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Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease
  1. Elena Myasoedova,
  2. Cynthia S Crowson,
  3. Hilal Maradit Kremers,
  4. Veronique L Roger,
  5. Patrick D Fitz-Gibbon,
  6. Terry M Therneau,
  7. Sherine E Gabriel
  1. Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Dr Sherine E Gabriel, Department of Health Sciences Research, Mayo Foundation, 200 First Street SW, Rochester, MN 55905, USA; gabriel.sherine{at}


Objective To examine the impact of systemic inflammation and serum lipids on cardiovascular disease (CVD) in rheumatoid arthritis (RA).

Methods In a population-based RA incident cohort (1987 American College of Rheumatology criteria first met between 1988 and 2007), details were collected of serum lipid measures, erythrocyte sedimentation rates (ESRs), C-reactive protein (CRP) measures and cardiovascular events, including ischaemic heart disease and heart failure. Cox models were used to examine the association of lipids and inflammation with the risk of CVD and mortality, adjusting for age, sex and year of RA incidence.

Results The study included 651 patients with RA (mean age 55.8 years, 69% female); 67% were rheumatoid factor positive. ESR was associated with the risk of CVD (HR=1.2 per 10 mm/h increase, 95% CI 1.1 to 1.3). Similar findings, although not statistically significant, were seen with CRP (p=0.07). A significant non-linear association for total cholesterol (TCh) with risk of CVD was found, with 3.3-fold increased risk for TCh <4 mmol/l (95% CI 1.5 to 7.2) and no increased risk of CVD for TCh ≥4 mmol/l (p=0.57). Low low-density lipoprotein cholesterol (LDL <2 mmol/l) was associated with marginally increased risk of CVD (p=0.10); there was no increased risk for LDL ≥2 mmol/l (p=0.76).

Conclusion Inflammatory measures (particularly, ESR) are significantly associated with the risk of CVD in RA. Lipids may have paradoxical associations with the risk of CVD in RA, whereby lower TCh and LDL levels are associated with increased cardiovascular risk.

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  • Funding This work was supported by an unrestricted grant from Genentech, a member of the Roche Group and was made possible by grants from the National Institutes of Health, NIAMS (R01 AR46849) and The Rochester Epidemiology Project (R01 AG034676 from the National Institute on Aging).

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval This study was conducted with the approval of Mayo Clinic and Olmsted Medical Center Institutional Review Boards.

  • Provenance and peer review Not commissioned; externally peer reviewed.