Exploring metabolic and inflammatory abnormalities in rheumatoid arthritis patients developing stroke disease: a case-control study using electronic medical record data in northern China
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Intend to investigate the roles of serum lipids, inflammatory markers, and serological status in rheumatoid arthritis and stroke patients by using case-control study.
Materials and methods
Clinical data were retrieved from the electronic medical record of the First Affiliated Hospital of China Medical University during January 2011 to March 2018. The obtained data were categorized into case groups and three control groups, in the ratios of 1:2, respectively, with all matching age and gender. Multinomial logistic regression analysis and restricted cubic spline were conducted examining the associations between serum lipids, inflammatory markers, serological status, and the risk of stroke among RA patients.
The present studies included 1057 study subjects. The elevated ESR, LDL-C levels, and much higher CRP levels ≥ 230 mg/L were independent risk factors for RA patients in developing stroke. Furthermore, we found that ESR and LDL-C levels could exhibit a linear association with the risk of comorbid stroke while CRP level had a nonlinearity association with stroke risk among RA patients.
A close monitoring is required for RA patients with dyslipidemia and elevated inflammatory markers, and the primary stroke preventive strategies should be directed against these risk factors.
KeywordsDyslipidemia Inflammatory marker Rheumatoid arthritis Serum lipids Stroke
FRX analyzed and interpreted the data and drafted the manuscript. LYF designed the study. FRX, TTW, HNL, YWX and MC collected the data. LYF contributed to the interpretation of the results and critical revision of the manuscript for important intellectual content and approved the final version of the manuscript. All authors have read and approved the final manuscript. FRX and LYF were the study guarantors.
This work was supported by grants from the Program of the National Natural Science Foundation of China (81673246).
Compliance with ethical standards
- 1.Junbo Ge YX (2013) Internal Medicine. 8 ed. People’s Medical Publishing House, BeiJingGoogle Scholar
- 2.Zhanguo Li F (2009) Rheumatoid arthritis. 1 ed: People’s Medical Publishing HouseGoogle Scholar
- 3.Lévy LFB, Barnetche T, Schaeverbeke T (2008) Incidence and risk of fatal myocardial infarction and stroke events in rheumatoid arthritis patients: a systematic review of the literature. Clin Exp Rheumatol 26:67Google Scholar
- 5.Mackey RH, Kuller LH, Deane KD, Walitt BT, Chang YF, Holers VM et al (2015) Rheumatoid arthritis, anti-cyclic citrullinated peptide positivity, and cardiovascular disease risk in the women’s health initiative. Arthritis Rheumatol 67:92311–92322. https://doi.org/10.1002/art.39198
- 6.Lindhardsen J, Gislason GH, Ahlehoff O, Madsen OR, Hansen PR.(2010) Increased risk of stroke and atrial fibrillation in rheumatoid arthritis - a nationwide cohort study. Eur Heart J 31156Google Scholar
- 7.Liou TH, Huang SW, Lin JW, Chang YS, Wu CW, Lin HW.(2014) Risk of stroke in patients with rheumatism: a nationwide longitudinal population-based study. Sci Rep.45110. doi: https://doi.org/10.1038/srep05110
- 8.Navarro-Millan I, Yang S, DuVall SL, Chen L, Baddley J, Cannon GW et al (2016) Association of hyperlipidaemia, inflammation and serological status and coronary heart disease among patients with rheumatoid arthritis: data from the National Veterans Health Administration. Ann Rheum Dis 75:2341–2347. https://doi.org/10.1136/annrheumdis-2013-204987 CrossRefGoogle Scholar
