1. Exploring the Lipid Paradox Theory in Rheumatoid Arthritis: Associations of Low Circulating Low‐Density Lipoprotein Concentration With Subclinical Coronary Atherosclerosis
- Author
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Cecilia P. Chung, Joan M. Bathon, Sabahat Bokhari, Roger S. Blumenthal, Mary Chester M. Wasko, Afshin Zartoshti, C. Michael Stein, Jon T. Giles, Amy H. Kao, and Moyses Szklo
- Subjects
Male ,medicine.medical_specialty ,Immunology ,Arthritis ,Coronary Artery Disease ,030204 cardiovascular system & hematology ,Gastroenterology ,Article ,Arthritis, Rheumatoid ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,Rheumatology ,Risk Factors ,Internal medicine ,Odds Ratio ,medicine ,Humans ,Immunology and Allergy ,cardiovascular diseases ,Coronary atherosclerosis ,Aged ,Subclinical infection ,030203 arthritis & rheumatology ,business.industry ,Case-control study ,Calcinosis ,Odds ratio ,Middle Aged ,Atherosclerosis ,medicine.disease ,Coronary Vessels ,Lipoproteins, LDL ,Logistic Models ,chemistry ,Cardiovascular Diseases ,Case-Control Studies ,Rheumatoid arthritis ,Low-density lipoprotein ,Calcium ,Female ,lipids (amino acids, peptides, and proteins) ,business ,Lipoprotein - Abstract
OBJECTIVE Rheumatoid arthritis (RA) patients with the lowest circulating low-density lipoprotein (LDL) concentrations are at heightened risk of cardiovascular events. However, the atherosclerosis burden within this subgroup is unknown. METHODS RA patients pooled from 4 cohort studies of cardiovascular disease (CVD; n = 546) were compared with non-RA controls from the Multi-Ethnic Study of Atherosclerosis (n = 5,279). Those taking lipid-lowering medications were excluded. Differences in cardiac computed tomography-derived Agatston coronary artery calcium (CAC) scores between the RA and control groups were compared across strata of LDL concentration. RESULTS Among those with low LDL concentrations ( 4-fold higher for RA patients than for controls (18.6 versus 4.6 Agatston units, respectively; P < 0.001), a difference significantly greater than that in any other LDL concentration stratum except LDL concentration ≥160 mg/dl. Similarly, 32% of the RA patients with low LDL concentration had a CAC score of ≥100 Agatston units compared with only 7% of controls in the same LDL concentration stratum (odds ratio 5.97; P < 0.001), a difference significantly greater than that in all of the other LDL concentration strata. Low LDL concentration was most strongly associated with higher CAC score among RA patients who were white, had ever smoked, or were not obese. Other than a higher frequency of current smokers, RA patients with low LDL concentrations did not have more CVD risk factors or higher measures of RA disease activity or severity than RA patients with higher LDL concentrations. CONCLUSION RA patients with low LDL concentration may represent a group for whom heightened screening and prevention of atherosclerotic CVD is appropriate.
- Published
- 2019