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Association of atherogenic indices with C-reactive protein and risk factors to assess cardiovascular risk in rheumatoid arthritis patient at TikurAnbessa Specialized Hospital, Addis Ababa

Gashaw Dessie

Abstract

Background

Rheumatoid arthritis (RA) is an autoimmune systemic chronic inflammatory disorder, which is characterized by joint stiffness, damage, and destruction of bone. In RA patients, the risk of cardiovascular disease is increased by 2–3 folds as compared to the general population. The major burden of RA is the development of cardiovascular diseases, including congestive heart failure, stroke, and myocardial infarction.

Introduction

Rheumatoid arthritis (RA) is an autoimmune systemic chronic inflammatory disorder, which is characterized by joint stiffness, damage, and destruction of bone [1]. The risk of cardiovascular disease (CVD) is elevated by 2–3 folds among RA patients as compared to the general population [2]. In RA patients, cardiovascular disease is the predominant risk factor of mortality similar to CVD associated complications of diabetes mellitus. The congestive heart failure, stroke, ischaemic cardiomyopathy, and myocardial infarction are the common CVDs, which are mainly associated with the development of atherosclerosis [3, 4].

Methods and materials

Study area and period

The study was conducted at TikurAnbessa Specialized Hospital rheumatology clinic. TikurAnbessa Specialized Hospital is the largest referral teaching hospital in Ethiopia. It serves as the country’s top referral hospital. It has 800 beds and gives diagnostic and treatment services for about 370,000–400,000 patients per year. The study period of this study was from June 2018-November 2018.

Results

Comparison of atherogenic indices and biochemical parameters among study participants
The levels of atherogenic indices (TC/HDL-C, LDL/HDL/L, and AIP) were computed for both RA patients and control groups. In RA patients, the Mean ± SD value of AIP, TC/HDL, and LDL/HDL were 0.36 ± 0.26, 3.64 ± 1.52, and 2.07 ±1.18 respectively. On the other hand, the Mean ± SD value of AIP, TC/HDL, and LDL/HDL for apparently healthy study participants were 0.28 ± 0.19, 3.40 ± 0.84, and 1.98 ± 0.73 respectively. The mean ± SD of hsCRP were 10.54±17.26 and 3.54 ±7.60 for both case and control groups respectively.

Discussion

The result of this study showed that the atherogenic indices are the potential biochemical markers to predict and manage the risk of cardiovascular disease in RA patients. In this study, the atherogenic indices, including AIP, TC/HDL-C, and LDL/HDL-Chad a statistically significant association with well-defined cardiovascular risk factors. The assessment of this study showed that women were more likely to have elevated LDL-C and TG values than men (Table 3). Thus, it was agreed with the previous finding [1]. On the other hand, the Mean ± SD of BMI value showed that RA patients had a higher level as compared to control. However, it didn’t show a statistically significant variation. The previous investigation also reports about the lack of significant association of BMI value among patients and apparently healthy study participants [23]. Regarding the assessment of socioeconomic status, RA patients with low monthly income had more likely to have elevated cardiovascular risk factors (Table 4). Low income status of study participants was significantly associated with hsCRP, and it was agreed with the study done in Turk [24].

Conclusions

In this study, the level of atherogenic indices didn’t show a statistically significant difference between RA patients and control groups. The result of this study showed that TC/HDL-C, LDL/HDL-C, and AIP had a statistically significant association with an elevated level of LDL-C and TG, which are well-defined cardiovascular risk factors. Similarly, they have a statistically significant association with hsCRP, which is another known cardiovascular risk factor and disease activity biochemical marker. There was a highly significant statistical association between atherogenic indices, elevated LDL-C, and TG values. The association of indices with cardiovascular risk factors showed that atherogenic indices may act as accurate markers to assess CVD risk due to fluctuation effect of disease activity. Therefore, the CVD risk assessment may be more enhanced by evaluation of atherogenic indices as compared to individual lipid profiles. Consequently, the result of this finding confirmed that atherogenic indices have the potential role in the prediction and management of CVD risk in RA patients

Acknowledgments

I sincerely acknowledge Addis Ababa University, University of Gondar, and TikurAnbessa Specialized Hospital for their support during the research work. I thank all the study participants who were enrolled in this study.

Citation: Dessie G (2022) Association of atherogenic indices with C-reactive protein and risk factors to assess cardiovascular risk in rheumatoid arthritis patient at TikurAnbessa Specialized Hospital, Addis Ababa. PLoS ONE 17(6): e0269431. https://doi.org/10.1371/journal.pone.0269431

Editor: Gualtiero I. Colombo, Centro CardiologicoMonzino, ITALY

Received: November 11, 2021; Accepted: May 21, 2022; Published: June 3, 2022

Copyright: © 2022 GashawDessie. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Data Availability: All the data are available within the paper.

Funding: The author received no specific funding for this work.

Competing interests: The author declared that no competing interests exist.

Abbreviations: AIP, Atherogenic index of plasma; BMI, body mass index; HDL-C, high density lipoprotein; hsCRP, high sensitivity C-reactive proteins; LDL-C, low density lipoprotein; RA, Rheumatoid arthritis; TC, total cholesterol; TG, triglycerides

https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0269431#abstract0

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