Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Tumor Necrosis Factor- Inhibitor Use Does Not Affect Lipid Profiles in Patients with Rheumatoid Arthritis.
Morris1, Stephanie J., Antohe1, Jana L., Sartorius2, Jennifer, Kirchner2, H. Les, Dancea1, Sorina, Wasko3, Mary Chester, Bili1, Androniki
Patients with rheumatoid arthritis (RA) have increased risk of cardiovascular disease (CVD). In some studies of RA patients, tumor necrosis factor-alpha (TNF-a) inhibitors and other biologic agents have been associated with adverse lipid profiles, a risk factor for CVD. This study examined the association of TNF-a inhibitor use with lipid levels in an RA inception cohort in a rural, tertiary health system using Electronic Health Record (EHR).
Patients diagnosed with RA (ICD-9 code 714.0 at >=2 office visits with a rheumatologist) from 1/1/2001 5/1/2009 were identified through the EHR (n=1539). The RA diagnosis was validated against the American College of Rheumatology criteria by manual review of 100 random charts with 97% concordance. Analysis was restricted to patients with at least one post-RA lipid result (n=706). Outcomes were lipid level results over time by TNF-a inhibitor usage status (infliximab, etanercept, and adalimumab). The lipid panel included low density lipoprotein (LDL), high density lipoprotein (HDL), total cholesterol (TC), and triglycerides. In addition, LDL/HDL and TC/HDL (the atherogenic index) were included as outcomes. Each patient's TNF-a inhibitor use status was evaluated at each lipid measurement date. Body mass index (BMI), erythrocyte sedimentation rate, C-reactive protein, rheumatoid factor (RF), anti-cyclic citrullinated peptide (CCP) antibodies, diabetes, hypertension, use of glucocorticoids, nonsteroidal anti-inflammatory medications, hydroxychloroquine, methotrexate, and lipid-lowering medications, were controlled for in a random effects, linear regression model. Time is represented as time since RA diagnosis to each lipid result date in years.
706 incident RA patients with 2851 lipid results were identified and were included in the analysis. The majority of patients were female (69%), and 98% were Caucasian, with median age of 65 years and BMI 29.8 kg/m2. RF and anti-CCP were positive in 79% and 42% (of the patients who had results recorded in the EHR) respectively. Of the 706 patients, 182 (25.8%) were ever on TNF-a inhibitors. In the regression models, use of TNF-a inhibitors was associated with the following estimated average changes in lipids over time: LDL increase of 0.49 mg/dl (p=0.811), HDL decrease of 0.51 mg/dl (p=0.517), TC increase of 1.64 mg/dl (p=0.505), triglycerides increase of 5.11 mg/dl (p=0.388), LDL/HDL increase 0.063 (p=0.224), and TC/HDL increase of 0.104 (p=0.132).
Use of TNF-a inhibitors in this inception RA cohort was not associated with significant changes in total cholesterol, LDL, HDL, LDL/HDL, or TC/HDL. These results are reassuring, given the widespread use of TNF inhibitors and increased risk of CVD in this patient population.
To cite this abstract, please use the following information:
Morris, Stephanie J., Antohe, Jana L., Sartorius, Jennifer, Kirchner, H. Les, Dancea, Sorina, Wasko, Mary Chester, et al; Tumor Necrosis Factor- Inhibitor Use Does Not Affect Lipid Profiles in Patients with Rheumatoid Arthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :345