Background/Purpose:

Rheumatoid arthritis (RA) is a systemic inflammatory autoimmune disease associated with an increased cardiovascular (CV) risk that is already present at the time of diagnosis. However, it is unclear at what point in the period before diagnosis of RA the CV risk increases. Therefore, we assessed CV risk factors and the 10-year risk of CV mortality in a cohort of subjects at risk for RA and analyzed associations with anti-citrullinated protein antibody (ACPA) status and arthritis development.

Methods:

In a cohort of 555 consecutive arthralgia patients with positivity for rheumatoid factor (RF) and / or ACPA, demographics, medical history, medication use and comorbidities were assessed. Lipid profile was determined and blood pressure was measured. The 10-year CV risk according to the European HeartSCORE was calculated for patients of whom data were complete.

Results:

ACPA positive patients (n=348) were younger (mean age 48.3 vs 51.5, p=0.002), had higher CRP levels (median 2.3 mg/l vs 2.0, p=0.007) and had lower cholesterol (mean level 5.2 mmol/l vs 5.6, p<0.001), HDL (mean level 1.0 mmol/l vs 1.2, p<0.001) and LDL levels (mean level 3.5 mmol/l vs 3.7, p=0.021) than ACPA negative patients. Patients who developed arthritis (n=188) had a higher heart rate (68 beats per minute vs 63, p=0.048) and lower cholesterol (mean level 5.2 vs 5.5, p=0.006), HDL (mean level 1.0 vs 1.1, p=0.003) and ApoB levels (mean level 0.8 g/l vs 0.9, p=0.011) compared to patients who did not develop arthritis. In ACPA positive patients, lower LDL was predictive for the development of arthritis.

The European HeartSCORE was calculated in 144 patients (median 1, IQR 0-2). 43.8% had a low risk (SCORE<1%), 48.7% a medium risk (SCORE 1-<5%) and 7.7% had a high to very high 10-year risk (SCORE≥5%) of cardiovascular mortality. The HeartSCORE was not associated with ACPA status or arthritis development.

Conclusion:

Similar lipid abnormalities as known in RA patients with untreated disease were also present in seropositive arthralgia patients at risk for RA. In ACPA positive patients, LDL predicted development of arthritis. However, arthralgia patients who developed arthritis did not have a higher CV risk score than those who did not develop arthritis. Also, despite differences in lipid profile, the CV risk score does not differ between ACPA positive and ACPA negative patients at risk for RA. Overall, differences in lipid profile were too small to have an effect on the 10 year risk of CV mortality as calculated by the European HeartSCORE.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lipid-profile-and-cardiovascular-risk-in-subjects-at-risk-for-rheumatoid-arthritis/