Dyslipidemia and changes in lipid profiles associated with rheumatoid arthritis and initiation of anti-TNF therapy

Abstract

OBJECTIVE

To investigate the frequency of lipid testing in clinical practice and explore the relationship between rheumatoid arthritis (RA), dyslipidemia, and other cardiovascular (CV) risk factors, with RA treatment.

METHODS

Patients in the retrospective database study were ≥18 years old and had ≥2 physician diagnoses for RA or osteoarthritis (OA) [comparator group] between March 2004-March 2008. Outcomes of interest included the percentage of RA and OA patients receiving lipid tests, lipid profiles (total cholesterol [TC], low-density lipoprotein cholesterol [LDL-C], and high-density lipoprotein cholesterol [HDL-C]) of RA vs. OA patients, and lipid profiles of RA patients before and after initiation with a tumor necrosis factor inhibitor (TNFi). We used multivariable regression to control potential confounders between the cohorts.

RESULTS

Over a median 2+ year follow-up, fewer RA patients than OA patients had at least one lipid test (62% [95% CI, 60-64] vs. 68% [95% CI, 65-71]). Mean TC and LDL-C were each 4 mg/dL lower in the RA cohort (P<0.0001); HDL-C was similar between cohorts. Across the RA cohort, 25.2% of patients had suboptimal LDL-C levels (≥130 mg/dL). Among RA patients not using lipid-lowering therapy who initiated TNFi therapy (n=96), mean TC and LDL-C increased by 5.4 and 4.0 mg/dL, respectively.

CONCLUSION

RA patients were less likely to be tested for hyperlipidemia and had more favorable lipid profiles than OA patients.TNFi therapy modestly increased all lipid parameters. Additional studies are needed to determine the effect of traditional CV risk factors, inflammation, and the impact of biologics on CV outcomes in RA patients. © 2012 by the American College of Rheumatology