RESEARCH - Lipid paradox in RA: impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease

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Ann Rheum Dis. 2011 Jan 7. [Epub ahead of print]

Lipid paradox in rheumatoid arthritis: the impact of serum lipid

measures and systemic inflammation on the risk of cardiovascular

disease.

Myasoedova E, Crowson CS, Kremers HM, VL, Fitz-Gibbon PD,

Therneau TM, SE.

Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.

Abstract

OBJECTIVE: To examine the impact of systemic inflammation and serum

lipids on cardiovascular disease (CVD) in rheumatoid arthritis (RA).

METHODS: In a population-based RA incident cohort (1987 American

College of Rheumatology criteria first met between 1988 and 2007),

details were collected of serum lipid measures, erythrocyte

sedimentation rates (ESRs), C-reactive protein (CRP) measures and

cardiovascular events, including ischaemic heart disease and heart

failure. models were used to examine the association of lipids and

inflammation with the risk of CVD and mortality, adjusting for age,

sex and year of RA incidence.

RESULTS: The study included 651 patients with RA (mean age 55.8

years, 69% female); 67% were rheumatoid factor positive. ESR was

associated with the risk of CVD (HR=1.2 per 10 mm/h increase, 95% CI

1.1 to 1.3). Similar findings, although not statistically significant,

were seen with CRP (p=0.07). A significant non-linear association for

total cholesterol (TCh) with risk of CVD was found, with 3.3-fold

increased risk for TCh <4 mmol/l (95% CI 1.5 to 7.2) and no increased

risk of CVD for TCh ≥4 mmol/l (p=0.57). Low low-density lipoprotein

cholesterol (LDL <2 mmol/l) was associated with marginally increased

risk of CVD (p=0.10); there was no increased risk for LDL ≥2 mmol/l

(p=0.76).

CONCLUSION: Inflammatory measures (particularly, ESR) are

significantly associated with the risk of CVD in RA. Lipids may have

paradoxical associations with the risk of CVD in RA, whereby lower TCh

and LDL levels are associated with increased cardiovascular risk.

PMID: 21216812

http://www.ncbi.nlm.nih.gov/pubmed/21216812

Not an MD