Lipid Profile and Its Correlation with Disease Severity in Kurdish Patients with Rheumatoid Arthritis
HDL-C correlates with disease severity in RA
Keywords:
Atherogenic index, Dyslipidemia, HDL cholesterol, Kurdistan, LDL cholesterol, Rheumatoid arthritisAbstract
Background: Cardiovascular diseases (CVD) are considered a main cause of mortality and morbidity in the late stages of rheumatoid arthritis (RA). Changes in lipid profiles and dyslipidemia are associated with atherosclerosis in RA, and this is the cause of cardiovascular complications in some patients. This study aims to investigate the prevalence of dyslipidemia in Kurdish patients with RA and the association between lipid profiles and disease activity in 190 RA patients.
Method: A cross-sectional study was conducted from 2020 to 2021 in the referral ward of Tohid Hospital and a private rheumatology clinic in Sanandaj. Plasma lipid profiles, including triglycerides (TG), total cholesterol (TC), and HDL-cholesterol, were measured by an auto-analyzer. Patients were classified into three groups based on Disease Activity Score at 28 joints (DAS28): remission (DAS28 < 2.6), low disease activity (2.6 < DAS28 < 3.2), and moderate/high disease activity (DAS28 > 3.2).
Results: As measured by LDL-C/HDL-C ratio and HDL-C, the atherogenic index significantly correlates with DAS28 in studied patients, whereas no correlations were detected with other lipid parameters. Besides, RA patients with high/moderate disease activity have significantly higher LDL-C/HDL-C and lower HDL levels compared to the patients in the remission group. There were no significant differences between the studied groups for other plasma lipid parameters. The prevalence of dyslipidemia was as follows: hypercholesterolemia 34.21%, hypertriglyceridemia 40.52%, hyper-LDL 24.73%, and hypo-HDL 13.68%. Even though only small samples were studied, these results suggest that disease severity correlates with lipid fractions, specifically HDL, and as a result, the LDL-C/HDL-C ratio in RA.
Conclusion: Higher rheumatoid arthritis disease activity was associated with an unfavorable lipid profile, especially the increased ratio of LDL-C/HDL-C and the decreased level of HDL-C. These findings support the potential value of atherogenic indices as indicators of cardiovascular risk in RA and should be confirmed in larger studies.
References
Rudan I, Sidhu S, Papana A, Meng SJ, Xin–Wei Y, Wang W, et al. Prevalence of rheumatoid arthritis in low– and middle–income countries: A systematic review and analysis. J Glob Health. 2015; 5(1): 010409.
Dijkshoorn B, Raadsen R, Nurmohamed MT. Cardiovascular disease risk in rheumatoid arthritis anno 2022. Journal of clinical medicine. 2022; 11(10): 2704.
Yan J, Yang S, Han L, Ba X, Shen P, Lin W, et al. Dyslipidemia in rheumatoid arthritis: the possible mechanisms. Frontiers in Immunology. 2023; 14: 1254753.
Myasoedova E, Crowson CS, Kremers HM, Roger VL, Fitz-Gibbon PD, Therneau TM, et al. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann Rheum Dis. 2011; 70(3): 482–487.
Yoshimura M, Fujieda Y, Sugawara M, Kono M, Kato M, Yokota I, et al. Disease activity as a risk factor for venous thromboembolism in rheumatoid arthritis analysed using time-averaged DAS28CRP: a nested case–control study. Rheumatology International. 2022; 42(11): 1939-46.
Skeoch S, Bruce IN. Atherosclerosis in rheumatoid arthritis: is it all about inflammation?. Nature Reviews Rheumatology. 2015; 11(7): 390-400.
Venetsanopoulou AI, Pelechas E, Voulgari PV, Drosos AA. The lipid paradox in rheumatoid arthritis: the dark horse of the augmented cardiovascular risk. Rheumatology international. 2020; 40(8): 1181-91.
Hollan I, Ronda N, Dessein P, Agewall S, Karpouzas G, Tamargo J, et al. Lipid management in rheumatoid arthritis: a position paper of the Working Group on Cardiovascular Pharmacotherapy of the European Society of Cardiology. European Heart Journal-Cardiovascular Pharmacotherapy. 2020; 6(2): 104-14.
Yan J, Yang S, Han L, Ba X, Shen P, Lin W, et al. Dyslipidemia in rheumatoid arthritis: the possible mechanisms. Front Immunol. 2023; 14: 1254753.
Giachi A, Cugno M, Gualtierotti R. Disease-modifying anti-rheumatic drugs improve the cardiovascular profile in patients with rheumatoid arthritis. Frontiers in Cardiovascular Medicine. 2022; 9: 1012661.
Sun KJ, Liu LL, Hu JH, Chen YY, Xu DY. Methotrexate can prevent cardiovascular events in patients with rheumatoid arthritis: An updated meta-analysis. Medicine. 2021; 100(7): e24579.
