Session Information
Title: Rheumatoid Arthritis - Clinical Aspects (ACR): Comorbidities, Treatment Outcomes and Mortality
Session Type: Abstract Submissions (ACR)
Background/Purpose:
Chronic hepatitis C (HCV) and rheumatoid arthritis (RA) have both been associated with higher cardiovascular disease (CVD) in US veterans. Whether the presence of both conditions compounds the risk of CVD remains unknown. We compared the prevalence of CVD in RA patients with and without HCV.
Methods:
In this cross-sectional study, 97 out of 1952 (5%) RA subjects were identified with HCV within the Veterans Affairs Rheumatoid Arthritis (VARA) registry by the presence of at least one diagnosis (ICD9) code for chronic HCV. This was validated by chart review in a subset of 28 RA patients, of which 25 (89%) were identified as HCV-antibody positive. At enrollment, the presence of cardiovascular disease (composite of myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, stroke, heart failure, and peripheral vascular disease) was determined using previously validated algorithms based on ICD9 codes and Current Procedural Terminology codes. Step-wise multivariable logistic regression models assessed differences in the prevalence of CVD, adjusting for factors known to be associated with CVD in RA.
Results:
At enrollment, HCV-positive RA patients were younger, were more likely to be African-American, were more likely to smoke, had a lower body mass index (BMI), and had shorter disease duration (Table 1). RA disease characteristics between the two groups were similar, though HCV-positive patients were less likely to be prescribed methotrexate and had higher disease activity scores. CVD was less prevalent in the HCV-positive RA patients [24 (25%) vs. 729 (39%)]. There was no difference noted in the prevalence of other comorbidities (type 2 diabetes, chronic kidney disease, or hypertension). LDL, HDL, and triglyceride levels were similar between groups (Table 1). After adjusting for age, sex, race, smoking, BMI, comorbidities, disease duration, and RA therapies, the prevalence of CVD was lower in the HCV-positive RA group [OR 0.58 (0.33-0.99) p=0.05]. In multivariate regression logistic models performed in a subset of 942 subjects with available data and adjusting for DAS28 scores, these associations were no longer significant [OR 0.55 (0.28-1.09), p=0.09 (Table 2)], although the point estimate remained similar.
Conclusion:
Patients with concomitant RA and chronic HCV appear to have a lower odds of prevalent CVD at enrollment compared to those with RA alone. It might be hypothesized that comorbid HCV infection modulates chronic systemic inflammation by altering known atherogenic pathways.
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Table 1: Baseline Demographics |
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HCV+RA N=97 |
HCV-RA N=1853 |
P value |
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Demographic data |
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Age (yrs) |
58.2 ± 7 |
63.9 ± 11.2 |
<0.001 |
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Men, N (%) |
94 (96.9) |
1640 (90.4) |
0.02 |
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Caucasian, N (%) |
59 (60.8) |
1390 (75.3) |
0.001 |
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Current smoker, N (%) |
46/97 (47.4) |
461/1814 (25.4) |
<0.001 |
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BMI (kg/m2) |
27.3 (0.56) |
28.5 (0.14) |
0.04 |
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Disease Duration (yrs) |
8.4 (9.4) |
10.9 (11.4) |
0.03 |
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RA disease Characteristics |
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DAS28 (N=986) |
4.7 (1.6) |
4.02 (1.6) |
0.003 |
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RF |
74/93 (80.0) |
1260/1632 (77.2) |
0.6 |
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CCP |
73/91 (80.2) |
1241/1626 (76.3) |
0.4 |
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Erosions |
44/79 (55.7) |
727/1403 (51.8) |
0.5 |
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Medications |
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Methotrexate, N (%) |
21 (23.3) |
852 (51.6) |
<0.001 |
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Prednisone, N (%) |
42 (46.7) |
625 (37.9) |
0.06 |
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Anti-TNFα, N (%) |
23 (25.6) |
321 (19.5) |
0.1 |
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Lipid panel |
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LDL (N=1128) |
102.5 ± 4.2 |
102.1 ± 1.05 |
0.93 |
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HDL (N=1157) |
46.5 ±2,5 |
44.7 ± 0.47 |
0.39 |
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Triglycerides (N=1133) |
129.7 ± 9.6 |
141.3 ± 2.7 |
0.33 |
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Comorbidities |
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CKD, N (%) |
3 (3.1) |
127 (6.9) |
0.15 |
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DM, N (%) |
25 (25.8) |
530 (28.6) |
0.55 |
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COPD, N (%) |
12 (12.4) |
144 (7.8) |
0.1 |
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HTN, N (%) |
68 (70.1) |
1212 (65.4) |
0.9 |
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CAD, N (%) |
17 (17.5) |
564 (30.4) |
0.01 |
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CVD, N (%) |
24 (24.7) |
729 (39.3) |
0.004 |
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Abbreviations: BMI=Body Mass Index; CKD=Chronic Kidney Disease; DM=Diabetes Mellitus; COPD=Chronic Obstructive Pulmonary Disease; HTN=hypertension; CAD=Coronary Artery Disease; CVD=Cardiovascular Disease |
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Table 2: Prevalence of cardiovascular disease in Hepatitis C positive RA patients compared to RA controls |
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OR (95% CI) |
P value |
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Model 1 (Observations 1905) |
0.70 (0.43-1.14) |
0.16 |
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Model 2 (Observations 1561) |
0.58 (0.33-0.99) |
0.05 |
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Model 3 (Observations 942) |
0.55 (0.28-1.09) |
0.09 |
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Model 1: adjusted for age, sex, race Model 2: Model 1 + DM, HTN, BMI, current smoking, methotrexate use, prednisone use, anti-TNF therapy use, disease duration Model 3: Model 2 + DAS28 |
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Abbreviations: DM=Diabetes Mellitus; HTN=hypertension; BMI= Body Mass Index; CRP=c-reactive protein; DAS28=disease activity score |
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Disclosure:
R. Patel,
None;
T. R. Mikuls,
None;
J. S. Richards,
None;
G. W. Cannon,
None;
G. S. Kerr,
None;
L. A. Davis,
None;
L. Caplan,
None;
J. F. Baker,
None.
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