Divergence of Cardiovascular Biomarkers of Lipids and Subclinical Myocardial Injury Among Rheumatoid Arthritis Patients With Increased Inflammation

Abstract

Objective. Patients with rheumatoid arthritis (RA) are 1.5 times more likely to develop cardiovascular disease (CVD) attributed to chronic inflammation. A decrease in inflammation in patients with RA is associated with increased low-density lipoprotein (LDL) cholesterol. This study was undertaken to prospectively evaluate the changes in lipid levels among RA patients experiencing changes in inflammation and determine the association with concomitant temporal patterns in markers of myocardial injury.Methods. A total of 196 patients were evaluated in a longitudinal RA cohort, with blood samples and high-sensitivity C-reactive protein (hsCRP) levels measured annually. Patients were stratified based on whether they experienced either a significant increase in inflammation (an increase in hsCRP of ≥10 mg/liter between any 2 time points 1 year apart; designated the increased inflammation cohort [n = 103]) or decrease in inflammation (a decrease in hsCRP of ≥10 mg/liter between any 2 time points 1 year apart; designated the decreased inflammation cohort [n = 93]). Routine and advanced lipids, markers of inflammation (interleukin-6, hsCRP, soluble tumor necrosis factor receptor II), and markers of subclinical myocardial injury (high-sensitivity cardiac troponin T [hs-cTnT], N-terminal pro-brain natriuretic peptide) were measured.Results. Among the patients in the increased inflammation cohort, the mean age was 59 years, 81% were women, and the mean RA disease duration was 17.9 years. The average increase in hsCRP levels was 36 mg/liter, and this increase was associated with significant reductions in LDL cholesterol, triglycerides, total cholesterol, apolipoprotein (Apo B), and Apo A-I levels. In the increased inflammation cohort at baseline, 45.6% of patients (47 of 103) had detectable circulating hs-cTnT, which further increased during inflammation (P = 0.02). In the decreased inflammation cohort, hs-cTnT levels remained stable despite a reduction in inflammation over follow-up. In both cohorts, hs-cTnT levels were associated with the overall estimated risk of CVD.Conclusion. Among RA patients who experienced an increase in inflammation, a significant decrease in routinely measured lipids, including LDL cholesterol, and an increase in markers of subclinical myocardial injury were observed. These findings highlight the divergence in biomarkers of CVD risk and suggest a role in future studies examining the benefit of including hs-cTnT for CVD risk stratification in RA.

Association of atherogenic indices with C-reactive protein and risk factors to assess cardiovascular risk in rheumatoid arthritis patient at Tikur Anbessa Specialized Hospital, Addis Ababa

“…Additionally, RA patients with increased LDL/HDL-C ratio were more likely to have a higher level of hsCRP. In contrast to this, a recent study reported that RA patients with an increase in the level of hsCRP had decreased value of LDL-C [ 33 ]. But, the study didn’t mention their correlation and CVD.…”

Short-term, intermediate-term and long-term risks of acute coronary syndrome in cohorts of patients with RA starting biologic DMARDs: results from four Nordic countries

“…Numerous studies have addressed aspects of CVD in patients with RA in relation to treatment, many of them reporting on beneficial effects of DMARDs (including methotrexate, TNFis and other bDMARDs) on CV risk factors such as glucose, cholesterol or lipid metabolism, blood pressure, endothelial function and arterial stiffness 12 13 21 22 33–36. Most studies focusing on the association between treatment and CV risk have compared groups of drugs rather than individual ones, at least with regard to TNFis.…”

Cardiovascular disease prevention in individuals with underlying chronic inflammatory disease

“…A study measuring the association of lipid changes with subclinical biomarkers of cardiovascular injury found that RA patients with enhanced inflammation had an increase in detectable hs-cTnT levels while a reduction in LDL-C was observed, a change typically associated with reduced cardiovascular risk. In contrast, RA patients experiencing a decrease in inflammation showed an increase in LDL-C without a change in circulating hs-cTnT levels [43 ▪ ]. These results highlight the importance of the future exploration of biomarkers for cardiovascular risk prediction and risk stratification in RA.…”