‘Lipid paradox’ may obscure cardiovascular risk in patients with inflammatory disease

Source/Disclosures

Published by:

Source:

Dao K. CVD and RA. Presented at: Rheumatology Nurses Society annual conference; August 2-5, 2023 (hybrid meeting).

Disclosures:
Dao reports financial disclosures with Pfizer.

ADD TOPIC TO EMAIL ALERTS

Receive an email when new articles are posted on

Please provide your email address to receive an email when new articles are posted on .

<button type="button" class="btn btn-primary" data-loading-text="Loading ” data-action=”subscribe”>
Subscribe

ADDED TO EMAIL ALERTS

We were unable to process your request. Please try again later. If you continue to have this issue please contact [email protected].

Back to Healio

AUSTIN, Texas — Providers should carefully consider the “lipid paradox” when monitoring cardiovascular risks in patients with rheumatic inflammatory diseases, noted a presenter at the 2023 Rheumatology Nurses Society annual conference.

According to Kathryn Dao, MD, FACP, FACR, of the University of Texas Southwestern Medical Center, patients with active inflammatory disease, including rheumatoid arthritis, demonstrate altered lipid catabolism. As such, these patients may exhibit low high-density lipid numbers and higher low-density lipid numbers, yet remain at risk, she said.

Kathryn Dao

“We normally think of low LDL as favorable for cardiovascular risk, but in a patient with active inflammatory disease, that is actually a warning, a red flag sign,” Dao told attendees. “In addition, HDL is oxidized in active inflammatory disease, so it cannot really clear out lipids from macrophages very well.

“Be careful about the lipid paradox,” she added. “Just because their LDL is really low, if they have really active disease, that does not mean that their risk for cardiac events is low.”

Dao stressed that providers caring for patients with RA should be wary of all the cardiovascular risks involved the disease.

“Rheumatoid arthritis itself can predispose a patient to cardiovascular disease,” she said. “Rheumatoid arthritis is a pro-inflammatory state, and it has been associated with accelerated atherosclerosis, endothelial dysfunction, as well as microvascular disease.”

As far as choosing therapies for patients who are at risk of enduring cardiovascular events, Dao suggested providers limit NSAIDs and glucocorticoid therapies in terms of doses and duration.

“Keep steroids to a minimum with regards to amount and duration,” she said. “Because, remember: Cumulative amounts of steroids also matter. Try to use more of your DMARDs.”

In addition to using therapies that may reduce the likelihood of cardiovascular events, Dao recommended assessing patients’ risk factors on a regular basis.

“Assess the patient’s cardiovascular risk factors regularly,” she said. “And you want to weigh the benefits of JAK inhibitors vs. active RA disease in patients with increased cardiovascular risk.”