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.


Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis Is Associated with Decreased Activity of Lecithin Cholesterol Acyl:Transferase, a High Density Lipoprotein (HDL)-Associated Protein Involved in Reverse Cholesterol Transport.

Charles-Schoeman2,  Christina, Lee3,  Yuen Yin, Amjadi3,  Sogol, FitzGerald4,  John D., Ranganath2,  Veena K., Taylor3,  Mihaela, McMahon2,  Maureen A.

Encino, CA
UCLA School of Medicine, Los Angeles, CA
UCLA School of Medicine
UCLA School of Medicine Rehabilitation, Los Angeles, CA

Purpose:

Patients with rheumatoid arthritis (RA) have increased cardiovascular (CV) risk which is not explained by traditional CV risk factors. Lecithin cholesterol acyl:transferase (LCAT) is an HDL-associated protein which promotes reverse cholesterol transport from cells and has been shown to protect low density lipoproteins (LDL) from oxidative modification. We previously reported that LCAT activity is decreased in RA patients compared to healthy controls, and that decreased LCAT activity is associated with abnormal anti-oxidant function of HDL. The aim of the current work was to determine whether decreased LCAT activity is associated with subclinical atherosclerosis in RA.

Methods:

Carotid artery ultrasound was performed in 110 patients with rheumatoid arthritis and fasting blood was collected for lipoprotein analyses. LCAT activity was measured in patient plasma as the change in ratio of the intact to hydrolyzed LCAT monomer substrate (470/390 nm of emission intensity) over time. Lipoprotein cholesterol levels were measured by standard methods and traditional cardiovascular risk factors, medication use, and RA disease characteristics were assessed for all patients.

Results:

Carotid plaque was identified in 49% of the RA patients studied. LCAT activity was significantly lower in patients with plaque compared to patients without plaque (See table). After multivariate analysis, LCAT activity (OR 0.002, p=0.009), age (OR 1.1, p<0.0001), and gender (OR 9.0, p=0.005) were significantly associated with plaque in RA patients.

GroupLCAT ActivityAge (yrs)F (%)HSCRP (mg/L)DAS28HDL-C (mg/dL)LDL-C (mg/dL)HTN (% yes)BMI (lb/in2)HAQ-DI
Plaque n = 540.219 ± 0.038*61 ± 11*78*7.3 ± 16.94.4 ± 1.962 ± 19106 ± 3259*27.4 ± 6.60.95 ± 0.77
No Plaque n = 560.237 ± 0.04349 ± 11937.1 ± 14.14.7 ± 1.759 ± 15104 ± 372327.7 ± 7.81.05 ± 0.88
F = Female; HTN = hypertension; DAS28 = Disease activity score with 28 joint count; HAQ - DI = health assessment questionnaire disability index;*p value < 0.05.

Conclusions:

Decreased LCAT activity is significantly associated with subclinical atherosclerosis in patients with rheumatoid arthritis. This data suggest that abnormalities in the reverse cholesterol transport pathway may contribute to the increased cardiovascular disease in RA. Further investigation of abnormalities in lipoprotein function including LCAT activity may be warranted as potential biomarkers and mechanisms for increased atherosclerotic risk in RA.

To cite this abstract, please use the following information:
Charles-Schoeman, Christina, Lee, Yuen Yin, Amjadi, Sogol, FitzGerald, John D., Ranganath, Veena K., Taylor, Mihaela, et al; Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis Is Associated with Decreased Activity of Lecithin Cholesterol Acyl:Transferase, a High Density Lipoprotein (HDL)-Associated Protein Involved in Reverse Cholesterol Transport. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :1058
DOI: 10.1002/art.28825

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