HDL Cholesterol Efflux Capacity and Concentration in Patients With Rheumatoid Arthritis: a Systematic Review and Meta-Analysis

Abstract

Background: HDL cholesterol efflux capacity has been proposed as an independent risk factor of cardiovascular diseases. However, the presented data has been less than convincing in RA. This meta-analysis aimed to identify whether CEC was impaired in RA or altered by drug therapy.Methods: PubMed, Embase, and Cochrane library databases were searched to identify studies for CEC in RA patients. The primary outcomes were CEC, high-density lipoprotein cholesterol and C-reactive protein.Results: A total of 11 eligible articles including 6 observational and 5 intervention studies. Pooled results showed there was no significantly decrease in the CEC of RA patients comparing with the healthy controls (SMD: -0.22, 95% CI: -0.65 to 0.20), whereas the plasma HDL-C levels was decreased in RA patients (WMD: -5.21, 95% CI: -7.69 to -2.72). Furthermore, in the before-after studies, CEC of RA patients (SMD: 0.20, 95% CI: 0.03 to 0.38) was increased but the plasma HDL-C levels (WMD: 3.26, 95% CI: -0.17 to 6.69) was similar after anti-rheumatic treatment comparing to the baseline. In addition, stratified analysis suggested that DAS28 could be potential sources of heterogeneity for CEC. The funnel plot was relatively symmetric and was not suggestive of presence of publication bias.Conclusion The current meta-analysis demonstrated a slight, nonsignificant, decrease in the CEC among RA patients as compared with healthy individuals, but it can be improved substantially following anti-rheumatic treatment. More large population studies evaluating the predictive role of CEC on cardiovascular risk in RA are needed.