**3. Results**

Six-hundred seventy-one patients were included in this study (Table 1). The study cohort included 53 (7.9%) women, had a mean age of 65.4 years [SD10.8], and a mean disease duration of 13.7 years [SD 11.5]. The majority were Caucasian (n = 543, 80.9%). Four hundred and twelve (61.4%) had radiographic changes consistent with RA, and 312 (46.5%) had nodules. Approximately 58.3% were on a traditional DMARD at their most recent clinic visit, while an additional 25.8% were receiving a combination of a biologic agent with a traditional DMARD. Fifty three percent of the study cohort was receiving prednisone.

The mean DAS28 was 3.2 [SD 1.3] and CRP was 1.3 [SD 1.9] mg/dl. The majority (78.8%) were either previous or current smokers. One-hundred eighty-nine subjects satisfied the modified criteria for MetS, corresponding to a prevalence of 28.2% (95 % CI 24.7-31.7). There were no significant differences in subject demographics, measures of disease severity or activity, use of biologic agents or DMARDS, prednisone use, or smoking status in RA subjects with MetS compared to those without MetS (Table 1). In a subanalysis of subjects with and without MetS, there were no significant differences in measures of disease activity in those taking statins compared to individuals not taking statins (data not shown). As expected, disease components of MetS were far more common in those with the syndrome in comparison to those without MetS (Figure 1). Of note, a BMI that exceeded 30 kg/m2 was present in only one-third of study patients, but comprised 66% of MetS patients and only 20% of individuals without MetS. The use of anti-hypertensive and lipid lowering agents

Association of Cardiovascular Disease

**P values not statically significant for all variables**  ۩ **V**eteran **A**ffairs **R**hematoid **A**rthritis Registry

DMARDS (Disease Modifying Anti-rheumatic drugs) \*Biologic Agents (mainly anti-tumor necrosis factor)

Syndrome with Cardiovascular Disease in VARA cohort

1.91 (1.31–2.79), compared to 1.68 (1.11–2.55) in the 749 women.

SD = Standard Deviation

CI = Confidence Interval

with the Metabolic Syndrome in a Predominantly Male Cohort with Rheumatoid Arthritis 239

*VARA� Cohort % (n), mean [SD]* 

Variables (N=671) 78% (482) 28% (189) Age 65.35 [SD 10.75] 65.23 [SD11.43] 65.66 [8.79] Female 7.9 (53) 9.8 (47) 3.2 (7) Caucasian 80.6 (543) 80.3 (387) 82.5 (156) African American 14.6 (98) 15.4 (74) 12.7 (24) Erosions present 61.4 (412) 63.9 (308) 55 (104) Disease Duratio 13.74 [SD 11.5] 14.08 [SD 11.61] 12.89 [SD 11.21] Nodules present 46.5 (312) 47.5 (229) 43.9 (83) RF Positive 88.4 (593) 89 (429) 86.8 (164) DAS28(3v)† 3.20 [SD 1.34] 3.21 [SD 1.33] 3.18 [SD 1.38] CRP 1.29 [SD 1.87] 1.37 [SD 1.98] 1.09 [SD 1.53] DMARDS 58.3 (391) 56.2 (271) 63.5 (120) DMARDS+Biologic\* 25.8 (173) 26.4 (127) 24.3 (46) Prednisone 43.5 (292) 46.7 (225) 35.5 (67) Ever Smoke 78.8 (529) 78.7 (379) 79.4 (150)

 MetS = Metabolic Syndrome DMARDS=Disease-Modifying Anti-Rheumatic Drugs \*Biological Agents (mainly anti-tumor necrosis factor) †Disease Activity Score, 28 joints

Rheumatoid Arthritis Patients with and without the Metabolic Syndrome

Table 1. Demographics and Parameters of Disease Severity and Activity of Veterans Affairs

*Variables OR 95% C.I. P value* 

MetS Present 2.91 1.95 4.34 <0.001 DMARDS 2.27 1.47 3.50 <0.001 Age 1.04 1.02 1.07 <0.001 Ever Smoking 1.67 0.99 2.82 0.05 Gender (male) 0.38 0.11 1.29 0.12 DMARDS+Biologic\* 1.06 0.66 1.72 0.80

Table 2. Multivariable Logistic Regression Model examining the association of Metabolic

of 615 men aged 50 to 75 years, the prevalence of MetS varied from 17% - 32% when assessing the agreement in the various definitions of MetS (Dekker et al., 2005). When using NCEP-ATPIII criteria, the hazard ratio for fatal and non-fatal CVD in men with MetS was

A similar risk for CVD occurs for RA patients with MetS, but these results are obtained from cohorts consisting primarily of female patients (Dessein et al., 2002; Karvounaris et al., 2007).

Lower Upper

% (Number) MetS Absent MetS Present

were nearly universal among those meeting criteria for MetS, with over 95% use. Logistic regression analysis revealed MetS to be associated with an approximately three-fold risk of CVD (OR=2.9; 95% CI 1.95-4.34), after adjusting for age, sex, DMARD / biologic use, and smoking status (Table 2). There was no increased CVD risk with individual components of the metabolic syndrome.

Anti-DM = Treatment for diabetes with insulin and/or oral hypoglycemic medications Anti-Lipid = Treatment for dyslipidemia with cholesterol lowering medications Anti-HTN = Treatment for high blood pressure with medications

Fig. 1. MetS Components Frequency in VARA cohort
