Association of Systemic Inflammation with Lipid Profiles and Management in Patients with Rheumatoid Arthritis

Abstract

Lead Author's Financial Disclosures Nothing to disclose. Study Funding None. Background/Synopsis Cardiovascular disease (CVD) is a leading cause of premature mortality among patients with rheumatoid arthritis (RA). The use of lipid-lowering therapies in this population has been associated with not only improved CVD outcomes and lipid profiles but also decreased systemic inflammation. Furthermore, increased inflammation has been associated with low total cholesterol, LDL and HDL levels, referred to as the 'lipid paradox,' adding complexity to optimal management and therapeutic interventions. Objective/Purpose This study sought to demonstrate a correlation between systemic inflammation as by erythrocyte sedimentation rate (ESR) and lipid markers in RA patients while characterizing lipid monitoring and management practices in this population. Methods This was a retrospective cross-sectional study of RA patients seen ≥ 2 times in an outpatient rheumatology clinic from October 2015 to October 2020 at a minority-serving metropolitan academic medical center. Patients were excluded if they did not have a reported ESR in the electronic medical record (EMR). Clinical variables for each patient were defined by the first reported value during the study period. Elevated ESR was defined as ≥ 20 mm/hr. Statistical methods included t-test and chi-square test as appropriate. Results Among 756 patients with RA, the mean age was 54.1 years, 80.7% were female and 43.4% were non-Hispanic Black. 200 (26.5%) patients had a lipid panel reported in the EMR. Patients with elevated ESR were not significantly more likely to have been evaluated with a lipid panel than those with normal ESR (29.5% versus 23.5%, P=0.06). Patients with an elevated ESR had a significantly lower LDL than those with a normal ESR (94.6 mg/dl versus 105.4 mg/dL, P=0.03). When comparing patients with elevated and normal ESR, the following lipid components were not significantly different: total cholesterol (P=0.09), HDL cholesterol (P=0.87) or triglycerides (P=0.67). A significant difference in the prescription of lipid-lowering medications between patients with elevated and normal ESR was not detected (9.9% versus 8.1%, P=0.38). Conclusions Among patients with elevated ESR, only 29.5% of patients were evaluated with a lipid profile and 9.9% patients were prescribed a lipid-lowering medication despite evidence that these therapies decrease both CVD risk and inflammation. The study findings contribute to the existing evidence behind the 'lipid paradox,' as LDL is inversely correlated with inflammation among patients with RA. Thus, due to the 'lipid paradox' and RA-associated inflammation, patients with elevated ESR and RA may benefit from specialized risk evaluation and rigorous management of atherosclerotic CVD with a lipid specialist or preventive cardiologist. Nothing to disclose.