title: Public healthcare attendance associates with enhanced conventional and non-conventional atherosclerotic cardiovascular disease risk burdens in established rheumatoid arthritis.
abstract: OBJECTIVE
  To assess whether public healthcare attendance associates with altered atherosclerotic cardiovascular disease risk in established rheumatoid arthritis (RA).
  
  
  METHODS
  We determined disparities in major conventional (hypertension, dyslipidemia, smoking and diabetes), other conventional (underweight, obesity, metabolic syndrome, chronic kidney disease, alcohol use, tension, depression and body height) and non-conventional (current and cumulative inflammation markers) cardiovascular risk factors between 424 consecutive public and 202 private healthcare patients in mixed regression models.
  
  
  RESULTS
  Eighty-one percent of public healthcare patients were black (67%) or caucasian (14%) and 83% of private healthcare cases were caucasian. Seventy percent of the patients had > or = 1 major conventional risk factor. After adjustment for age, gender, ethnic origin and statin use when appropriate, public healthcare attendance associated with the prevalence of hypertension (odds ratio (OR) [95%CI]=1.72 [1.03, 2.85]), having > or = 1 major conventional risk factor (OR [95%CI]=1.83 [1.09, 3.07]) and an increased mean (SD) number of such risk factors (p=0.03), metabolic syndrome frequency (OR [95%CI]=1.90 [1.07, 3.40]), alcohol use (OR [95%CI]=0.07 [0.03, 0.18]), shorter stature (p<0.0001), higher tension (p=0.02) and depression score (p<0.0001) and higher inflammatory markers including the disease activity score in 28 joints (p=0.005), C-reactive protein concentration (p=0.0006), Health Assessment Questionnaire disability index (p<0.0001), and number of deformed joints (p<0.0001). In sensitivity analyses performed in caucasian Africans, public healthcare attendance associated with increased frequencies of each major conventional risk factor (OR=2.06 to 3.69) and higher other conventional and non-conventional mediated cardiovascular risk.
  
  
  CONCLUSIONS
  Public healthcare patients with established RA experience markedly enhanced conventional and non-conventional cardiovascular risk burdens.
authors.affiliation: Department of Rheumatology, University of the Witwatersrand and Charlotte Maxeke Johannesburg Academic Hospital, Johannesburg, South Africa. dessein@telkomsa.net
authors.forename: P  H
authors.initials: P
authors.lastname: Dessein
authors.forename: B  F
authors.initials: B
authors.lastname: Christian
authors.forename: A J
authors.initials: AJ
authors.lastname: Woodiwiss
authors.forename: G  R
authors.initials: G
authors.lastname: Norton
authors.forename: A
authors.initials: A
authors.lastname: Solomon
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D050197:Atherosclerosis / Q000453:epidemiology*; D044383:Black People / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data*; D015995:Prevalence; D017149:Private Sector / Q000706:statistics & numerical data*; D017150:Public Sector / Q000706:statistics & numerical data*; D012044:Regression Analysis; D012307:Risk Factors; D013019:South Africa / Q000453:epidemiology; D035862:Vulnerable Populations / Q000706:statistics & numerical data; D044465:White People / Q000706:statistics & numerical data