Background/Purpose: Cardiovascular disease (CVD) is one of the main cause of mortality and morbidity in patients with spondyloarthritis (SpA), partially explained by traditional CV risk factors (CVRF). Other non-conventional CVRF, probably related to chronic systemic inflammation, may be involved. In this sense, lipoprotein (a) [Lp (a)], an non-conventional risk factor with proatherogenic and thrombogenic properties, could be involved, since it seems to act as an acute-phase reactant, however, there are few data on this aspect in these patients. The purpose of this study is to evaluate the prevalence of hyperlipoproteinemia (a) in patients with SpA and analyze the possible related factors.

Methods: Analysis of the baseline visit of patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) of the CARMA project (CARdiovascular in Reumatology), a prospective cohort study of 10 years of follow-up, to evaluate the cardiovascular risk in chronic rheumatic inflammatory diseases, including rheumatoid arthritis, AS and PsA, followed in 67 Spanish rheumatology centers. A multivariate logistic regression model was performed, in which the dependent variable was hyperliproteinemia (a), defined as the plasma concentration of lipoprotein (a) [Lp (a)] > 50 mg/dl. Sociodemographic factors and those related to the disease itself, classic CVRF, lipid profile and apolipoproteins, and treatments have been included as independent variables.

Results: 1459 patients were analyzed, 738 with AS and 721 with PsA, and 677 controls. Plasma concentrations of Lp(a) were available in 57.7% of the patients with AS and in 57.1% of the patients with PsA, and in 58% of the controls. A 19.2% (95% CI: 16.80-22.05) of the patients with SpA, 20.7% (95% CI: 16.91-24.82) of AS and 17.7% (95% CI: 14.15-21.75) of PsA, respectively, and a 16.7% (95% CI: 13.23-20.86; p=0.326) of the control group, had hyperlipoproteinemia (a), without statistically significant differences between groups. After adjusting for age and sex, SpA patients were more likely to have hyperlipoproteinemia (a) than control group (OR : 1.43, CI:1.00-2.04; p=0.05), especially in patients with AS (OR: 1.81, 95% CI: 1.18-2.77; p=0.007).In the model adjusted for possible confounding factors, high values of apolipoprotein B in all patients, non-steroidal antiinflammatories in AS, and sex (women) in PsA, were associated with a higher probability of presenting hyperlipoproteinemia (a).

Conclusion: Patients with SpA show a moderately increased risk of hyperliproteinemia (a) compared to the control group, especially in those with AS. No specific factors of the disease have been identified that are associated with hyperlipoproteinemia (a) in each of the analyzed groups. The determination of Lp (a) may be of potential interest to improve the assessment of CV risk in patients with SpA, especially in those with a moderate / high CV risk according to the algorithms of the risk tables.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/hyperlipoproteinemia-a-in-patients-with-spondyloarthritis-results-of-the-carma-study/