Metabolic syndrome and subclinical atherosclerosis in rheumatoid arthritis.
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 > or = 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 > or = 0.1). The National Cholesterol Education Program-defined MetSyn was not associated with CCA-IMT or plaque (p > or = 0.3).


CONCLUSIONS
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.
Dessein
Patrick H
PH
Department of Rheumatology, Johannesburg Hospital, Johannesburg, South Africa. Dessein@telkomsa.net
Tobias
Milton
M
Veller
Martin G
MG
D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000453:epidemiology*; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology*; D001794:Blood Pressure; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000473:pathology; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D024821:Metabolic Syndrome / Q000175:diagnosis / Q000453:epidemiology*; D008875:Middle Aged; D009504:Neutrophils / Q000473:pathology; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood; D014463:Ultrasonography
D014280:Triglycerides