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Abstract: Background: Levels of apolipoprotein (apo) B48 may be increased in conditions associated with systemic inflammation and increased cardiovascular disease (CVD) risk such as rheumatoid arthritis (RA). We aimed to evaluate apo B48 levels in patients with RA in relation to subclinical atherosclerosis. Methods: Patients with RA (without CVD) and controls without RA but with high CVD risk (based on the presence of diabetes mellitus or a history of CVD) and healthy controls were included in this cross‐sectional study. Carotid intima‐media thickness (cIMT) was measured as a surrogate for vascular damage. Results: In total, 312 patients with RA, 65 controls with high CVD risk and 36 healthy controls were included. Patients with RA had the highest mean apo B48 (10.00 ± 6.65 mg/L) compared to controls with high CVD risk and healthy controls (8.37 ± 5.16 and 5.22 ± 2.46, P < .001). Triglycerides levels were comparable with controls. In RA, apo B48 correlated positively with triglycerides (r = .645; P < .001) but not with cIMT. However, in RA subjects not using lipid or blood pressure lowering medication, a weak correlation was found with cIMT (r = .157; P = .014). RA patients in the highest apo B48 tertile were more often rheumatoid factor positive and anti‐CCP positive compared to the lowest tertile. Conclusion: Rheumatoid arthritis patients have higher levels of apo B48 compared to controls with high CVD risk and healthy controls, with normal levels of triglycerides. This accumulation of atherogenic chylomicron remnants may contribute to the elevated CVD risk in RA patients. [ABSTRACT FROM AUTHOR]

Introduction: Patients with Rheumatoid Arthritis (RA) have an increased risk for cardiovascular disease (CVD) compared to the general population. No long term intervention trials on CVD risk factors in RA have been published so far, and a debate on the efficacy of controlling traditional risk factors in RA is ongoing. Methods: In this open-label randomised controlled trial, RA patients <70 years without prior CVD or diabetes mellitus were randomized to either a treat-to-target approach (according to pre-specified treatment targets) or usual care regarding traditional CVD risk factors. The primary outcome was defined as change in carotid intima media thickness (cIMT) as a marker for subclinical atherosclerosis and the secondary outcome was a composite of cardiovascular events. Results: A total of 320 patients underwent randomization and 218 completed 5 years follow-up (115 for treat-to-target group and 103 for usual care). Mean (± SD) baseline cIMT in the treat-to-target group was 0.570 ± 0.108 vs. 0.569 ± 0.113 mm (p=0.91) for usual care. The primary outcome reached statistical significance showing decreased progression of cIMT in those allocated to the treat-to-target intervention compared to usual care (0.029 ± 0.081 vs. 0.056 ± 0.103 mm; p=0.034). There was no difference in antihypertensive treatment between groups, however more patients in the treat-to-target group received statin treatment compared to usual care (48.3% vs. 21.4%; p<0.001), resulting lower LDL-C level (2.5 ± 0.8 vs. 3.1 ± 0.6 mmol/L; p<0.001). Cardiovascular events occurred in 1.3% of the patients in the treat-to-target group vs. 4.7% in those receiving usual care (p=0.048), leading to an absolute risk reduction of 3.4%. The numbers needed to treat to prevent one single cardiovascular event over 5 years was 30, which is much lower than in most secondary prevention CVD intervention trials using anti-hypertensives or lipid lowering therapy in non-RA populations. Conclusions: Intensive treat-to-target intervention of traditional CVD risk factors for primary prevention in RA is efficient. These data underscore the urgency for cardiovascular risk management programs in RA and provide for the first time support for implementation of current guidelines targeting traditional risk factors. [ABSTRACT FROM AUTHOR]