title: Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration.
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.
authors.affiliation: Birmingham VA Medical Center, Birmingham, Alabama, USA University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: Iris
authors.initials: I
authors.lastname: Navarro-Millán
authors.affiliation: Birmingham VA Medical Center, Birmingham, Alabama, USA University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: Shuo
authors.initials: S
authors.lastname: Yang
authors.affiliation: VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Scott L
authors.initials: SL
authors.lastname: DuVall
authors.affiliation: Birmingham VA Medical Center, Birmingham, Alabama, USA University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: Lang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Birmingham VA Medical Center, Birmingham, Alabama, USA University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: John
authors.initials: J
authors.lastname: Baddley
authors.affiliation: VA Salt Lake City Health Care System and University of Utah School of Medicine, Salt Lake City, Utah, USA.
authors.forename: Grant W
authors.initials: GW
authors.lastname: Cannon
authors.affiliation: University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Delzell
authors.affiliation: University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: Jie
authors.initials: J
authors.lastname: Zhang
authors.affiliation: University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: Monika M
authors.initials: MM
authors.lastname: Safford
authors.affiliation: University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: Nivedita M
authors.initials: NM
authors.lastname: Patkar
authors.affiliation: Omaha VA and University of Nebraska Medical Center, Omaha, Nebraska, USA.
authors.forename: Ted R
authors.initials: TR
authors.lastname: Mikuls
authors.affiliation: Birmingham VA Medical Center, Birmingham, Alabama, USA University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: Jasvinder A
authors.initials: JA
authors.lastname: Singh
authors.affiliation: Birmingham VA Medical Center, Birmingham, Alabama, USA University of Alabama at Birmingham Division of Clinical Immunology and Rheumatology, Birmingham, Alabama, USA.
authors.forename: Jeffrey R
authors.initials: JR
authors.lastname: Curtis
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000150:complications*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000032:analysis; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D003327:Coronary Disease / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood* / Q000150:complications; D015994:Incidence; D007249:Inflammation / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology / Q000209:etiology*; D016016:Proportional Hazards Models; D020521:Stroke / Q000097:blood / Q000209:etiology; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D002097:C-Reactive Protein
keywords: Cardiovascular Disease; Inflammation; Rheumatoid Arthritis