Cardiovascular Disease in Postmenopausal Women with Metabolic Syndrome

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The characteristics of metabolic syndrome are different in men and women with early rheumatoid arthritis, and while men have an overall higher prevalence and frequency of individual metabolic syndrome components, postmenopausal women may be particularly vulnerable and require careful surveillance and screening, say researchers writing in ACR Open Rheumatology last month.

Metabolic syndrome is disproportionately higher in established rheumatoid arthritis compared with the general population, but its prevalence in early rheumatoid arthritis is conflicting. In rheumatoid arthritis, the majority of studies have found no significant differences in metabolic syndrome prevalence between men and women, but these studies have mainly focused on patients with established rheumatoid arthritis. The few studies exploring this topic in early rheumatoid arthritis have not assessed sex‐specific variations in metabolic syndrome components and associated factors. Meanwhile, no study has explored menopause and its impact on metabolic syndrome for women with early rheumatoid arthritis.

“Understanding sex‐related variations in metabolic syndrome -especially in rheumatoid arthritis with a clear female predominance-will help inform whether customized cardiovascular disease risk assessment and management for men and women with early rheumatoid arthritis may be justified,” wrote the authors, led by Bindee Kuriya, M.D., of the University of Toronto in Canada.

In this cross‐sectional study, researchers estimated the prevalence and factors associated with metabolic syndrome in men and women with early rheumatoid arthritis in 1543 participants (71 percent female, mean age was 54 years).

“Our metabolic syndrome prevalence estimate of 31 percent is in keeping with other published reports,” the authors wrote.

Metabolic syndrome prevalence was higher in men (42 percent) than women (26 percent, P < 0.0001) and increased with age. Frequent metabolic syndrome components in men were hypertension (62 percent), impaired glucose tolerance (40 percent), obesity (36 percent), and low high‐density lipoprotein cholesterol (36 percent). Postmenopausal women had greater frequency of hypertension (65 percent), impaired glucose tolerance (32 percent), and high triglycerides (21 percent) compared with premenopausal women (P < 0.001).

Metabolic syndrome was negatively associated with seropositivity and pulmonary disease in men, and associated with increasing age in women. Corticosteroid use and psychiatric comorbidity were associated with metabolic syndrome in postmenopausal and premenopausal women, respectively. Metabolic syndrome status was not explained by disease activity or core rheumatoid arthritis measures.

“These findings suggest that between‐ and within‐sex differences may be important when considering comorbidity management in early rheumatoid arthritis.

“Postmenopausal women have a cumulative profile that should be considered as high risk for cardiovascular disease development. At the bedside, this would translate to judicious use of NSAIDs and corticosteroids, and frequent surveillance of glucose levels, blood pressure, and weight/BMI among postmenopausal women, regardless of age,” the authors wrote.

REFERENCE

Kuriya, B. , Schieir, O. , Valois, M. F., et al. “Prevalence and Characteristics of Metabolic Syndrome Differ in Men and Women with Early Rheumatoid Arthritis.”ACR Open Rheumatology. August 28, 2019. doi:10.1002/acr2.11075