Postprandial Apolipoprotein B48 is Associated with Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis

Abstract

Objective: To describe postprandial lipemia in patients with rheumatoid arthritis (RA) and to analyze its association with subclinical atherosclerosis measured as carotid intima-media thickness (cIMT). Methods: We performed an observational study of 40 patients with RA and 40 sex and age-matched controls. Patients with dyslipidemia were excluded. Pathologically increased cIMT was defined as a carotid thickness greater than the 90th percentile (>p90) for age and sex. Fasting and postprandial plasma lipids, cholesterol, triglycerides, apolipoprotein B48 (ApoB48), and total ApoB were evaluated. The other variables included were clinical and laboratory values, Framingham score, and the 28-joint Disease Activity Score (DAS28). Two multivariate models were constructed to identify factors associated with pathologic cIMT in patients with RA. Results: Fasting lipid values were similar in patients with RA and controls, although those of postprandial ApoB48 were higher (median (IQR), 14.4 (10.8–12.1) vs. 12.1 (2.3–9,8); p = 0.042). Pathologic cIMT was recorded in 10 patients with RA (25%) and nine controls (22.5%). In patients with RA, pathologic cIMT was associated with postprandial ApoB48 (OR (95% CI), 1.15 (1.0–1.3)) and total ApoB (OR [95% CI], 1.12 [1.1–1.2]). The second model revealed a mean increase of 0.256 mm for cIMT in patients with elevated anticitrullinated protein antibodies (ACPAs). Conclusion: Postprandial ApoB48 levels in patients with RA are higher than in controls. Postprandial ApoB48 and total ApoB levels and markers of severity, such as ACPAs, are associated with pathologic cIMT in patients with RA. Our findings could indicate that these atherogenic particles have a negative effect on the endothelium.

Association between Carotid Intima-Media Thickness and the Use of Biological or Small Molecule Therapies in Patients with Rheumatoid Arthritis

“…The rates of RF and anti-CCP positivity and radiological erosions were similar to those reported in other Spanish series of patients with RA [ 35 , 36 ]. On the other hand, we did not find significant associations between these factors and the CIMT, which have been observed in smaller cohorts [ 33 , 37 ]. Regarding acute-phase reactants, as in other research [ 38 ], a correlation was observed between ESR and CIMT.…”

“…On the other hand, while there was a trend towards a larger CIMT, the differences did not reach statistical significance. This finding has also been reported in previous studies [ 33 ] and may be due to the relatively low inflammatory activity in our patients, which might have had a beneficial effect on CIMT. Other research has demonstrated that effective control of the disease may abrogate any specific effect on RA on atherosclerosis progression [ 34 ].…”

Postprandial Hyperlipidemia: Association with Inflammation and Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis

“…We defined PPHL as postprandial triglycerides >220 mg/dL and/or postprandial ApoB48 levels greater than the 75th percentile (>p75) [14]. The highest postprandial ApoB48 values reported to date in patients with RA were those previously published by our group [15]. Burggraaf et al [16] also reported that patients with RA had higher baseline ApoB48 levels than controls and that the accumulation of atherogenic chylomicron remnants could contribute to the risk of cardiovascular events in affected patients.…”

“…In a previous study [ 15 ], we observed that patients with RA experienced a more marked increase in postprandial lipidemia than healthy controls and that ApoB48 levels were associated with cIMT. However, the factors associated with this increase in ApoB48 were not analyzed because they were not the objective of the study.…”

“…Furthermore, postprandial triglyceride levels >220 mg/dL are also considered abnormally high [ 14 ]. Postprandial lipidemia has been shown to be higher in RA patients than healthy controls, and an association between postprandial ApoB48 levels and pathologic carotid intima media thickness (cIMT) has been reported [ 15 , 16 ].…”