title: The association between reduction in inflammation and changes in lipoprotein levels and HDL cholesterol efflux capacity in rheumatoid arthritis.
abstract: BACKGROUND
  Potent anti-inflammatory rheumatoid arthritis (RA) treatments are associated with reduced cardiovascular risk as well as increases in low-density lipoprotein (LDL) cholesterol. This apparent paradox may be explained by favorable changes in other lipid measurements. The objective of this study was to determine the longitudinal association between changes in inflammation with advanced lipoprotein measurements and high-density lipoprotein (HDL) cholesterol efflux capacity.
  
  
  RESULTS
  We conducted this study in a longitudinal RA cohort from a large academic center, including subjects with high-sensitivity C-reactive protein (hs-CRP) reduction ≥10 mg/L at 2 time points 1 year apart. Subjects receiving statins during the study period or preceding 6 months were excluded. We compared total cholesterol, LDL cholesterol, HDL cholesterol, apolipoprotein B, and apolipoprotein A1 levels and HDL cholesterol efflux capacity at baseline and 1-year follow-up by using the paired t test. We also assessed the correlations between reductions in hs-CRP with percentage change in lipid parameters. We studied 90 RA subjects (mean age 57 years, 89% female), all of whom were receiving disease-modifying antirheumatic drugs. We observed a 7.2% increase in LDL cholesterol levels (P=0.02) and improvement in efflux capacity by 5.7% (P=0.002) between baseline and follow-up, with a median hs-CRP reduction of 23.5 mg/L. We observed significant correlations between reductions in hs-CRP with increases in apolipoprotein A1 (r=0.27, P=0.01) and HDL cholesterol efflux capacity (r=0.24, P=0.02).
  
  
  CONCLUSIONS
  Among RA subjects experiencing reductions in hs-CRP, we observed increased LDL cholesterol levels and concomitant improvements in HDL cholesterol efflux capacity. These findings provide further insight into lipid modulation and the beneficial effect of reduction in inflammation on lipids in vivo.
authors: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA (K.P.L., M.F., J.S.C., C.I., M.E.W., N.S.S.).
authors: Katherine P
authors: KP
authors: Liao
authors: NIH Heart, Blood and Lung Institute, Bethesda, MD (M.P.P., N.N.M.).
authors: Martin P
authors: MP
authors: Playford
authors: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA (K.P.L., M.F., J.S.C., C.I., M.E.W., N.S.S.).
authors: Michelle
authors: M
authors: Frits
authors: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA (K.P.L., M.F., J.S.C., C.I., M.E.W., N.S.S.).
authors: Jonathan S
authors: JS
authors: Coblyn
authors: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA (K.P.L., M.F., J.S.C., C.I., M.E.W., N.S.S.).
authors: Christine
authors: C
authors: Iannaccone
authors: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA (K.P.L., M.F., J.S.C., C.I., M.E.W., N.S.S.).
authors: Michael E
authors: ME
authors: Weinblatt
authors: Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA (K.P.L., M.F., J.S.C., C.I., M.E.W., N.S.S.).
authors: Nancy S
authors: NS
authors: Shadick
authors: NIH Heart, Blood and Lung Institute, Bethesda, MD (M.P.P., N.N.M.).
