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These findings highlight the divergence in biomarkers of CVD risk and suggest a role in future studies examining the benefit of including hs-cTnT for CVD risk stratification in RA.Medicare Program: Medicare is a federal government program which provides health insurance to people who are 65 or older. ConclusionĪmong RA patients who experienced an increase in inflammation, a significant decrease in routinely measured lipids, including LDL cholesterol, and an increase in markers of subclinical myocardial injury were observed. In both cohorts, hs-cTnT levels were associated with the overall estimated risk of CVD. In the decreased inflammation cohort, hs-cTnT levels remained stable despite a reduction in inflammation over follow-up. In the increased inflammation cohort at baseline, 45.6% of patients (47 of 103) had detectable circulating hs-cTnT, which further increased during inflammation ( P = 0.02). The average increase in hsCRP levels was 36 mg/liter, and this increase was associated with significant reductions in LDL cholesterol, triglycerides, total cholesterol, apolipoprotein (Apo B), and Apo A-I levels. ResultsĪmong the patients in the increased inflammation cohort, the mean age was 59 years, 81% were women, and the mean RA disease duration was 17.9 years. Routine and advanced lipids, markers of inflammation (interleukin-6, hsCRP, soluble tumor necrosis factor receptor II), and markers of subclinical myocardial injury (high-sensitivity cardiac troponin T, N-terminal pro–brain natriuretic peptide) were measured. Patients were stratified based on whether they experienced either a significant increase in inflammation (an increase in hsCRP of ≥10 mg/liter between any 2 time points 1 year apart designated the increased inflammation cohort ) or decrease in inflammation (a decrease in hsCRP of ≥10 mg/liter between any 2 time points 1 year apart designated the decreased inflammation cohort ). MethodsĪ total of 196 patients were evaluated in a longitudinal RA cohort, with blood samples and high-sensitivity C-reactive protein (hsCRP) levels measured annually. This study was undertaken to prospectively evaluate the changes in lipid levels among RA patients experiencing changes in inflammation and determine the association with concomitant temporal patterns in markers of myocardial injury.
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A decrease in inflammation in patients with RA is associated with increased low-density lipoprotein (LDL) cholesterol. Patients with rheumatoid arthritis (RA) are 1.5 times more likely to develop cardiovascular disease (CVD) attributed to chronic inflammation. No other disclosures relevant to this article were reported. Plutzky has received consulting fees, speaking fees, and/or honoraria from Amarin, Alnylam, Correvio, Janssen, Eidos, and Genfit (less than $10,000 each) and from Novo Nordisk, Janssen, Vivus, and Amgen (more than $10,000 each), has received research support from Boehringer Ingelheim, and holds a patent for retinaldehyde dehydrogenase inhibition to treat obesity via thermogenesis. Mehta has received consulting fees, speaking fees, and/or honoraria from Amgen, Eli Lilly, and LEO (less than $10,000 each) and research support from AbbVie, Celgene, Janssen, and Novartis. Di Carli has received consulting fees, speaking fees, and/or honoraria from Janssen and Bayer (less than $10,000 each) and research support from Gilead and Spectrum Dynamics. Shadick has received consulting fees, speaking fees, and/or honoraria from Bristol Myers Squibb (less than $10,000) and research support from Sanofi, Crescendo Biosciences, Bristol Myers Squibb, Mallinckrodt, Eli Lilly, and Amgen. Weinblatt has received consulting fees, speaking fees, and/or honoraria from AbbVie, Can-Fite, GlaxoSmithKline, Horizon, Johnson & Johnson, Pfizer, Roche, Scipher, and SetPoint (less than $10,000 each) and from Arena, Corrona, and Gilead (more than $10,000 each) and has received research support from Crescendo Biosciences, Bristol Myers Squibb, Sanofi, Eli Lilly, and Amgen.