Lipid Levels and CV Events in RA Save

Rheumatoid arthritis not only affects the joints but can also increase risk for cardiovascular disease. The mechanism of the increased risk of cardiovascular disease in rheumatoid arthritis remains uncertain. Studies characterizing the relationship between LDL cholesterol and CVD are few and often confusing.

The study by Myasoedova et al (http://1.usa.gov/1LT0DDL) revealed that RA patients who have lower LDL cholesterol levels have a risk of CVD similar to patients with high LDL cholesterol levels, termed the “lipid paradox”. Another group of researchers concludes in their study that HDL cholesterol was associated with a lower risk of CVD, assuming that HDL cholesterol levels have the expected association with CV risk in RA independent of LDL cholesterol levels (http://1.usa.gov/1MzKZii).

A need for further research could not be underestimated. A large cohort study enrolled 16,085 RA patients and 48,499 non-RA controls. The associations between lipid levels and incidence of major adverse CV events (MACE) was tested.

No significant increase in CV risk was observed between the lowest quintile of LDL cholesterol levels (≤91.0 mg/dl) and the second, third, or fourth quintiles, whereas the highest quintile (>190.0 mg/dl) conveyed a 40% increase in risk of major adverse CV events (MACE) (hazard ratio [HR] 1.40, 95% confidence interval [95% CI] 1.17–1.68).

The relationship between HDL cholesterol levels and incidence of MACE was also nonlinear and similar between RA patients and non-RA controls (P= 0.39).

This study concluded that the complex relationship between LDL cholesterol levels, HDL cholesterol levels, and the risk of MACE was nonlinear and not statistically significantly different between RA patients and an age and sex-matched non-RA cohort.