The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis

Jie Zhang, Lang Chen, Elizabeth Delzell, Paul Muntner, William B. Hillegass, Monika M. Safford, Iris Yolanda Navarro Millan, Cynthia Crowson, Jeffrey R. Curtis

Research output: Contribution to journalArticle

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Abstract

Objective To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- And high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients. Methods We conducted a retrospective cohort study using 2005.2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess nonlinear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes. Results We identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol >60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS. Conclusions This study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.

Original languageEnglish (US)
Pages (from-to)1301-1308
Number of pages8
JournalAnnals of the rheumatic diseases
Volume73
Issue number7
DOIs
StatePublished - Jan 1 2014

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LDL Lipoproteins
Rheumatoid Arthritis
Biomarkers
Lipids
Myocardial Infarction
Stroke
C-Reactive Protein
Blood Sedimentation
Sedimentation
Splines
HDL Cholesterol
Cohort Studies
Retrospective Studies
Health
Inflammation
Physicians
Incidence
Serum

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology
  • Biochemistry, Genetics and Molecular Biology(all)

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The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. / Zhang, Jie; Chen, Lang; Delzell, Elizabeth; Muntner, Paul; Hillegass, William B.; Safford, Monika M.; Millan, Iris Yolanda Navarro; Crowson, Cynthia; Curtis, Jeffrey R.

In: Annals of the rheumatic diseases, Vol. 73, No. 7, 01.01.2014, p. 1301-1308.

Research output: Contribution to journalArticle

Zhang, Jie ; Chen, Lang ; Delzell, Elizabeth ; Muntner, Paul ; Hillegass, William B. ; Safford, Monika M. ; Millan, Iris Yolanda Navarro ; Crowson, Cynthia ; Curtis, Jeffrey R. / The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. In: Annals of the rheumatic diseases. 2014 ; Vol. 73, No. 7. pp. 1301-1308.
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T1 - The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis

AU - Zhang, Jie

AU - Chen, Lang

AU - Delzell, Elizabeth

AU - Muntner, Paul

AU - Hillegass, William B.

AU - Safford, Monika M.

AU - Millan, Iris Yolanda Navarro

AU - Crowson, Cynthia

AU - Curtis, Jeffrey R.

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N2 - Objective To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- And high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients. Methods We conducted a retrospective cohort study using 2005.2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess nonlinear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes. Results We identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol >60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS. Conclusions This study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.

AB - Objective To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- And high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients. Methods We conducted a retrospective cohort study using 2005.2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess nonlinear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes. Results We identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol >60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS. Conclusions This study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.

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