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Exploring the Lipid Paradox Theory in Rheumatoid Arthritis: Associations of Low Circulating Low‐Density Lipoprotein Concentration With Subclinical Coronary Atherosclerosis
- Source :
- Arthritis Rheumatol
- Publication Year :
- 2019
- Publisher :
- Wiley, 2019.
-
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.
- 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
Subjects
Details
- ISSN :
- 23265205 and 23265191
- Volume :
- 71
- Database :
- OpenAIRE
- Journal :
- Arthritis & Rheumatology
- Accession number :
- edsair.doi.dedup.....8076686241a21bfc287cfde4ed3bed1e