- 10.Semb AG, Kvien TK, Aastveit AH, Jungner I, Pedersen TR, Walldius G et al (2010) Lipids, myocardial infarction and ischaemic stroke in patients with rheumatoid arthritis in the Apolipoprotein-related Mortality RISk (AMORIS) Study. Ann Rheum Dis 69:111996–112001. https://doi.org/10.1136/ard.2009.126128 CrossRefGoogle Scholar
- 11.Zhang J, Chen L, Delzell E, Muntner P, Hillegass WB, Safford MM et al (2014) The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann Rheum Dis 73:71301–71308. https://doi.org/10.1136/annrheumdis-2013-204715 Google Scholar
- 14.Arnett FC, Edworthy SM, Bloch DA (1988) The American Rheumatism Association 1987 Revised Criteria for the Classification of Rheumatoid Arthritis. Arthritis Rheum p. 315–24Google Scholar
- 15.Association CN.(2013) Diagnosis of various cerebrovascular diseases(1995). J Clin Exp Med 12:71Google Scholar
- 16.adults TjcopacoabliC (2012) Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults. The joint committee on prevention and control of abnormal blood lipids in Chinese adultsGoogle Scholar
- 17.adults. TjcopacoabliC (2016) Guidelines on Prevention and Treatment of Blood Lipid Abnormality in Chinese Adults(2016 Revised). Guidelines and consensus. Chinese Circulation Journal: The joint committee on prevention and control of abnormal blood lipids in Chinese adultsGoogle Scholar
- 18.Wolfe F, Freundlich B, Straus WL (2003) Increase in cardiovascular and cerebrovascular disease prevalence in rheumatoid arthritis. J Rheumatol 30:136–140Google Scholar
- 22.Myasoedova E, Crowson CS, Kremers HM, Roger VL, Fitz-Gibbon PD, Therneau TM et al (2011) Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis 70:3482–3487. https://doi.org/10.1136/ard.2010.135871 CrossRefGoogle Scholar
- 23.Jurcut C, Jurcut R, Tanasescu C (2004) Cardiovascular risk and rheumatoid arthritis: from mechanisms of atherosclerosis to therapeutic approach. Rom J Int Med 42:4659–4669Google Scholar
- 24.Combe B, Cantagrel A, Goupille P, Bozonnat MC, Sibilia J, Eliaou JF et al (2003) Predictive factors of 5-year health assessment questionnaire disability in early rheumatoid arthritis. J Rheumatol 30:112344–112349Google Scholar
- 25.Guillemin F, Gerard N, van Leeuwen M, Smedstad LM, Kvien TK, van den Heuvel W (2003) Prognostic factors for joint destruction in rheumatoid arthritis: a prospective longitudinal study of 318 patients. J Rheumat 30:122585–122589Google Scholar
- 29.Pearson TA, Mensah GA, Alexander RW, Anderson JL, Cannon RO 3rd, Criqui M et al (2003) Markers of inflammation and cardiovascular disease: application to clinical and public health practice: a statement for healthcare professionals from the Centers for Disease Control and Prevention and the American Heart Association. Circulation 107:3499–3511Google Scholar
- 31.Curb JD, Abbott RD, Rodriguez BL, Sakkinen P, Popper JS, Yano K et al (2003) C-reactive protein and the future risk of thromboembolic stroke in healthy men. Circulation 107:152016–152020. https://doi.org/10.1161/01.cir.0000065228.20100.f7 CrossRefGoogle Scholar
- 32.Min Su TS (2011) The correlation between vascular endothelial dysfunction and serum inflammatory factors and serum lipid levels in patients with rheumatoid arthritis. Chin J Clin Lab Sci 29:4265. https://doi.org/10.13602/j.cnki.jcls.2011.04.034
- 34.Greenberg JD, Kremer JM, Curtis JR, Hochberg MC, Reed G, Tsao P et al (2011) Tumour necrosis factor antagonist use and associated risk reduction of cardiovascular events among patients with rheumatoid arthritis. Ann Rheum Dis 70:4576–4582. https://doi.org/10.1136/ard.2010.129916 CrossRefGoogle Scholar
- 39.Xie F, Yun H, Levitan EB, Muntner P, Curtis JR (2018) Tocilizumab and the risk for cardiovascular disease: a direct comparison among biologic disease-modifying antirheumatic drugs for rheumatoid arthritis patients. Arthritis Care Res. https://doi.org/10.1002/acr.23737