Abstract
Objective:To determine the frequency of modifiable cardiovascular risk factors in Rheumatoid Arthritis patients at tertiary care hospital.Methods:During this study 246 patients of Rheumatoid Arthritis were enrolled from outpatients department of Medicine of Central Park Medical College Hospital, Lahore from July 1, 2016 to January 31, 2017. Demographic data and questions related to study were noted. After 14 hours of fasting 5ml of venous blood was drawn for Cholesterol, triglycerides, HDL and blood sugar level. Blood tests were performed on COBAS c III (ROCHE), Framingham 10 year Risk score was calculated for every individual.Results:The mean age of male population was (50.2 ±7.5) and females (48.4±7.6) and female gender was common. Seventy eight (78%) of study population has one modifiable risk factor. Most frequent risk factor found in this study was BMI>30 in 48.4% (n=119), High LDL 43.5% (n=107), moderate to high FRS score 40.2% (n=99), Hypertension 37.4% (n=92), Diabetes Mellitus was present in 22.8% (n=56), while smoking was least frequent risk factors with frequency of 15.9% (n=39). Framingham cardiovascular risk score was significantly different, males were having higher mean 10 year risk score (19.7%) and females (8.7%) with (p-<0.01). Regression analysis revealed that older patients of Rheumatoid Arthritis with disease duration of more than seven years are four times more likely to have High Framingham risk score, moderate to high LDL and diabetes mellitus with significant high Odds ratio (p-value <0.05).Conclusion:Rheumatoid Arthritis patients are having increased chances of developing cardiovascular risk factors leading to cardiovascular events with male sex, increasing age and disease duration.
Highlights
Rheumatoid arthritis is the most common inflammatory arthritis affecting 0.5 to 1% of general population worldwide.[1]
RA is a high-grade inflammatory disease with an overlapping cellular and cytokine profile; it has been hypothesized that rheumatoid inflammation is a major cause of the accelerated atherosclerosis observed in this patient population, there is increasing evidence that traditional non modifiable and modifiable cardiovascular risk factors play an important role in the higher risk of coronary atherosclerosis and coronary heart disease (CHD) events in patients with RA.[3]
Sample size was estimated using openepi sample size calculator by inserting the 80% prevalence of at least one modifiable risk factor in RA patients 3,with 5% margin of error and 95% confidence interval n = 246 patient for this study. All those patients of rheumatoid arthritis who were seropositive for either Rheumatoid factor or Anti citrillinuted peptides or both were included in this study, their demographic data and disease duration number of Disease Modifying anti rheumatoid drugs usage asked in detail
Summary
Rheumatoid arthritis is the most common inflammatory arthritis affecting 0.5 to 1% of general population worldwide.[1]. Research in the last three decades has shown that AT is not degenerative or inevitable It is an autoimmune-inflammatory disease associated with infectious and inflammatory factors characterized by lipoprotein metabolism alteration that leads to immune system activation with the consequent proliferation of smooth muscle cells, narrowing arteries, and atheroma formation. Both humoral and cellular immune mechanisms have been proposed to participate in the onset and progression of AT.[4]
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