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Hydroxychloroquine use associated with improvement in lipid profiles in rheumatoid arthritis patients
Stephanie J Morris1, Mary Chester M Wasko, Jana L Antohe
1Geisinger Health System, Danville, Pennsylvania 17822, USA.
Insights
Hydroxychloroquine (HCQ) use in rheumatoid arthritis (RA) patients was linked to improved lipid profiles, including lower LDL and total cholesterol. This suggests HCQ may help manage cardiovascular disease risk factors in RA.
Area of Science:
- Rheumatology
- Cardiology
- Pharmacology
Background:
- Cardiovascular disease (CVD) is a primary cause of mortality in rheumatoid arthritis (RA) patients.
- Effective disease-modifying therapies that mitigate CVD risk factors, such as dyslipidemia, are crucial for RA management.
- Hydroxychloroquine (HCQ) is a common RA treatment, but its impact on cardiovascular risk factors requires further investigation.
Purpose of the Study:
- To investigate the association between hydroxychloroquine (HCQ) use and lipid level changes in an inception rheumatoid arthritis (RA) cohort.
- To determine if HCQ treatment influences key lipid parameters, including LDL, HDL, total cholesterol, and triglycerides.
- To assess HCQ's potential role in managing dyslipidemia, a significant risk factor for CVD in RA patients.
Main Methods:
- Retrospective analysis of an inception RA cohort (n=1,539) diagnosed between 2001 and 2008.
- Inclusion criteria required at least one post-diagnosis lipid level measurement (n=706).
- Linear mixed-effects regression models were used to analyze lipid levels (LDL, HDL, total cholesterol, triglycerides, LDL/HDL, total cholesterol/HDL), controlling for demographic and clinical factors.
Main Results:
- HCQ use was associated with a significant average decrease in LDL cholesterol (-7.55 mg/dL, P<0.001) and total cholesterol (-7.70 mg/dL, P=0.002).
- Significant reductions were also observed in LDL/HDL ratio (-0.136, P=0.008) and total cholesterol/HDL ratio (-0.191, P=0.006).
- While HCQ showed a trend towards decreasing triglycerides (P=0.06), its effect on HDL cholesterol was not statistically significant (P=0.20).
Conclusions:
- Hydroxychloroquine (HCQ) use in RA patients is independently associated with favorable changes in lipid profiles, specifically reducing LDL and total cholesterol.
- These findings support HCQ's utility as an initial or adjunctive therapy for RA patients, particularly those at high risk for cardiovascular disease.
- Given its established safety profile and cost-effectiveness, HCQ may contribute to cardiovascular risk reduction in the RA population.
Objective:
Cardiovascular disease (CVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Disease-modifying therapies that improve risk factors for CVD, such as dyslipidemia, are desired. This study used an electronic health record to determine if hydroxychloroquine (HCQ) use was associated with an improvement in lipid levels in an inception RA cohort.
Methods:
All adult individuals with the initial diagnosis of RA between January 1, 2001, and March 31, 2008, were identified (n=1,539). Only patients with at least one lipid level post-RA diagnosis were included (n=706). Information on demographics, medical history, body mass index (BMI), laboratory measures, and medications were collected at office visits. Potential risk and protective factors for dyslipidemia were controlled for in linear mixed-effects regression models for low-density lipoprotein (LDL), high-density lipoprotein (HDL), total cholesterol, triglycerides, LDL/HDL, and total cholesterol/HDL.
Results:
Patients were 69% women and 98% white, with a median age of 65 years and a median BMI of 29.8 kg/m2. In the adjusted regression models, HCQ use was associated with the following average differences in lipids: LDL decrease of 7.55 mg/dl (P<0.001), HDL increase of 1.02 mg/dl (P=0.20), total cholesterol decrease of 7.70 mg/dl (P=0.002), triglycerides decrease of 10.91 mg/dl (P=0.06), LDL/HDL decrease of 0.136 (P=0.008), and total cholesterol/HDL decrease of 0.191 (P=0.006), which were stable over time.
Conclusion:
Use of HCQ in this RA cohort was independently associated with a significant decrease in LDL, total cholesterol, LDL/HDL, and total cholesterol/HDL. Considering these results, its safety profile, and low cost, HCQ remains a valuable initial or adjunct therapy in this patient population at high risk for CVD.
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