Abstract
IntroductionHigher levels of high density lipoprotein (HDL) subfractions HDL3-chol and particularly HDL2-chol protect against cardiovascular disease (CVD), but inflammation reduces the HDL level and may impair its anti-atherogenic effect. Changed HDL composition through the impact of inflammation on HDL subfractions may contribute to the excess risk of CVD in rheumatoid arthritis (RA). In this study, we investigated whether HDL2-chol and HDL3-chol concentrations differ between RA patients and healthy controls, and whether these levels are related to the level of RA disease activity.MethodsNon-fasting blood samples were collected from 45 RA patients and 45 healthy controls. None of the participants had a history of CVD, diabetes, or used lipid-lowering drugs. HDL2-chol and HDL3-chol concentrations were obtained by ultracentrifugation. Regression modeling was used to compare HDL subfraction levels between RA patients and healthy controls, and to analyze the effect of disease activity on HDL2-chol and HDL3-chol.ResultsHDL2-chol and HDL3-chol were significantly lower in RA patients compared to healthy controls (P = 0.01, P = 0.005, respectively). The HDL2:HDL3 ratio was significantly lower in patients compared to controls (P = 0.04). Reduced HDL2-chol and HDL3-chol levels were primarily present in female RA patients and not in male RA patients. A modest effect of the disease activity score in 28 joins ( DAS28) on HDL2-chol concentrations was found, after correction for disease duration, glucocorticosteroid use and body mass index (BMI), with a 0.06 mmol/L decrease with every point increase in DAS28 (P = 0.05). DAS28 did not significantly affect HDL3-chol concentrations (P = 0.186).ConclusionsBoth HDL subfractions but particularly HDL2-chol concentrations were decreased in RA, primarily in women. This seems to be associated with disease activity and is of clinical relevance. The reduction of the HDL subfraction concentrations, particularly the supposedly beneficial HDL2-chol, may negatively impact the cardiovascular risk profile of women with RA.
Highlights
Higher levels of high density lipoprotein (HDL) subfractions HDL3-chol and HDL2-chol protect against cardiovascular disease (CVD), but inflammation reduces the HDL level and may impair its antiatherogenic effect
The results show that total cholesterol (TC) and low-density-lipoprotein cholesterol (LDL) levels did not differ significantly, while TG and Apo B levels were significantly higher in rheumatoid arthritis (RA), and HDL and Apo A-1 levels were lower (Table 2)
Results regarding HDL2-chol concentrations demonstrated a larger difference between RA patients and controls, compared to HDL3-chol, and the HDL2:HDL3 ratio was significantly lower in RA patients (Table 2)
Summary
Higher levels of high density lipoprotein (HDL) subfractions HDL3-chol and HDL2-chol protect against cardiovascular disease (CVD), but inflammation reduces the HDL level and may impair its antiatherogenic effect. The risk of cardiovascular that there is no difference in risk of CVD between patients with low or high disease activity [9]. In the general population, increased levels of total cholesterol (TC), low-density-lipoprotein cholesterol (LDL) and triglycerides, and decreased levels of highdensity lipoprotein cholesterol (HDL), that is, a proatherogenic lipid profile, are important risk factors for CVD [10]. HDL is regarded as the main anti-atherogenic lipoprotein and increased levels of HDL have been associated with a protective effect against cardiovascular mortality and morbidity [11,12]. This advantageous effect of HDL is supposed to be accomplished primarily through the reverse cholesterol transport (RCT) and the neutralization of oxidized lipids [13]
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