title: The metabolic syndrome is amplified in hypothyroid rheumatoid arthritis patients: a cross-sectional study.
abstract: OBJECTIVE
  Rheumatoid arthritis (RA) patients are at increased risk of cardiovascular disease (CVD), which is even more pronounced in hypothyroid RA patients. An unfavourable cardiovascular risk profile conferred by a higher prevalence of the metabolic syndrome (MetS) and a higher Framingham risk score might explain this amplified cardiovascular morbidity. This study compared first, MetS (features) and second, the Framingham 10-year CVD risk in RA patients with hypothyroidism compared with euthyroid RA patients.
  
  
  METHODS
  RA patients participating in the CARRE investigation were divided into two groups: hypothyroid and euthyroid RA patients. MetS according to the National Cholesterol Education Program Third Adult Treatment Panel criteria and the Framingham risk score was compared between hypothyroid and non-hypothyroid CVD event-free RA patients.
  
  
  RESULTS
  In total, 257 RA patients were included: 236 with RA (91.8%) and 21 with hypothyroid RA (8.2%), respectively. The prevalence of the MetS was significantly higher in hypothyroid RA patients (43%) compared with RA patients (20%). Moreover, female hypothyroid RA patients had a higher Framingham risk score compared with euthyroid RA patients. With RA patients as the reference category, the age and gender-adjusted prevalence odds ratio for the MetS was 3.5 (95% CI 1.3 to 9.1) in hypothyroid RA.
  
  
  CONCLUSIONS
  Hypothyroid RA patients, particularly female patients, have a more unfavourable cardiovascular risk profile, reflected by an increased prevalence of the MetS and higher Framingham score, than euthyroid RA patients, suggesting a greater need for cardiovascular risk management in these patients to prevent future CVD events.
authors.affiliation: VU University Medical Centre, Departments of Internal Medicine and Rheumatology, 1007 MB Amsterdam, The Netherlands.
authors.forename: H G
authors.initials: HG
authors.lastname: Raterman
authors.forename: I C
authors.initials: IC
authors.lastname: van Eijk
authors.forename: A E
authors.initials: AE
authors.lastname: Voskuyl
authors.forename: M J L
authors.initials: MJ
authors.lastname: Peters
authors.forename: B A C
authors.initials: BA
authors.lastname: Dijkmans
authors.forename: V P
authors.initials: VP
authors.lastname: van Halm
authors.forename: S
authors.initials: S
authors.lastname: Simsek
authors.forename: W F
authors.initials: WF
authors.lastname: Lems
authors.forename: M T
authors.initials: MT
authors.lastname: Nurmohamed
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D002318:Cardiovascular Diseases / Q000209:etiology; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D007037:Hypothyroidism / Q000150:complications; D008297:Male; D024821:Metabolic Syndrome / Q000209:etiology*; D008875:Middle Aged; D012737:Sex Factors