Cardiovascular risk factors in patients with rheumatoid arthritis at Kenyatta National Hospital

Abstract

Introduction and background Rheumatoid arthritis is associated with excess cardiovascular morbidity and mortality predominantly due to accelerated coronary artery and cerebrovascular atherosclerosis. Objective: To identify traditional cardiovascular risk factors in patients with rheumatoid arthritis at Kenyatta National Hospital and compare with healthy controls Study design/site: This was a descriptive comparative cross sectional survey done at KNH medical outpatient clinic. The study population consisted of patients with rheumatoid arthritis and the controls were individuals without RA age and sex matched staff of KNH. All those who consented were enrolled and a clinical evaluation was done. Consecutive sampling was done on those who fulfilled ACR criteria for patients with RA and also for the controls who consented to participate in the trial. Methodology The patients/controls who met inclusion criteria and signed an informed consent, filled a questionnaire with the help of an assistant and had their weight, height, Blood pressure, waist circumference, hip circumference measured. Blood was also taken for fasting blood sugar and lipid profile analysis. They were given back their results and accorded treatment according to the outcome of their results. Results One hundred patients with RA were screened out of which 80 were enrolled. In the control group one hundred and five were screened, twenty five were excluded and 80 were enrolled. The prevalence of hypertension among RA patients was 41.3 %( 24.4- 58.1) Vs 22.5% (3.2-41.8) in the control group and this was statistically significant (P = 0.017). Diabetes in RA patients was 6.3% Vs 5% (p =1) in the controls, prevalence of dyslipidemia in RA patients was 71.3 % (59.6-83) Vs 73.8 % (62.6-85) in the control group (p =0.723). The prevalence of smoking in RA patients was 5% Vs 2.5% (p=0.681) in the control group, while the prevalence of obesity was 22.5% in the patients with RA Vs 32.5% in the control group (p=0.157). Study participants with abnormal WHR were 33.8% in those with RA Vs 33.8% in the control group. Family history of sudden death in patients with RA was 5% Vs 10% in the controls, no family history of stroke or heart attack was reported in the patients with RA. Ten percent of the controls had a family history of sudden death. Family history stroke was 1.3% in the controls and no history of heart attack was reported in the control group. Eighty percent of patients with RA were on at least one DMARD, 57.5% were on steroids and 37.5% were on NSAIDS. Conclusion There is a high prevalence of hypertension in patients with RA; hypertension was also associated with the use of DMARDS and steroids and this was statistically significant. There was no significant difference between patients and controls in terms of other risk factors such as diabetes mellitus, dyslipidemia, smoking, BMI, WHR, and family history of cardiovascular events. Recommendations Clinicians should keenly look out for hypertension In patients with RA for early identification and manage it appropriately.