Abstract
Objective: To describe postprandial lipemia in patients with rheumatoid arthritis (RA) and to analyze its association with subclinical atherosclerosis measured as carotid intima-media thickness (cIMT). Methods: We performed an observational study of 40 patients with RA and 40 sex and age-matched controls. Patients with dyslipidemia were excluded. Pathologically increased cIMT was defined as a carotid thickness greater than the 90th percentile (>p90) for age and sex. Fasting and postprandial plasma lipids, cholesterol, triglycerides, apolipoprotein B48 (ApoB48), and total ApoB were evaluated. The other variables included were clinical and laboratory values, Framingham score, and the 28-joint Disease Activity Score (DAS28). Two multivariate models were constructed to identify factors associated with pathologic cIMT in patients with RA. Results: Fasting lipid values were similar in patients with RA and controls, although those of postprandial ApoB48 were higher (median (IQR), 14.4 (10.8–12.1) vs. 12.1 (2.3–9,8); p = 0.042). Pathologic cIMT was recorded in 10 patients with RA (25%) and nine controls (22.5%). In patients with RA, pathologic cIMT was associated with postprandial ApoB48 (OR (95% CI), 1.15 (1.0–1.3)) and total ApoB (OR [95% CI], 1.12 [1.1–1.2]). The second model revealed a mean increase of 0.256 mm for cIMT in patients with elevated anticitrullinated protein antibodies (ACPAs). Conclusion: Postprandial ApoB48 levels in patients with RA are higher than in controls. Postprandial ApoB48 and total ApoB levels and markers of severity, such as ACPAs, are associated with pathologic cIMT in patients with RA. Our findings could indicate that these atherogenic particles have a negative effect on the endothelium.
Highlights
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent synovitis, bone erosions, and functional disability
Hyperlipidemia is an increasingly interesting cardiovascular risk factor given that postprandial triglycerides are similar to and even better than fasting triglycerides as a predictor of cardiovascular disease, with the practical advantage that the patient is not required to fast [15,35,36]
We gave patients with rheumatoid arthritis (RA) and controls a mixed breakfast containing 50 g of different types of fat to determine the potential association with subclinical atherosclerosis measured using carotid intima-media thickness (cIMT)
Summary
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by persistent synovitis, bone erosions, and functional disability It is associated with premature death and multiple morbidities [1], mainly because the cardiovascular risk of affected patients is similar to that of patients with type 2 diabetes mellitus [2]. Ultrasound measurement of intima-media thickness (IMT) and the presence of plaques in the carotid artery has been reported to be a useful test for detecting subclinical atherosclerosis [8,9,10]. It has been considered valid for confirming accelerated atherogenesis in persons with RA. In a study of a cohort of patients with chronic RA and no traditional cardiovascular risk factors or previous cardiovascular events, carotid IMT (cIMT) revealed abnormally high values compared with healthy controls [11]
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