Session Information
Session Type: Abstract Submissions (ACR)
Background/Purpose: An increased prevalence of cardiovascular disease (CVD) and coronary heart disease (CHD) has been reported in patients with spondyloarthritides (SpA). This study investigated the prevalence of CVD risk factors, CVD including CHD and stroke in veterans with SpA (including PsA, Ankylosing Spondylitis (AS), and reactive arthritis (ReA) at the Jackson VAMC.
Methods: A retrospective chart review using ICD-9 codes for PsA, AS, and ReA was performed at Jackson, VAMC. Data including age, race, gender, medications, ESR, CRP, lipid panel, HbA1c, 25-OH Vitamin D level, hypertension (HTN), smoking, statin use, and CVD events were tabulated. Age, sex and race matched controls were selected from VA clinics with a 2:1 ratio. Comparisons of CHD, stroke, and CVD risk factors were made to a matched population from the American Heart Association data, as well as the CDC’s 2003-2004 evaluation of chronic disease in Male veterans. Risk factors included smoking, dyslipidemia (DLD), HTN, and diabetes Mellitus (DM). Prevalence ration and odds ratio were calculated by standard method. Statistical significant (alpha <0.05) was calculated using Chi-square and Fisher's exact test.
Results: There were 81 patients, 79 were male and 2 female. With a mean age of patients with PsA, AS, and ReA being 61,8, 60.4, and 56, respectively. There was a significant increase in the prevalence of CHD and its risk factors in the SpA, PsA, and AS patients when compared with the AHA data, and General Male vets from the 2003-04-control population. When compared to the matched controls, prevalence was increased in the overall SpA, PsA and AS patients but did not achieve statistical significance suggesting increased an risk despite having slightly lower prevalence of risk factors. Also, in both SpA and matched controls population there was an increased prevalence of these risk factors, when compared to the AHA and national data. There was insufficient number of black patients in the cohort to assess effect of ethnicity.
Conclusion: Our results suggest that patients with SpA have an increased risk of developing CHD as well its risk factors. Our study is unique as increased risk and it quantification have not been previously reported in the U.S. veteran population. The increased CHD risk attributable to the increased prevalence of risk factors cannot be determined in this study but has been suggested to be over and above them.
Table 1 CHD comparison among spondyloarthropathies and 3 controls.
|
CHD |
% |
SpA |
PsA |
AS |
ReA |
|
% |
|
26.9 |
29.3 |
30.4 |
14.2 |
|
AHA Controls |
9.1 |
PR= 2.96 OR= 3.72 p-value= 0.002 |
PR= 3.21 OR= 4.18 p-value=0.003 |
PR= 3.34 OR= 4.42 p-value= 0.01 |
PR= 1.56
|
|
General Male Veterans |
11.5 |
PR= 2.34 OR= 2.83 p-value=0.01 |
PR= 2.55 OR= 3.18 p-value= 0.04 |
PR= 2.64 OR= 3.36 p-value=0.05 |
PR= 1.23
|
|
Matched Controls |
18.6 |
PR= 1.45 OR= 2.83 p-value – NS |
PR= 1.57 OR= 3.18 p-value- NS |
PR= 1.63 OR= 3.36 p-value- NS |
PR= 0.76
|
Table 2 CHD Risk Factors
|
|
AHA Controls (1) (%) |
General Male Veterans (2) % |
Matched Controls (3) % |
SpA (%) |
PsA (%) |
AS (%) |
ReA (%) |
|
DM PR
|
7.6 |
13.6 |
29.5 |
24.7 3.25 1.81 0.84 |
22.7 2.99 1.67 0.77 |
26.1 3.43 1.92 0.88 |
28.6 3.76 2.10 0.97 |
|
HTN PR
|
34.4
|
41.2 |
66 |
70.4 2.05 1.71 1.07 |
70.5 2.05 1.71 1.07 |
73.9 2.15 1.79 1.12 |
64.3 1.87 1.56 0.97 |
|
DLD PR
|
45.2 |
44.6 |
69 |
60.5 1.34 1.36 0.88 |
69.8 1.54 1.57 1.01 |
56.5 1.25 1.27 0.82 |
42.5 0.95 0.96 0.62 |
|
Smoking PR
|
23.1 |
22.8 |
63.1 |
62.7 2.71 1.50 0.99 |
62.5 2.71 1.54 0.99 |
56.5 2.45 0.87 0.9 |
75 3.25 1.83 1.19 |
|
Family Hx PR |
|
|
34.1 |
27.8 0.87 |
25 0.73 |
36.4 1.07 |
21.4 0.63 |
Disclosure:
T. Mains,
None;
V. Majithia,
None.
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