TRADITIONAL AND NON-TRADITIONAL CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH RHEUMATOID ARTHRITIS

TRADITIONAL AND NON-TRADITIONAL CARDIOVASCULAR RISK FACTORS IN PATIENTS WITH RHEUMATOID ARTHRITIS Dr. Mazen Al Zo’ubi, MD Rheumatology Division, Internal Medicine Department, King Hussein Hospital, The Royal Medical Services of Jordan.

Contents • Introduction • Method • Results • Discussion • Conclusion

Introduction ❖ Rheumatoid Arthritis is the highest prevalent inflammatory arthritis(1). ❖ Affecting 0.5-1% of general population(1). ❖ Median survival is 17 years shorter than expected for general population(2).

Introduction ❖ As a high-grade inflammatory disease, both traditional and non-traditional risk factors play an important role in developing CVD in RA patients(3).

Introduction ➢ Over the last three-decade Atherosclerosis considered to be an autoimmune-inflammatory disease associated with infectious and inflammatory factors(4). ➢ Immune system activation will lead to consequent proliferation of smooth muscle cells, narrowing arteries, and atheroma formation(4).

Introduction ✓ Systemic inflammatory response in RA is critical to accelerated atherogenesis operating via accentuation of established and novel risk pathways(5). ✓ Long term suppression of systemic inflammatory response should be effective in reducing the risk of coronary heart disease(5).

Methodology Design Cross-sectional, Retrospective Patients 103 Rheumatoid Arthritis patients Location Outpatient Rheumatology Clinic, King Hussein hospital, The Royal Medical Services. Time From September 1st, 2019 to November 30th, 2019.

Methodology Inclusion Exclusion Other diagnosis of Criteria Criteria inflammatory arthritis e.g. SLE, Age: 30-74 years Psoriatic Arthritis, Etc. Rheumatoid History of DM and Arthritis diagnosis CVD. > one year SPSS statics 24 was used to perform statistics

Results

Result Prevalence of modifiable risk factors PREVALENCE OF MODIFIABLE RISK FACTORS PREVALENCE 35 18.4 24.3 7.8 40.8

Modifiable CVS risk factors Distribution of risk factors in Rheumatoid Arthritis

Gender characteristics Basic Characteristic of Sample Data (n = 103).

Gender characteristics cont. Characteristic Gender P-value Male Female 0.85 0.00 n % n% 0.35 Hypertension Yes 7 36.8 29 34.5 0.99 Smoking No Comparative Serology Yes 12 63.2 55 65.5 analysis of study No parameters Positive 9 47.4 10 11.9 Negative No MTX 10 52.6 74 88.1 12 63.2 62 73.8 7 36.8 22 26.2 6 31.6 28 33.3 DMARDs MTX only 8 42.1 35 41.7 MTX 5 26.3 21 25.0 combination

Gender characteristics cont. Characteristic Gender P-value 0.00 Male Female 0.00 n% n % <30 17 89.5 44 52.4 BMI >30 2 10.5 40 47.6 DAS 28 Comparative analysis Remission 6 31.6 18 21.4 of study parameters FRS Low 4 21.1 24 28.6 7 36.8 34 40.5 Moderate 2 10.5 8 9.5 High 9 47.4 69 82.1 Low 10 52.6 15 17.9 Moderate-High

FRS characteristics Characteristic FRS P-value Age Low Moderate-High 0.00 Cholesterol 0.58 Triglyceride Mean SD Mean SD 0.01 0.48 LDL 44.4 9.7 58.4 9.00 0.84 HDL 0.23 BMI 183.9 36.9 179.3 33.6 0.48 Disease duration 0.81 Comparative DAS 28 127.9 65.6 164.7 53.15 analysis of study parameters 122.6 34.4 117.1 32.7 51.4 15.0 50.4 34.4 28.0 5.4 29.5 4.8 9.1 6.5 8.0 7.4 3.5 1.2 3.4 1.5

FRS characteristics Characteristic FRS P-value Low Moderate-High 0.15 0.00 n% n % 0.98 72.0 0.55 No 66 84.6 18 28.0 Yes 32.0 Smoking No 12 15.4 7 68.0 Hypertension Yes 28.0 Comparative analysis Negative 59 75.6 8 72.0 of study parameters Serology Positive 0.00 No MTX 19 24.4 17 28.0 DMARDs MTX only 72.0 MTX 22 28.2 7 combination 56 71.8 18 3 3.8 0 24 30.8 7 51 65.4 18

Discussion The leading cause of mortality in RA(6) Increases the cardiovascular mortality(6) Are common in RA, the high systemic inflammatory burden associate with RA appears to be decisive factor(6) It is important to control baseline cardiovascular risks to decrease complications(6)

Final message RA patients should Avoid sedentary lifestyle encourage to: Use healthy diet Remain physically active as much possible Quit smoking Yearly cardiovascular risk score estimation to be done

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