Moghimi N, Davatchi F, Rahimi E, Saidi A, Rashadmanesh N, Moghimi S, et al. WHO-ILAR COPCORD study (stage 1, urban study) in Sanandaj, Iran. Clin Rheumatol. 2015; 34 (3): 535-543.
Visseren FL, Mach F, Smulders YM, Carballo D, Koskinas KC, Bäck M, et al. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice: Developed by the Task Force for cardiovascular disease prevention in clinical practice with representatives of the European Society of Cardiology and 12 medical societies With the special contribution of the European Association of Preventive Cardiology (EAPC). European heart journal. 2021; 42(34): 3227-337.
Koncsos P, Fülöp P, Juhász I, Bíró K, Márk L, Simonyi G, et al. Changes in triglyceride, HDL-C, and non-HDL-C levels in patients with acute coronary syndrome. Wien Klin Wochenschr. 2016; 128(23-24): 858-63
Akiyama M, Mawatari T, Nakashima Y, Miyahara H, Yamada H, Okazaki K, et al. Prevalence of dyslipidemia in Japanese patients with rheumatoid arthritis and effects of atorvastatin treatment. Clin Rheumatol. 2015; 34(11): 1867-1875.
Kinoshita M, Yokote K, Arai H, Iida M, Ishigaki Y, Ishibashi S, et al. Japan Atherosclerosis Society (JAS) guidelines for prevention of atherosclerotic cardiovascular diseases 2017. Journal of atherosclerosis and thrombosis. 2018; 25(9): 846-984.
Kim JY, Lee EY, Park JK, Song YW, Kim JR, Cho KH. Patients with rheumatoid arthritis show altered lipoprotein profiles with dysfunctional high-density lipoproteins that can exacerbate inflammatory and atherogenic process. PLoS One. 2016; 11(10): e0164564.
Vyletelová V, Nováková M, Pašková Ľ. Alterations of HDL’s to piHDL’s proteome in patients with chronic inflammatory diseases, and HDL-targeted therapies. Pharmaceuticals. 2022; 15(10): 1278.
Bonacina F, Pirillo A, Catapano AL, Norata GD. HDL in immune-inflammatory responses: implications beyond cardiovascular diseases. Cells. 2021; 10(5): 1061.
Frangie C, Daher J. Role of myeloperoxidase in inflammation and atherosclerosis. Biomedical reports. 2022; 16(6): 1-1.
Vivekanandan-Giri A, Slocum JL, Byun J, Tang C, Sands RL, Gillespie BW, et al. High density lipoprotein is targeted for oxidation by myeloperoxidase in rheumatoid arthritis. Annals of the rheumatic diseases. 2013; 72(10): 1725-31.
Pirillo A, Tibolla G, Norata GD, Catapano AL. HDL: to treat or not to treat?. Current atherosclerosis reports. 2014; 16: 1-0.
Boers M, Nurmohamed MT, Doelman CJ, Lard LR, Verhoeven AC, Voskuyl AE, et al. Influence of glucocorticoids and disease activity on total and high density lipoprotein cholesterol in patients with rheumatoid arthritis. Ann Rheum Dis. 2003; 62(9): 842-845.
Govindan KS, Basha S, Ramesh V, Kumar CN, Swathi S. A comparative study on serum lipoprotein (a) and lipid profile between rheumatoid arthritis patients and normal subjects. Journal of Pharmacy and Bioallied Sciences. 2015; 7(Suppl 1): S22-5.
Charles-Schoeman C, Lee YY, Grijalva V, Amjadi S, FitzGerald J, Ranganath VK, et al. Cholesterol efflux by high density lipoproteins is impaired in patients with active rheumatoid arthritis. Annals of the rheumatic diseases. 2012; 71(7): 1157-62.
Venetsanopoulou AI, Pelechas E, Voulgari PV, Drosos AA. The lipid paradox in rheumatoid arthritis: the dark horse of the augmented cardiovascular risk. Rheumatology international. 2020; 40(8): 1181-91.
Botta E, Meroño T, Saucedo C, Martín M, Tetzlaff W, Sorroche P, et al. Associations between disease activity, markers of HDL functionality and arterial stiffness in patients with rheumatoid arthritis. Atherosclerosis. 2016; 251: 438-44.
Chung CP, Oeser A, Raggi P, Sokka T, Pincus T, Solus JF, et al. Lipoprotein subclasses determined by nuclear magnetic resonance spectroscopy and coronary atherosclerosis in patients with rheumatoid arthritis. J Rheumatol. 2010 Aug 1;37(8):1633-8.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Chronic Diseases Journal
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 Unported License which allows users to read, copy, distribute and make derivative works for non-commercial purposes from the material, as long as the author of the original work is cited properly.
