Session Information
Title: Rheumatoid Arthritis - Clinical Aspects II: Clinical Features & Comorbidity/Cardiovascular Disease
Session Type: Abstract Submissions (ACR)
Glucocorticoid use is associated with increase in HDL in
Rheumatoid Arthritis Patients
Background/Purpose: Atherogenic lipid profiles are common in active RA, with most common being decreased HDL. Glucocorticoids (GC) use is reported to have variable associations with lipid profiles in RA, and the potential differential effect of GC dose on lipid levels is unknown. We sought to evaluate the association of GC dose with lipid changes in RA.
Methods: Patients with RA diagnosed between 1/1/01-11/30/11, receiving oral or intravenous GC and having lipid levels tested prior to and at least 1 year after treatment with ongoing GC were identified. A cohort of RA patients not on GC was constructed for comparison. GC exposure was calculated as a weighted daily dosage in prednisone equivalents. GC exposure was analyzed as a continuous and as a dichotomous <7.5mg/day (low) vs. ≥7.5mg/day (high) GC dose. Primary outcome was change in HDL in the low vs. high GC groups. Secondary outcomes were changes in LDL, total cholesterol (TC), triglycerides (TG) and TC/HDL in the same fashion. A similar analysis between the patients on GC vs. not on GC was performed. Linear regression models were used to calculate the outcome, adjusting for age, gender, body mass index (BMI), diabetes, HTN, hyperlipidemia, RF, ESR, statin, NSAID, methotrexate (MTX), hydroxychloroquine (HCQ) and TNF-α inhibitor use.
Results: 202 patients on GC and 463 patients not on GC were included. Baseline characteristics are shown in Table 1. The changes in lipid levels according to GC use are shown in Table 2. Any GC and high dose GC use were associated with increased HDL, but no other significant lipid changes, compared to non-GC users. There were no significant differences in HDL or other lipids between the low vs. high GC groups. Sensitivity analysis, excluding patients on statins, showed similar results.
Conclusion: In this RA cohort, any GC and high dose GC (median 10.4 mg/day) use were associated with increased HDL, whereas low dose was not. Although our results need to be replicated in other RA cohorts, these findings are reassuring in this patient population at high risk for cardiovascular disease.
Table 1. Baseline patient characteristics
|
|
Patients on GC |
No GC
|
||
|
|
All N=202 |
GC <7.5 N=87 |
GC ≥7.5 N=115 |
N=463 |
|
GC dose * (median) |
8.4 (5.6-11.1) |
5.2 (5.0-6.2) |
10.4 (9.3-14.5) |
|
|
Age (mean ± SD years) |
64.7 (11.7) |
64.5 (11.2) |
64.8 (12.1) |
62.8 (11.4) |
|
Female |
137 (67.8) |
61 (70.1) |
76 (66.1) |
293 (67.2) |
|
BMI |
30.6 (6.5) N=166 |
30.4 (6.5) N=66 |
30.7 (6.6) N=100 |
30.5 (6.2) N=358 |
|
ESR |
35.6 (24.8) N=154 |
30.8 (22.5) N=60 |
38.6 (25.9) N=94 |
34.2 (24.5) N=313 |
|
RF |
124 (61.4) |
41 (47.1) |
83 (72.2) |
254 (58.3) |
|
Diabetes |
88 (43.6) |
39 (44.8) |
49 (42.6) |
161 (36.9) |
|
HTN |
136 (67.3) |
59 (67.8) |
77 (67.0) |
302 (69.3) |
|
Hyperlipidemia* |
141 (69.8) |
53 (60.9) |
88 (76.5) |
316 (72.5) |
|
HCQ use |
42 (20.8) |
20 (23.0) |
22 (19.1) |
106 (24.3) |
|
NSAID use |
96 (47.5) |
41 (47.1) |
55 (47.8) |
196 (45.0) |
|
Statin use |
74 (36.6) |
29 (33.3) |
45 (39.1) |
163 (37.4) |
|
Anti-TNF use |
23 11.4) |
10 (11.5) |
13 (11.3) |
47 (10.8) |
|
MTX use |
107 (53.0) |
49 (56.3) |
58 (50.4) |
184 (42.2) |
Table 2. Change in lipids according to GC use[1]
|
|
Any GC |
GC <7.5 |
GC ≥ 7.5 |
No GC |
|
Pre-treatment HDL |
52.4 (15.8) |
55.4 (16.0) |
50.1 (15.4) |
52.2 (15.3) |
|
Highest post-treatment HDL |
58.1 (16.6) |
60.1 (15.6) |
56.5 (17.2) |
55.4 (16.0) |
|
Change in HDL |
5.7 (11.6)* |
4.7 (12.1) |
6.5 (11.3)* |
3.2 (10.5)* |
|
Pre-treatment TC |
191 (43) |
197 (34) |
187 (48) |
194 (43) |
|
Lowest post-treatment TC |
189 (41) |
193 (36) |
186 (45) |
186 (41) |
|
Change in TC |
2.4 (36.5) |
3.6 (3.9) |
1.5 (40.3) |
7.8 (37.7) |
|
Pre-treatment TC/HDL |
3.9 (1.2) |
3.8 (1.2) |
4.0 (1.2) |
4.0 (1.2) |
|
Lowest post-treatment TC/HDL |
3.5 (1.0) |
3.4 (1.0) |
3.5 (1.1) |
3.6 (1.2) |
|
Change in TC/HDL |
0.39 (0.91) |
0.37 (0.94) |
0.40 (0.89) |
0.35 (0.93) |
|
Pre-treatment LDL |
106 (35) |
110 (33) |
103 (36) |
110 (35) |
|
Lowest post-treatment LDL |
96 (33) |
103 (30) |
97 (34) |
100 (33) |
|
Change in LDL |
6.4 (32.3) |
6.9 (28.5) |
6.0 (34.8) |
9.9 (32.6) |
|
Pre-treatment TG |
160 (113) |
151 (84.1) |
167 (130) |
157 (90) |
|
Lowest post-treatment TG |
149 (81) |
147 (81) |
152 (82) |
149 (83) |
|
Change in TG |
11.1 (90.3) |
4.3 (78.4) |
16.2 (98.3) |
7.8 (68.4) |
*Statistically significant findings p-value<0.05:
GC vs. No GC: change in HDL: p=0.006
High GC dose vs. No GC: change in HDL: p=0.012
[1]Adjusted for age, gender, BMI, ESR, RF, DM, HTN, hyperlipidemia, and use of TNF-α inhibitors, MTX, statins, HCQ, and NSAIDs
Disclosure:
L. L. Schroeder,
None;
X. Tang,
None;
M. C. M. Wasko,
None;
A. Bili,
None.
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