Risk factor profiles for atherosclerotic cardiovascular disease in black and other Africans with established rheumatoid arthritis.
OBJECTIVE
Black Africans reportedly experience a distinctly low risk for atherosclerotic cardiovascular disease (CVD). We investigated whether this protection was present among Africans with established rheumatoid arthritis (RA).


METHODS
We determined disparities in CVD risk factor profiles (major conventional: hypertension, dyslipidemia, smoking, and diabetes; other conventional: underweight, obesity, metabolic syndrome, chronic kidney disease, alcohol consumption, tension, depression, and body height; nonconventional: rheumatoid factor status and markers of inflammation) and arterial stiffness (brachial pulse pressure) between 291 black and 335 other (229 white, 64 Asian, and 42 mixed ancestry) consecutive Africans with RA in multivariable regression models.


RESULTS
After adjusting for demographic characteristics and healthcare sector attendance, black Africans had more prevalent hypertension (OR 1.76, p = 0.01) and diabetes (OR 1.90, p = 0.07), smoked less frequently (OR 0.12, p < 0.0001), and had concurrent lower total and high-density lipoprotein cholesterol concentrations that resulted in unaltered atherogenic indices (p = 0.2) than the other participants in the study. These findings translated into global scores for major conventional risk factor-mediated future CVD event rates that were not reduced in black patients. Proportions of individual metabolic syndrome components differed between black and other patients but their total numbers of metabolic risk factors (p = 0.4) and metabolic syndrome frequencies (OR 1.44, p = 0.1) were similar. Black ethnicity did not independently associate with rheumatoid factor status, markers of inflammation, and brachial pulse pressures.


CONCLUSIONS
The overall conventional and nonconventional atherosclerotic CVD risk burdens and arterial stiffness were not reduced in black patients with RA. CVD risk should be assessed and managed independent of ethnic origin and epidemiological transition stage in RA.
Department of Rheumatology, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa.
Ahmed
A
Solomon
Berenice F
BF
Christian
Gavin R
GR
Norton
Angela J
AJ
Woodiwiss
Patrick H
PH
Dessein
D001158:Arteries / Q000503:physiopathology; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000208:ethnology* / Q000503:physiopathology; D050197:Atherosclerosis / Q000150:complications* / Q000208:ethnology* / Q000503:physiopathology; D044383:Black People / Q000208:ethnology; D001794:Blood Pressure; D015992:Body Mass Index; D003920:Diabetes Mellitus / Q000208:ethnology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000208:ethnology; D007596:Joints / Q000503:physiopathology; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000209:etiology; D015995:Prevalence; D012044:Regression Analysis; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D055105:Waist Circumference