Publications

Increased inflammation and CV disease have been associated with lower total cholesterol (TC) and low density lipoprotein (LDL-C) levels in RA patients – an apparent paradox to what is observed in the general population. Previously, reduced high-density lipoprotein (HDL-C) levels have been associated with increased risk of CV, and an inverse relationship observed with levels of HDL-C level and C-reactive protein (CRP).This analysis of the literature with regard to studies using DMARDs in RA patients, shows that both non-biologic and biologic DMARDs, including TNFs, tocilizumab and tofacitinib may reduce CV risk and major adverse cardiac events (MACE) in spite of higher lipid levels, including LDL-C and TC. The authors also discuss that lower cholesterol levels in patients with RA may, in part, be driven by an increase in cholesterol ester metabolism, which may be reversed by DMARD therapy. In addition, correlations are now emerging between reduced inflammation in RA, increases in lipid levels and changes in specific lipoprotein composition, for example an increase in PON-1 activity, with some DMARDS including tofacitinib.In RA patients, unlike in the general population, CV risk is not predicted by the traditional scoring systems, LDL-C, HDL-C and TC/HDL-C ratio. Although the interactions appear complex and are still being understood, this analysis shows that monitoring lipid levels is important for patients with RA, and suggests the CV risk profile of therapies may become important in treatment selection.