Hyperuricaemia: a marker of increased cardiovascular risk in rheumatic patients: analysis of the ACT-CVD cohort

Background Gout and hyperuricaemia may be associated with increased cardiovascular risk, but analyses in different populations show conflicting results. This study investigates the impact of serum uric acid, inflammation and traditional CV risk parameters on CV event risk in patients with gouty arthritis and patients with non-gouty rheumatic disease. Methods cross-sectional and prospective multivariate analysis of the relation between tertiles of serum uric acid and individual traditional CV risk factors in a cohort of gouty arthritis (GA, n=172), rheumatoid arthritis (RA, n=480) and osteoarthritis (OA, n=206) patients. Main outcome measures: systolic blood pressure, TC/HDL ratio, GlyHb, BMI and first CV events. Results Individual CV risk factors were significantly less favourable in GA (systolic blood pressure, TC/HDL ratio, BMI, p<0.05). In RA and OA, but not in GA, individual cardiometabolic parameters correlated with serum uric acid values (OA: RA: systolic blood pressure, TC/HDL ratio, BMI; systolic blood pressure, TC/HDL ratio, GlyHb, BMI; p<0.05). In non-GA individuals the highest tertile of serum uric acid (>0.34 mmol/L) and NT proBNP level were independent predictors of first CV events, against age and GlyHb level in GA (p<0.05). The hazard of first CV events was equally significantly increased in GA patients (HR 3.169, 95% CI 1.287-7.806) and non-GA individuals with a serum uric acid ≥ 0.34 mmol/L (HR 3.721, 95% CI 1.603-8.634) compared to non-GA individuals with a serum uric acid < 0.27. Conclusions GA is associated with a 3.1-fold hazard of first CV events. In non-GA rheumatic patients increasing serum uric acid is associated with increased CV risk, whereas CV risk in GA is independent of serum uric acid values. The presence of GA or a baseline serum uric acid in the upper range are possibly stronger predictors of first CV events than some traditional CV risk factors or parameters of inflammatio

Cardiovascular case fatality in rheumatoid arthritis is decreasing; first prospective analysis of a current low disease activity rheumatoid arthritis cohort and review of the literature

Background Previous studies found increased case fatality after myocardial infarction and more frequent sudden death in RA patients compared to non-RA subjects. The RA associated CV risk might be explained by the combined effects of chronic systemic inflammation and increased lifestyle associated cardiovascular risk factors, and modified by the use of medication such as non steroidal anti-inflammatory drugs, corticosteroids and disease modifying anti-rheumatic drugs. Trends in case fatality rate in RA after the introduction of potent anti-inflammatory biologic therapies and treat-to-target treatment strategies aiming at remission are not known. This study was performed to examine the cardiovascular fatality rate in current low disease activity RA, and to evaluate trends in RA associated CV case fatality over time. Methods Prospective study to determine the incidence of fatal and nonfatal CV events in 480 RA patients included in the ACT-CVD cohort between February 2009 and December 2011. Patients with prior CV disease were excluded. Cox regression analysis was performed to determine CV event risk and contributing risk factors over time. The results of the cohort analysis were put into the context of a review of the literature to evaluate trends in RA associated CV fatality rate over time. Results The study included 480 RA patients, 72.3% female with median disease duration of 4.2 years, 72.1% being in clinical remission (Disease Activity Score in 28 joints). During a mean follow up of 2.9 years 29 patients (6%) experienced a first CV event, 2 fatal and 27 non-fatal, corresponding to a 6.9% case fatality rate. Comparison with previous studies in cohorts with successive enrolment periods shows a trend towards a decrease in CV case fatality in RA from 52.9% in 1998 to 6.9% in our study. Conclusion CV case fatality in current low disease activity RA is importantly lower than in previous studies, and a trend towards decreasing CV fatality in RA is suggeste

Reading tea leaves worldwide: decoupled drivers of initial litter decomposition mass‐loss rate and stabilization

The breakdown of plant material fuels soil functioning and biodiversity. Currently, process understanding of global decomposition patterns and the drivers of such patterns are hampered by the lack of coherent large‐scale datasets. We buried 36,000 individual litterbags (tea bags) worldwide and found an overall negative correlation between initial mass‐loss rates and stabilization factors of plant‐derived carbon, using the Tea Bag Index (TBI). The stabilization factor quantifies the degree to which easy‐to‐degrade components accumulate during early‐stage decomposition (e.g. by environmental limitations). However, agriculture and an interaction between moisture and temperature led to a decoupling between initial mass‐loss rates and stabilization, notably in colder locations. Using TBI improved mass‐loss estimates of natural litter compared to models that ignored stabilization. Ignoring the transformation of dead plant material to more recalcitrant substances during early‐stage decomposition, and the environmental control of this transformation, could overestimate carbon losses during early decomposition in carbon cycle models

