RESEARCH - RA is associated with a high prevalence of hypothyroidism that amplifies its cardiovascular risk

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Published Online First: 8 June 2007. doi:10.1136/ard.2006.068130

ls of the Rheumatic Diseases 2008;67:229-232

Copyright C 2008 BMJ Publishing Group Ltd & European League Against

Rheumatism

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EXTENDED REPORTS

Rheumatoid arthritis is associated with a high prevalence of hypothyroidism

that amplifies its cardiovascular risk

H G Raterman 1, V P van Halm 2, A E Voskuyl 1, S Simsek 3, B A C Dijkmans 1,

M T Nurmohamed 4

1 Department of Rheumatology, VU University Medical Center, Amsterdam, The

Netherlands

2 Department of Rheumatology, Jan van Breemen Institute Amsterdam, The

Netherlands

3 Department of Clinical Endocrinology, VU University Medical Center,

Amsterdam, The Netherlands

4 Department of Internal Medicine, VU University Medical Center, Amsterdam,

The Netherlands

Objective: Rheumatoid arthritis (RA) patients have an increased risk of

developing cardiovascular diseases (CVD). Other autoimmune diseases such as

hypothyroidism are also associated with an enhanced risk for CVD. Our

objective was to determine first, the prevalence of hypothyroid disorders in

RA patients, and second, the risk of CVD in RA patients with hypothyroid

abnormalities.

Methods: Subjects were RA patients who participated in an ongoing

prospective cohort study of cardiovascular mortality and morbidity (n = 358)

in which hypothyroid abnormalities were assessed. CVD was defined as a

verified medical history of coronary, cerebral or peripheral arterial

disease.

Results: Clinical hypothyroidism was observed in 16 of 236 female RA

patients (6.8%), which is significantly higher than in the general

population of The Netherlands. Subclinical hypothyroidism was detected in 6

out of 236 RA women (2.5%). In female RA patients, CVD was present in 6 out

of 16 (37.5%) of all hypothyroid women. The odds ratio for CVD comparing

female hypothyroid RA patients with female euthyroid RA patients was 4.1

(95% CI 1.2-14.3) after adjustment for sex, age, diabetes, smoking (ever),

hypertension and statin use.

Conclusions: Clinical hypothyroidism was observed three times more often in

female RA patients than females in the general population. In female RA

patients, clinical hypothyroidism was associated with a fourfold higher risk

of CVD in comparison with euthyroid female RA patients independently of the

traditional risk factors.

http://ard.bmj.com/cgi/content/abstract/67/2/229

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