Background/Purpose: To study the effect of the metabolic syndrome (MetS) on incident vascular events and mortality in 4 rheumatic diseases over an 8-years’ follow-up.

Methods: Consecutive patients who fulfilled the ACR criteria for SLE, EULAR/ACR criteria for RA, ASAS criteria for SpA and CASPAR criteria for psoriatic arthritis (PSA) were recruited in a 2009/2010. At baseline, patients had the following measurements: body weight, height, waist circumference, blood pressure and fasting blood for assay of glucose and lipid (total cholesterol, HDL and LDL cholesterol, triglyceride). The MetS was defined by the updated joint consensus criteria, using the Asian criteria for central obesity, when ≥3/5 components on waist circumference, blood pressure, triglyceride, HDL and glucose. Patients were followed longitudinally for new vascular events and mortality. Comparison was made between those with and without the MetS at baseline. Cox regression analysis was performed to evaluate the impact of MetS on vascular events and mortality.

Results:

1497 patients were studied (693 RA, 577 SLE, 121 SpA and 106 PSA). The age at entry was highest in RA (53.4±12.0 years) and lowest in SpA patients (39.0±11.9 years). The MetS was present in 137 RA (20%), 85 SLE (15%), 13 SpA (11%) and 39 PSA (37%) patients, respectively. Over 94 months’ follow-up, new cardiovascular (acute coronary syndrome or angina) and cerebrovascular (ischemic stroke or transient ischemic attack) events developed in 51 and 29 patients, respectively. The incidence of vascular events (per 100 patient-years) was highest in RA patients (0.84), followed by PSA (0.71), SLE (0.67) and SpA (0.62). There were 99 deaths (12 vascular deaths). The mortality rate (per 100 patient-years) was highest in RA patients (1.04), followed by SLE (0.93), PSA (0.24) and SpA (0.21). Patients with MetS had significantly higher rates of vascular events (9.5% vs 4.8%; p=0.003), all-cause mortality (11.4% vs 5.6%; p<0.001) and vascular mortality (2.2% vs 0.5%; p=0.004) than those without. Cox regression showed that MetS was independently associated with new cardiovascular events (HR 1.98[1.08-3.63]; p=0.03) or any vascular events (HR 1.64[1.01-2.66]; p=0.04), after adjustment for age, sex, duration of underlying disease, ever smoking, LDL and underlying disease (SLE vs non-SLE). A diagnosis of SLE was independently associated with new cerebrovascular events in a separate Cox regression model (HR 4.66[1.80-12.1]; p=0.002). The MetS, however, was not significantly associated with new cerebrovascular events (HR 1.74[0.76-3.97]; p=0.19), all-cause mortality (HR 1.33[0.85-2.07]; p=0.21) or vascular mortality (HR 2.91[0.89-9.51; p=0.08) after adjustment for the same covariates. Factors independently associated with all-cause mortality were age (HR 1.12[1.10-1.14] per year; p<0.001), ever smoking (HR 3.26[1.82-5.84]; p<0.001) and SLE (HR 3.18[1.88-5.37]; p<0.001).

Conclusion: MetS is common in patients with rheumatic diseases. The presence of the MetS increases the risk of new cardiovascular events in these patients over 8 years, which is independent of the underlying rheumatic disease and other risk factors. The MetS is not independently associated with mortality in these four rheumatic diseases.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/effect-of-the-metabolic-syndrome-on-incident-vascular-events-and-mortality-in-four-rheumatic-diseases-an-8-year-longitudinal-analysis/