 mg/dL) was inversely associated with MI (hazard ratio (HR)=0.68, 95% CI 0.55 to 0.85) and stroke (HR=0.69, 95% CI 0.50 to 0.96). Higher CRP >2.17 mg/dL (vs CRP <0.26 mg/dL) was associated with increased risk (HR=2.43, 95% CI 1.77 to 3.33) for MI and 2.02 (95% CI 1.32 to 3.08) for stroke. ESR >47 mm/h compared with <8 mm/h had an HR 1.87 (95% CI 1.39 to 2.52) for MI and 2.00 (95% CI 1.26 to 3.18) for stroke. The association between MI was significant for RA seropositivity (HR=1.23, 95% CI 1.03 to 1.48). Conclusions. In this predominantly older male RA cohort, there was no clear association between LDL-C and CHD, whereas higher HDL-C was inversely associated with MI and stroke. CRP and ESR were similarly associated with increase MI risk and stroke, reflecting the prominent role of inflammation in CHD risk in RA.

Original languageEnglish (US)
Pages (from-to)341-347
Number of pages7
JournalAnnals of the Rheumatic Diseases
Volume75
Issue number2
DOIs
StatePublished - Feb 1 2016

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Veterans Health
United States Department of Veterans Affairs
Hyperlipidemias
Coronary Disease
Rheumatoid Arthritis
Stroke
Health
C-Reactive Protein
LDL Cholesterol
HDL Cholesterol
Inflammation
Myocardial Infarction
Sedimentation
Blood Sedimentation
Hazards
Lipids
Proportional Hazards Models
Incidence
Serum

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

Cite this

Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis : Data from the National Veterans Health Administration. / Navarro-Millán, Iris; Yang, Shuo; DuVall, Scott L.; Chen, Lang; Baddley, John; Cannon, Grant W.; Delzell, Elizabeth S.; Zhang, Jie; Safford, Monika M.; Patkar, Nivedita M.; Mikuls, Ted R; Singh, Jasvinder A.; Curtis, Jeffrey R.

In: Annals of the Rheumatic Diseases, Vol. 75, No. 2, 01.02.2016, p. 341-347.

Research output: Contribution to journalArticle

Navarro-Millán, Iris ; Yang, Shuo ; DuVall, Scott L. ; Chen, Lang ; Baddley, John ; Cannon, Grant W. ; Delzell, Elizabeth S. ; Zhang, Jie ; Safford, Monika M. ; Patkar, Nivedita M. ; Mikuls, Ted R ; Singh, Jasvinder A. ; Curtis, Jeffrey R. / Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis : Data from the National Veterans Health Administration. In: Annals of the Rheumatic Diseases. 2016 ; Vol. 75, No. 2. pp. 341-347.
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abstract = "Objective. To examine the association of serum lipids, inflammation and seropositivity on coronary heart disease (CHD) and stroke in patients with rheumatoid arthritis (RA). Methods. The incidence of hospitalised myocardial infarction (MI) or stroke was calculated in a cohort of patients with RA receiving care within the national Veterans Health Administration from 1998 to 2011. Cox proportional hazard models were used to examine the association between these outcomes and low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as time-varying variables, divided into quintiles. Results. There were 37 568 patients with RA in the cohort with mean age of 63 years (SD 12.1); 90{\%} were men. There was a no clear association between LDL-C and CHD/stroke. Compared with lower HDL-C (<34 mg/dL), higher HDL-C (≥54 mg/dL) was inversely associated with MI (hazard ratio (HR)=0.68, 95{\%} CI 0.55 to 0.85) and stroke (HR=0.69, 95{\%} CI 0.50 to 0.96). Higher CRP >2.17 mg/dL (vs CRP <0.26 mg/dL) was associated with increased risk (HR=2.43, 95{\%} CI 1.77 to 3.33) for MI and 2.02 (95{\%} CI 1.32 to 3.08) for stroke. ESR >47 mm/h compared with <8 mm/h had an HR 1.87 (95{\%} CI 1.39 to 2.52) for MI and 2.00 (95{\%} CI 1.26 to 3.18) for stroke. The association between MI was significant for RA seropositivity (HR=1.23, 95{\%} CI 1.03 to 1.48). Conclusions. In this predominantly older male RA cohort, there was no clear association between LDL-C and CHD, whereas higher HDL-C was inversely associated with MI and stroke. CRP and ESR were similarly associated with increase MI risk and stroke, reflecting the prominent role of inflammation in CHD risk in RA.",
author = "Iris Navarro-Mill{\'a}n and Shuo Yang and DuVall, {Scott L.} and Lang Chen and John Baddley and Cannon, {Grant W.} and Delzell, {Elizabeth S.} and Jie Zhang and Safford, {Monika M.} and Patkar, {Nivedita M.} and Mikuls, {Ted R} and Singh, {Jasvinder A.} and Curtis, {Jeffrey R.}",
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T1 - Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis

T2 - Data from the National Veterans Health Administration

AU - Navarro-Millán, Iris

AU - Yang, Shuo

AU - DuVall, Scott L.

