Indications for lowering LDL cholesterol in rheumatoid arthritis: an unrecognized problem

To evaluate the prevalence of patients with rheumatoid arthritis (RA) in whom lowering low density lipoprotein cholesterol (LDL-C) should be considered in accord with the ATPIII guidelines. The treatment goals are based on the number of risk factors (RF) other than LDL-C. The goal for 0-1 RF is < 160 mg/l, for multiple RF < 130 mg/l, and < 100 mg/l for coronary heart disease (CHD) or CHD risk equivalent (other clinical atherosclerotic diseases and diabetes mellitus).

A cross-sectional study was conducted in 145 patients with RA. We recorded the patients' characteristics, the potential risk factors for CHD, and results of lipid profile tests [total cholesterol (TC), high density lipoprotein cholesterol, and LDL-C].

Of the 145 patients recruited, 23 had LDL-C lowering therapy. Of the remaining 122 patients (mean age 54 +/- 15 years), of whom 101 (83%) were women, 109 were taking a disease modifying antirheumatic drug. At the time of the study, disease duration was 12 +/- 10 years. Twenty-seven (22%) of the 122 patients needed lowering of LDL-C. If RA was considered as an additional risk factor or a major risk factor, like diabetes mellitus, 35 patients (29%) and 86 (70%) patients, respectively, needed lowering therapy.

Our study shows the high percentage of patients with RA for whom LDL-C intervention should be considered. As cardiovascular morbidity and mortality is increased in patients with RA, it would be useful to determine whether RA should be considered as an independent cardiovascular risk factor or as a major risk factor like diabetes that warrants more aggressive cardiac prevention measures.