Background Patients with rheumatoid arthritis (RA) are at increased cardiovascular risk with contribution of both inflammation and traditional risk factors. Dyslipidemia is an important risk factor and lipid-lowering therapy plays a key role in cardio-preventive treatment. A new class of low density lipoprotein cholesterol (LDL-C) lowering drugs, proprotein convertase subtilisin/kexin type 9 (PCSK9)-inhibitors are now emerging. In view of a lower rate of musculoskeletal side effects these drugs might be preferred over statins in patients with RA. Active inflammation in RA leads to a decline in lipid levels, but the relation between inflammation and PCSK9 levels is unknown.
Objectives To assess PSCK9 levels in RA patients, and the relationship with lipid levels and disease activity.
Methods PSCK9 levels were assessed using ELISA in 97 randomly selected patients. Lipid profile assessment comprised TC, HDL-C, LDL-C and triglycerides. Disease activity was assessed using disease activity score of 28 joints (DAS28).
Results The mean age of RA patients was 54.5 years (± 10.8) and they were predominantly female (74.2%). The mean PCSK9 value in RA patients was 214.75 (± 73.3), which is similar to that in the general population . PCSK9 values were associated with TC (corrected B 22.34, 95% CI 6.80–37.88, p0.005) and triglycerides (corrected B 21.02, 95% CI -0.84–42.89, p0.044) (table 2). 77 patients had low disease activity (DAS28 ≤3.2), 11 patients had medium disease activity (DAS28 >3.2 and ≤5.1) and 20 patients had highly active disease (DAS28 >5.1). Mean PCSK9 values were 213.01, 246.96 and 258.30 ng/mL, respectively. Patients with active disease had a higher PCSK9 level (corrected B 42.555 95% CI 0.769–84.341, p 0.046) compared to patients with low disease activity (table 1).
Conclusions PCSK9 levels in RA are similar to the general population. RA patients with active disease had higher PCSK9 levels compared to patients with low disease activity. Altogether, PCSK9 inhibitors could be an alternative treatment for dyslipidemia in RA patients who experience side effects of statins, albeit that a formal trial still has to be conducted in this category of patients.
Lambert G, Petrides F, Chatelais M et al. J Am Coll Cardiol. 2014 Jun 10;63(22):2365–73.
Disclosure of Interest None declared