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Changes in serum cholesterol loading capacity are linked to coronary atherosclerosis progression in rheumatoid

George Athanasios Karpouzas1,2, Bianca Papotti3, Sarah R Ormseth4

  • 1Internal Medicine- Rheumatology, The Lundquist Institute, Torrance, California, USA gkarpouzas@lundquist.org.

RMD Open
|December 24, 2024
PubMed

Insights

Changes in cholesterol loading capacity (CLC) in rheumatoid arthritis (RA) patients predict atherosclerosis progression. RA therapies like biologics and statins may favorably impact this relationship, unlike prednisone.

Area of Science:

  • Cardiovascular Science
  • Rheumatology
  • Immunology

Background:

  • Rheumatoid arthritis (RA) is associated with increased cardiovascular risk, partly due to cholesterol loading on macrophages leading to foam cell formation.
  • The impact of evolving cholesterol loading capacity (CLC) and RA treatments on coronary plaque progression in RA patients remains unclear.

Purpose of the Study:

  • To investigate the association between longitudinal changes in CLC and the progression of coronary atherosclerosis in patients with RA.
  • To explore the influence of RA therapies on the relationship between CLC changes and atherosclerosis.

Main Methods:

  • A prospective observational cohort study involving 100 RA patients without baseline cardiovascular disease.
  • Coronary CT angiography assessed atherosclerosis (plaque types, CAC score) at baseline and after ~7 years. Serum CLC was measured using a fluorometric assay on monocyte-derived macrophages.
  • Progression defined by plaque changes, increased CAC score, or development of extensive/obstructive disease.

Main Results:

  • Increased CLC change was significantly associated with a higher likelihood of progression in non-calcified plaques (OR 2.55), fully calcified plaques (OR 3.10), and coronary artery calcium (CAC) score (OR 1.80).
  • Higher CLC change also predicted new extensive or obstructive coronary artery disease (OR 2.43).
  • Prednisone use showed an unfavorable interaction, while biologics and statins demonstrated favorable interactions with CLC change regarding atherosclerosis progression (p≤0.048).

Conclusions:

  • Longitudinal changes in cholesterol loading capacity are a significant predictor of atherosclerosis progression in RA patients.
  • This association is dose-dependent and includes the development of lipid-rich non-calcified plaques and extensive or obstructive coronary artery disease, which pose the highest cardiovascular risk.
  • RA therapies differentially modulate the link between CLC dynamics and cardiovascular disease progression.
Abstract

Keywords:
Arthritis, RheumatoidAtherosclerosisBiomarkersLipids

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