Background/Purpose:

Patients with rheumatoid arthritis (RA) have a marked increase in cardiovascular (CV) morbidity and mortality compared to the general population. Conventional lipid profiles are insufficient to stratify CV risk in this population, and may not capture many of the lipoprotein abnormalities which predispose to atherosclerosis (ATH). Nuclear magnetic resonance (NMR) spectroscopy simultaneously quantifies the number, size, and composition of lipoprotein particles, providing a better understanding of the modifications in each lipoprotein. The current work investigated the relationship of lipoprotein profiles by NMR spectroscopy with progression of carotid ATH in a longitudinal cohort of patients with RA.

Methods: The study population included 119 RA patients who had carotid ultrasounds performed at 2 time points separated by a mean ± SD of 5.5 ± 1.2 years at a single academic center. The number and type of carotid plaques were assessed, and an ATH score provided by the same radiologist for all scans. Fasting blood was collected for lipoprotein analysis, inflammatory markers, and lipoprotein particle profiles measured by NMR spectroscopy (Liposcience Inc. Raleigh, North Carolina, USA). Traditional cardiovascular risk factors, medication use, and RA disease characteristics were assessed for all patients at baseline and follow-up visits.

Results:

In RA patients without baseline carotid ATH, mean large very low density lipoprotein (VLDL) particle concentrations were significantly higher in patients with incident plaque formation over the follow-up period, compared to patients without incident plaque formation (p<0.05). Similar trends were noted in evaluation of all RA patients with plaque progression regardless of baseline ATH status. In multivariate analysis controlling for significant traditional CV risk factors, RA disease characteristics, medication use, and the presence of carotid plaque on baseline ultrasound, large VLDL concentrations remained significantly associated with increased risk of carotid plaque progression measured by ≥ one unit increase in carotid ATH score (p<0.05). Similar results were noted when defining ATH progression by ≥ one new carotid plaque from the baseline scan. Triglyceride levels were also significantly associated with plaque progression in univariate analysis, but did not remain significant in multivariate analysis. Mean total, LDL, and HDL cholesterol levels were not associated with carotid ATH progression in this cohort.

Conclusion:

The current work suggests a relationship between large VLDL particles and cardiovascular risk in RA patients as assessed by the progression of carotid ATH over 5 year longitudinal follow-up. Further CV outcome studies may be warranted to determine if large VLDL particles are a useful biomarker of CV risk in patients with RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/increased-concentration-of-large-very-low-density-lipoprotein-particles-associates-with-progression-of-carotid-atherosclerosis-in-rheumatoid-arthritis/