TY - JOUR
T1 - Exploring the Lipid Paradox Theory in Rheumatoid Arthritis
T2 - Associations of Low Circulating Low-Density Lipoprotein Concentration With Subclinical Coronary Atherosclerosis
AU - Giles, Jon T.
AU - Wasko, Mary Chester M.
AU - Chung, Cecilia P.
AU - Szklo, Moyses
AU - Blumenthal, Roger S.
AU - Kao, Amy
AU - Bokhari, Sabahat
AU - Zartoshti, Afshin
AU - Stein, C. Michael
AU - Bathon, Joan M.
N1 - Funding Information:
We would like to thank the Johns Hopkins Bayview Medical Center General Clinical Research Center and staff, the field center of the Baltimore MESA cohort, and the MESA Coordinating Center at the University of Washington, Seattle. The authors thank the other investigators and staff of and participants in the MESA study for their valuable contributions.
Publisher Copyright:
© 2019, American College of Rheumatology
PY - 2019/9/1
Y1 - 2019/9/1
N2 - Objective: Rheumatoid arthritis (RA) patients with the lowest circulating low-density lipoprotein (LDL) concentrations are at heightened risk of cardiovascular events. However, the atherosclerosis burden within this subgroup is unknown. Methods: RA patients pooled from 4 cohort studies of cardiovascular disease (CVD; n = 546) were compared with non-RA controls from the Multi-Ethnic Study of Atherosclerosis (n = 5,279). Those taking lipid-lowering medications were excluded. Differences in cardiac computed tomography–derived Agatston coronary artery calcium (CAC) scores between the RA and control groups were compared across strata of LDL concentration. Results: Among those with low LDL concentrations (<70 mg/dl), mean adjusted CAC scores were >4-fold higher for RA patients than for controls (18.6 versus 4.6 Agatston units, respectively; P < 0.001), a difference significantly greater than that in any other LDL concentration stratum except LDL concentration ≥160 mg/dl. Similarly, 32% of the RA patients with low LDL concentration had a CAC score of ≥100 Agatston units compared with only 7% of controls in the same LDL concentration stratum (odds ratio 5.97; P < 0.001), a difference significantly greater than that in all of the other LDL concentration strata. Low LDL concentration was most strongly associated with higher CAC score among RA patients who were white, had ever smoked, or were not obese. Other than a higher frequency of current smokers, RA patients with low LDL concentrations did not have more CVD risk factors or higher measures of RA disease activity or severity than RA patients with higher LDL concentrations. Conclusion: RA patients with low LDL concentration may represent a group for whom heightened screening and prevention of atherosclerotic CVD is appropriate.
AB - Objective: Rheumatoid arthritis (RA) patients with the lowest circulating low-density lipoprotein (LDL) concentrations are at heightened risk of cardiovascular events. However, the atherosclerosis burden within this subgroup is unknown. Methods: RA patients pooled from 4 cohort studies of cardiovascular disease (CVD; n = 546) were compared with non-RA controls from the Multi-Ethnic Study of Atherosclerosis (n = 5,279). Those taking lipid-lowering medications were excluded. Differences in cardiac computed tomography–derived Agatston coronary artery calcium (CAC) scores between the RA and control groups were compared across strata of LDL concentration. Results: Among those with low LDL concentrations (<70 mg/dl), mean adjusted CAC scores were >4-fold higher for RA patients than for controls (18.6 versus 4.6 Agatston units, respectively; P < 0.001), a difference significantly greater than that in any other LDL concentration stratum except LDL concentration ≥160 mg/dl. Similarly, 32% of the RA patients with low LDL concentration had a CAC score of ≥100 Agatston units compared with only 7% of controls in the same LDL concentration stratum (odds ratio 5.97; P < 0.001), a difference significantly greater than that in all of the other LDL concentration strata. Low LDL concentration was most strongly associated with higher CAC score among RA patients who were white, had ever smoked, or were not obese. Other than a higher frequency of current smokers, RA patients with low LDL concentrations did not have more CVD risk factors or higher measures of RA disease activity or severity than RA patients with higher LDL concentrations. Conclusion: RA patients with low LDL concentration may represent a group for whom heightened screening and prevention of atherosclerotic CVD is appropriate.
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U2 - 10.1002/art.40889
DO - 10.1002/art.40889
M3 - Article
C2 - 30883031
AN - SCOPUS:85069923597
VL - 71
SP - 1426
EP - 1436
JO - Arthritis and Rheumatology
JF - Arthritis and Rheumatology
SN - 2326-5191
IS - 9
ER -