Carotid Atherosclerosis and Cardiovascular Risk Factors in Patients With Rheumatoid Arthritis at Kenyatta National Hospital

Abstract

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease associated with increased cardiovascular disease. The purpose of my study was to determine the prevalence of carotid atherosclerosis and selected cardiovascular risk factors namely: hypertension, diabetes, obesity, dyslipidaemia and smoking among patients with RA at the Outpatient Rheumatoid clinic in Kenyatta National Hospital. Methodology: This was a cross-sectional descriptive study with a comparative arm, undertaken at the Kenyatta National Hospital, Rheumatology clinic. Study subjects with RA were patients who satisfied the ACR/EULAR 2010 criteria and above the age of 18 years. Comparative arm comprised of age and sex matched individuals without RA. History of medications used, diabetes, hypertension and cigarette smoking were obtained. Bilateral carotid Doppler ultrasounds, blood pressure, weight and height were recorded. Drawing of blood was done from each participant to measure the non-fasting total cholesterol and blood sugar level. The outcomes of interest were prevalence of carotid atherosclerosis as defined as Carotid intima-medial thickness, CIMT, of more than 0.9 mm or carotid plaque, CIMT of more than 1.5 mm and the prevalence of cardiovascular risk factors. Data was analysed by use of SPSS version 21, p value <0.05 considered as significant. Results: 78 RA subjects were randomly selected of which 8 were excluded. 73 controls were recruited, giving a total of 143 participants. Of all the study participants, not even one had a previous history of cardiovascular event. The prevalence of subclinical carotid atherosclerosis among RA patients was 28.6% Vs 13.7% in those with no RA (p = 0.029). The prevalence of hypertension was 30% in RA Vs 35.6% in those with no RA (p=0.475), Diabetes 4.3% in RA Vs 11.0% in those with no RA (p=0.134). Prevalence of dyslipidaemia was 21.4% among those with RA and 13.7% among those with no RA

(p=0.224). The prevalence of abnormal BMI (>25) was 58.6% among those with RA and 75.3% among those with no RA (p=0.033). Conclusion: Almost one in every three RA patients had subclinical atherosclerosis. RA patients were more prone to dyslipidaemia than those with no RA. Recommendation: Subclinical atherosclerosis and dyslipidaemia is common in RA and the clinicians should be alert and intervene early to prevent cardiovascular diseases.