Elevated disease activity is associated with a deteriorated lipid profile in patients with ankylosing spondylitis

V P van Halm ¹, J C van Denderen ², M JL Peters ¹, J WR Twisk ¹, M van der Paardt ¹, I E van der Horst -Bruinsma ¹, R J van der Stadt ², M HMT de Koning ², B AC Dijkmans ¹ and M T Nurmohamed ^2*

¹ VU University Medical Center, Netherlands
² Jan van Breemen Institute, Netherlands

^* To whom correspondence should be addressed. E-mail: m.nurmohamed{at}janvanbreemen.nl.

Accepted 23 April 2006

Abstract

Objectives:Cardiovascular mortality is increased in patients with ankylosing spondylitis (AS). A possible explanation might be a more prevalent atherogenic lipid profile in AS compared to the general population. It has been postulated that inflammation deteriorates the lipid profile, thereby increasing cardiovascular risk. The present study explores the association between disease activity and the lipid profile in patients with AS.

Methods:AS disease activity parameters and lipid levels (total cholesterol (TC), HDL-cholesterol (HDLc) and triglycerides) were measured in 45 AS patients during 6 months after starting leflunomide or placebo treatment. Findings in this treatment group were compared to 10 AS patients treated with etanercept. A specialised regression model, adjusting for repeated measurements, age and gender was used to assess the influence of the disease activity variables on the lipid levels.

Results:Multilevel regression analyses revealed significant associations between disease activity parameters and lipid levels, for instance an increase of 30 mm/hr in erythrocyte sedimentation rate was associated with decrease of approximately 6% in TC level and a decrease in HDLc levels of approximately 11%. Similar significant associations were found between other disease activity parameters and lipid levels.

Conclusion:Increases in disease activity were associated with decreases in lipid levels. The decrease in HDLc levels tended to be almost twice as large as the decrease in TC levels, resulting in a more atherogenic lipid profile. Hence, effective treatment of disease activity in AS might lower the cardiovascular risk by improving the lipid profile.

Keywords: ankylosing spondylitis, cardiovascular disease, disease activity, lipid profile

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