AU - Chen, Lang

AU - Baddley, John

AU - Cannon, Grant W.

AU - Delzell, Elizabeth S.

AU - Zhang, Jie

AU - Safford, Monika M.

AU - Patkar, Nivedita M.

AU - Mikuls, Ted R

AU - Singh, Jasvinder A.

AU - Curtis, Jeffrey R.

PY - 2016/2/1

Y1 - 2016/2/1

N2 - Objective. To examine the association of serum lipids, inflammation and seropositivity on coronary heart disease (CHD) and stroke in patients with rheumatoid arthritis (RA). Methods. The incidence of hospitalised myocardial infarction (MI) or stroke was calculated in a cohort of patients with RA receiving care within the national Veterans Health Administration from 1998 to 2011. Cox proportional hazard models were used to examine the association between these outcomes and low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as time-varying variables, divided into quintiles. Results. There were 37 568 patients with RA in the cohort with mean age of 63 years (SD 12.1); 90% were men. There was a no clear association between LDL-C and CHD/stroke. Compared with lower HDL-C (<34 mg/dL), higher HDL-C (≥54 mg/dL) was inversely associated with MI (hazard ratio (HR)=0.68, 95% CI 0.55 to 0.85) and stroke (HR=0.69, 95% CI 0.50 to 0.96). Higher CRP >2.17 mg/dL (vs CRP <0.26 mg/dL) was associated with increased risk (HR=2.43, 95% CI 1.77 to 3.33) for MI and 2.02 (95% CI 1.32 to 3.08) for stroke. ESR >47 mm/h compared with <8 mm/h had an HR 1.87 (95% CI 1.39 to 2.52) for MI and 2.00 (95% CI 1.26 to 3.18) for stroke. The association between MI was significant for RA seropositivity (HR=1.23, 95% CI 1.03 to 1.48). Conclusions. In this predominantly older male RA cohort, there was no clear association between LDL-C and CHD, whereas higher HDL-C was inversely associated with MI and stroke. CRP and ESR were similarly associated with increase MI risk and stroke, reflecting the prominent role of inflammation in CHD risk in RA.

AB - Objective. To examine the association of serum lipids, inflammation and seropositivity on coronary heart disease (CHD) and stroke in patients with rheumatoid arthritis (RA). Methods. The incidence of hospitalised myocardial infarction (MI) or stroke was calculated in a cohort of patients with RA receiving care within the national Veterans Health Administration from 1998 to 2011. Cox proportional hazard models were used to examine the association between these outcomes and low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), C reactive protein (CRP) and erythrocyte sedimentation rate (ESR) as time-varying variables, divided into quintiles. Results. There were 37 568 patients with RA in the cohort with mean age of 63 years (SD 12.1); 90% were men. There was a no clear association between LDL-C and CHD/stroke. Compared with lower HDL-C (<34 mg/dL), higher HDL-C (≥54 mg/dL) was inversely associated with MI (hazard ratio (HR)=0.68, 95% CI 0.55 to 0.85) and stroke (HR=0.69, 95% CI 0.50 to 0.96). Higher CRP >2.17 mg/dL (vs CRP <0.26 mg/dL) was associated with increased risk (HR=2.43, 95% CI 1.77 to 3.33) for MI and 2.02 (95% CI 1.32 to 3.08) for stroke. ESR >47 mm/h compared with <8 mm/h had an HR 1.87 (95% CI 1.39 to 2.52) for MI and 2.00 (95% CI 1.26 to 3.18) for stroke. The association between MI was significant for RA seropositivity (HR=1.23, 95% CI 1.03 to 1.48). Conclusions. In this predominantly older male RA cohort, there was no clear association between LDL-C and CHD, whereas higher HDL-C was inversely associated with MI and stroke. CRP and ESR were similarly associated with increase MI risk and stroke, reflecting the prominent role of inflammation in CHD risk in RA.

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