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Effects of disease activity on lipoprotein levels in patients with early arthritis: can oxidized LDL cholesterol explain the lipid paradox theory?

Authors
  • Fernández-Ortiz, Ana M.1
  • Ortiz, Ana M.2
  • Pérez, Silvia3
  • Toledano, Esther4
  • Abásolo, Lydia4
  • González-Gay, Miguel A.5
  • Castañeda, Santos2, 6
  • González-Álvaro, Isidoro2
  • 1 Hospital General de Almansa, Albacete, Spain , Albacete (Spain)
  • 2 Hospital Universitario La Princesa, IIS-IP, Diego de León 62, Madrid, 28006, Spain , Madrid (Spain)
  • 3 Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain , Madrid (Spain)
  • 4 Hospital Clínico San Carlos, IdISSC, Madrid, Spain , Madrid (Spain)
  • 5 University of Cantabria, Santander, Spain , Santander (Spain)
  • 6 Universidad Autónoma Madrid, Madrid, Spain , Madrid (Spain)
Type
Published Article
Journal
Arthritis Research & Therapy
Publisher
Springer Science and Business Media LLC
Publication Date
Sep 11, 2020
Volume
22
Issue
1
Identifiers
DOI: 10.1186/s13075-020-02307-8
Source
Springer Nature
Keywords
License
Green

Abstract

BackgroundAn increased risk of cardiovascular (CV) complications has been described in patients with rheumatoid arthritis (RA). It is the result of the combined effect of classic CV risk factors and others that are specific to the disease.MethodsWe assessed data from 448 early arthritis (EA) patients: 79% women, age (median [p25-p75]) at onset: 55 [44–67] years and disease duration at study entry 5 [3–8] months; and 72% fulfilled the 1987 RA criteria at 2 years of follow-up. Rheumatoid factor was positive in 54% of patients and anti-citrullinated peptide antibodies in 50%. The follow-up of patients ranged from 2 to 5 years with more than 1400 visits with lipoprotein measurements available (mean 2.5 visits/patient). Demographic- and disease-related variables were systematically recorded. Total cholesterol (TC), high-density lipoprotein (HDL-C), and low-density lipoprotein (LDL-C) levels were obtained from routine laboratory tests. Oxidized-LDL (oxLDL-C) levels were assessed using a commercial ELISA kit. We fitted population-averaged models nested by patient and visit to determine the effect of independent variables on serum levels of TC, its fractions, and oxLDL-C.ResultsAfter adjustment for several confounders, high-disease activity was significantly associated with decreased TC, HDL-C, and LDL-C levels and increased oxLDL-C levels. Standardized coefficients showed that the effect of disease activity was greater on oxLDL-C and HDL-C. Interestingly, we observed that those patients with lower levels of LDL-C showed higher oxLDL-C/LDL-C ratios.ConclusionsHigh-disease activity in EA patients results in changes in the HDL-C and oxLDL-C levels, which in turn may contribute to the increased risk of CV disease observed in these patients.

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