Non-Steroidal Anti-Inflammatory Drugs: An Overview of Cardiovascular Risks

pharmaceutical

Increased Serum Uric Acid: Consequence or Cause of Increased Cardiovascular Risk

Background/Purpose: Reports on cardiovascular (CV) disease in hyperuricemia and gout show conflicting results. Some studies show hyperuricemia to be an independent risk factor for CV events and death, others find no such associations or only with gouty arthritis. Gout and hyperuricemia have also been associated with individual CV risk factors such as increasing age, male sex, overweight, hypertension, dyslipidemia, diabetes and inflammation. Studies evaluating the complex associations between serum uric acid, inflammation, gouty arthritis and CV risk are lacking. This study was done to investigate the associations between serum uric acid and cardiometabolic risk factors and estimated CV risk in patients with gouty arthritis, non-gouty arthritis, and degenerative joint disease. To explore the effect of uric acid lowering therapy (ULT) on CV risk. Methods: Analysis of the relation between serum uric acid and estimated 10-year risk of CV death (SCORE risk calculation, low risk version corrected for diabetes by increasing age with 15 years) and individual CV risk factors, i.e. systolic blood pressure (SBP), TC/HDL ratio (TC/HDL), diabetes and smoking in patients with osteoarthritis (OA, n197), rheumatoid arthritis (RA, n675) and gouty arthritis (GA, n201) in a cohort of consecutive patients attending the Arthritis Center Twente in 2009. Subanalysis of the effect of uric acid lowering therapy (ULT; allopurinol or benzbromarone, target serum uric acid 0.36 mmol/L) on estimated 10-year CV risk in GA patients. Differences between groups and associations between CV risk variables and tertiles of serum uric acid were tested with ANOVA (for continuous cardiovascular risk factors) or Chi squared statistics (for nominal cardiovascular risk factors), adjusted for differences by age and sex. Results: mean estimated 10-year CV risk was significantly higher in GA (GA 9.5% vs 5.7% in OA and RA, p0.05). In RA and OA mean estimated 10-year cardiovascular risk as well as individual cardiometabolic parameters (OA: mean SBP, mean TC/HDL; RA: mean SBP, mean TC/HDL, prevalence diabetes. p0.05) correlated with serum uric acid values. None of these correlations were present in GA. In GA plasma uric acid was lower in patients on ULT (0.32 mmol/l ULT vs 0.47 mmol/l non-ULT, p0.05), age and frequency of CV events did not differ from non-ULT users. ULT did not affect mean estimated 10-year CV risk (9.7% ULT vs 8.9% non-ULT, p0.05). Conclusion: Gouty arthritis is a red flag for increased CV risk, as shown by higher prevalence of previous CV events and increased metabolic parameters of CV risk. Serum uric acid is associated with metabolic parameters of CV risk and 10-year risk of CV death. Effective ULT does not affect 10-year CV risk. Increased serum uric acid is therefore probably secondary to a high cardiometabolic risk profile

Increased cardiovascular risk factors in different rheumatic disease compared with the general population

Objectives. To study the prevalence of cardiovascular risk factors among patients attending a rheumatology outpatient clinic in comparison with the general population. \ud \ud Methods. Cross-sectional comparison between a rheumatic outpatient cohort of consecutive patients (n = 1233) between 36 and 75 years of age attending the Arthritis Center Twente (ACT) in the year 2009: RA (n = 546), gout (n = 129), OA (n = 168), CTD (n = 85), PMR (n = 91) and chronic localized or generalized pain syndromes (CPSs; n = 214) and a random sample from a long-lasting population-based health study in the Netherlands (n = 4523). The main outcome measures were hypertension (systolic blood pressure ≥ 140 mmHg and/or a diastolic blood pressure ≥ 90 mmHg and/or the use of antihypertensive medication), abnormal cholesterol profile (total cholesterol ≥ 6.5 mmol/l, and/or high-density lipoprotein < 0.9 mmol/l and/or use of lipid lowering medication), overweight (BMI ≥ 25 kg/m2), obesity (BMI ≥ 30 kg/m2) and cigarette smoking habits (self-reported current smoking). \ud \ud Results. Compared with the general population, patients with rheumatic diseases have a significantly higher prevalence of hypertension (PACT = 68%, Pgeneral = 57%), being overweight (PACT = 72%, Pgeneral = 62%), obesity (PACT = 30%, Pgeneral = 17%) and cigarette smoking (PACT = 26%, Pgeneral = 21%). The worst risk profile was found in gout patients, with higher prevalence of all cardiovascular risk factors studied. \ud \ud Conclusion. Lifestyle-associated potentially modifiable cardiovascular risk factors are over-represented along the whole spectrum of chronic rheumatic diseases, and not only in RA, as suggested by preceding studies

Non-Steroidal Anti-Inflammatory Drugs: An Overview of Cardiovascular Risks

While aspirin may offer protection, other non-aspirin non-steroidal anti-inflammatory drugs (NSAIDs) can cause serious cardiovascular side effects and complications. This has led to a general "black box" warning for cardiovascular adverse events for NSAIDs. This review explores the different mechanisms underlying the protective effects of aspirin, the NSAID associated renovascular effects causing hypertension, edema and heart failure, the cardiovascular effects causing myocardial infarction and stroke, and the possible deleterious interaction between NSAIDs and aspiri