Session Information
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Despite remarkable improvements in RA treatment, there is evidence indicating that the mortality gap between RA patients and the general population is not closing. The increase in mortality in RA is predominantly due to cardiovascular (CV) disease. Literature suggests that important links exist between RA inflammation and atherosclerosis in CV diseases.Dyslipidemia is a well-known risk factor of atherosclerosis. Previous studies have suggested that anti-malarials, chloroquine diphosphate and hydroxychloroquine(HCQ), used in the treatment of autoimmune diseases, have a beneficial effect on the lipid levels. However the studies had small sample sizes. We have analyzed a Veterans Affair (VA) RA cohort of 2925 patients to characterize the effect of 4 months use of HCQ in lipid levels.
Methods: Data for this cohort was obtained from the department of VA administrative data base. All adult (age>=18 years) individuals with a diagnosis of RA ( ICD 9 code) at 2 or more outpatient visits from 1999 to 2009 ,were identified. Only patients with at least one lipid level measured at 120-180 days prior to staring HCQ were included. Lipids levels at pre start date of HCQ and post start date of HCQ (120-180 days) were compared using students t-test and then adjusted for age, sex, race, CRP and statin use with multivariable regression (ANOVA/ANCOVA) for the change in different lipid levels. To give equal weight to covariables we conducted an analysis of marginal means for race in each lipid level. All analyses were performed with STATA 11.
Results:
Demographics
|
|
Yes on Statin |
No on Statin |
All |
|
Gender Male (N/%) |
402 (15.61%) |
2174 (84.39%) |
2576 |
|
Age (mean/SD) |
69 (9.6) |
64(12.20) |
|
|
Race White (N/%) |
369 (15.50%) |
1868 (83.50%) |
2237 |
|
AA (N/%) |
28 (8.26%) |
312 (91.74%) |
340 |
|
Others (N/%) |
13 (3.06%) |
123 (4.92%) |
136 |
|
Unknown (N/%) |
15 (3.53%) |
197 (7.88%) |
212 |
|
Pre-CRP mg/dl (mean/SD) |
16.13 (13.53) |
5.16 (12.14) |
|
|
Post-CRP mg/dl (mean/SD) |
11.22 (37.9) |
5.90(17.94) |
|
Lipid changes in HCQ users
|
|
Pre-mean (SE) |
Post-mean (SE) |
Total Difference |
P value |
|
Cholesterol |
176.17 (.87) |
171.65 (.90) |
4.52 |
0.00 |
|
LDL |
103.77 (.76) |
98.86 (.76) |
4.91 |
0.00 |
|
HDL |
45.80 (.32) |
46.18 (.32) |
-0.38 |
0.06 |
|
Non-HDL |
130.37 (.85) |
125.46 (.86) |
4.91 |
0.00 |
|
AI |
4.17 (.38) |
4.0 (.03) |
0.17 |
0.00 |
Lipid changes in HCQ users by statin use groups.
|
|
Yes Statins Mean (SD) |
No Statins Mean (SD) |
|
Change in Cholesterol |
2.32 (37.72) |
2.41 (33.18) |
|
Change in LDL |
4.76 (30.52) |
5.09 (31.78) |
|
Change in HDL |
-0.35 (9.78) |
– 0.41 (1.09) |
|
Change in non HDL |
2.92 (37.069) |
5.52 (32.17) |
|
Change in AI |
.068 (1.29) |
.164 (1.29) |
After adjusting for sex, age, race, statin use and post crp values > 10mg/dl using a linear regression, the factor driving the change in the different lipid levels was race (p values for total cholesterol (TC) 0.006,LDL 0.09, non-HDL 0.03, TC/HDL 0.08 and HDL 0.17). When looking at race individually using marginal means analysis the race in the subgroup others was the more influential.
Conclusion: Our results suggest gender and race play a role in the effects of HCQ on lipid profiles in RA patients.Use of HCQ in males is found to be associated with positive changes in the lipid profiles independent from the use of statins. There is a suggestion that whites and African Americans might be less susceptivle to HCQ effect on lipid profiles.
To cite this abstract in AMA style:
Guevara M, NG B, Gove N. Race Plays a Role in Influencing the Modest Lipid Lowering Effects of Hydroxychloroquine in Patients with Rheumatoid Arthritis, Independent of Statin Use [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/race-plays-a-role-in-influencing-the-modest-lipid-lowering-effects-of-hydroxychloroquine-in-patients-with-rheumatoid-arthritis-independent-of-statin-use/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/race-plays-a-role-in-influencing-the-modest-lipid-lowering-effects-of-hydroxychloroquine-in-patients-with-rheumatoid-arthritis-independent-of-statin-use/