authors: Nehal N
authors: NN
authors: Mehta
mesh_terms: D000328:Adult; D000368:Aged; D018501:Antirheumatic Agents / Q000008:administration & dosage; D016632:Apolipoprotein A-I / Q000097:blood; D001055:Apolipoproteins B / Q000097:blood; D001172:Arthritis, Rheumatoid / Q000097:blood* / Q000188:drug therapy / Q000276:immunology*; D002097:C-Reactive Protein / Q000032:analysis*; D002784:Cholesterol / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007249:Inflammation / Q000097:blood* / Q000188:drug therapy; D008075:Lipoproteins, HDL / Q000097:blood*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors
chemical_list: D018501:Antirheumatic Agents; D016632:Apolipoprotein A-I; D001055:Apolipoproteins B; D008078:Cholesterol, LDL; D008075:Lipoproteins, HDL; D002097:C-Reactive Protein; D002784:Cholesterol
keywords: inflammation; lipids; rheumatoid arthritis
references: Joint Bone Spine. 2008 Jan;75(1):22-4
references: 17888710
references: Am J Cardiol. 2008 Apr 1;101(7):1003-8
references: 18359322
references: N Engl J Med. 2008 Nov 20;359(21):2195-207
references: 18997196
references: Ann Rheum Dis. 2009 Jun;68(6):954-60
references: 18490431
references: Ann Rheum Dis. 2010 Jul;69(7):1310-4
references: 19854708
references: Ann Rheum Dis. 2010 Nov;69(11):1929-33
references: 20498216
references: Ann Rheum Dis. 2010 Nov;69(11):1996-2001
references: 20551156
references: Rheumatology (Oxford). 2011 Jan;50(1):40-6
references: 20847201
references: J Rheumatol. 2011 Jan;38(1):10-20
references: 20952462
references: N Engl J Med. 2011 Jan 13;364(2):127-35
references: 21226578
references: Ann Rheum Dis. 2011 Mar;70(3):482-7
references: 21216812
references: Rheumatology (Oxford). 2011 Mar;50(3):518-31
references: 21071477
references: Ann Rheum Dis. 2012 May;71(5):681-6
references: 21994234
references: Atherosclerosis. 2012 Jun;222(2):390-4
references: 22456230
references: Ann Rheum Dis. 2012 Jul;71(7):1157-62
references: 22267330
references: Am J Cardiol. 2012 Aug 1;110(3):420-4
references: 22521305
references: Ann Rheum Dis. 2012 Sep;71(9):1524-9
references: 22425941
references: Atherosclerosis. 2012 Sep;224(1):218-21
references: 22858285
references: Arch Intern Med. 2012 Dec 10;172(22):1707-10
references: 23147400
references: Arthritis Rheum. 2013 Jun;65(6):1430-8
references: 23460074
references: J Am Coll Cardiol. 2013 Aug 20;62(8):732-9
references: 23524048
references: Circulation. 2003 Jan 28;107(3):499-511
references: 12551878
references: Arthritis Care Res (Hoboken). 2013 Dec;65(12):2046-50
references: 23925980
references: Ann Rheum Dis. 2014 Jan;73(1):161-9
references: 23300117
references: Ann Rheum Dis. 2014 Mar;73(3):609-15
references: 23562986
references: J Invest Dermatol. 2014 Mar;134(3):635-42
references: 23985995
references: Arthritis Care Res (Hoboken). 2014 Mar;66(3):355-63
references: 24023053
references: Arterioscler Thromb Vasc Biol. 2014 Apr;34(4):779-89
references: 24407029
references: Ann Rheum Dis. 2014 Jul;73(7):1301-8
references: 24796336
references: Ann Rheum Dis. 2014 Aug;73(8):1495-9
references: 23716069
references: N Engl J Med. 2014 Dec 18;371(25):2383-93
references: 25404125
references: Ann Rheum Dis. 2015 Apr;74(4):694-702
references: 24368514
references: Circulation. 2003 Mar 11;107(9):1303-7
references: 12628952
references: Semin Arthritis Rheum. 1992 Dec;22(3):172-8
references: 1295090
references: Arthritis Rheum. 1995 Jan;38(1):44-8
references: 7818570
references: Arthritis Rheum. 1996 Jan;39(1):34-40
references: 8546736
references: Clin Chem. 1998 Jun;44(6 Pt 1):1242-50
references: 9625048
references: Clin Chem. 1998 Jul;44(7):1452-8
references: 9665423
references: Ann Rheum Dis. 2004 Dec;63(12):1535-7
references: 15547075
references: N Engl J Med. 2005 Jan 6;352(1):20-8
references: 15635109
references: N Engl J Med. 2005 Jan 6;352(1):29-38
references: 15635110
references: Ann Rheum Dis. 2005 Feb;64(2):303-5
references: 15231512
references: Ann Rheum Dis. 2005 May;64(5):765-6
references: 15458960
references: JAMA. 2005 Jul 20;294(3):326-33
references: 16030277
references: J Rheumatol. 2006 Dec;33(12):2440-6
references: 17014005
references: JAMA. 2007 Feb 14;297(6):611-9
references: 17299196
references: Arthritis Rheum. 2007 Sep;56(9):2905-12
references: 17763428
references: Ann Rheum Dis. 2007 Nov;66(11):1503-7
references: 17472994