Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

High-Density Lipoprotein Subfractions HDL2 and HDL3 Are Reduced in Female Patients with Rheumatoid Arthritis and Do Not Appear to Be Affected by Disease Activity.

Arts,  Elke.E.A., Fransen,  Jaap, Lemmers,  Heidi, Joosten,  Leo A.B., Van Riel,  Piet L.C.M., Popa,  Calin


High-density lipoprotein cholesterol (HDL) is associated with anti-atherogenic properties. Higher levels of HDL subfractions HDL3 and particularly HDL2 protect for cardiovascular disease (CVD). Inflammation reduces HDL concentration and possibly impairs its anti-atherogenic effect. HDL composition and the impact of inflammation/disease activity on HDL subfractions in RA is still unknown. The objective of this study was to assess HDL2 and HDL3 concentrations in RA patients and their association with the level of disease activity.


Non-fasting blood samples were collected from 45 RA patients and 45 healthy controls, who did not suffer from inflammatory conditions (13 men and 32 women in both groups). None of the participants had a history of CVD or diabetes, or used lipid-lowering drugs. HDL2 and HDL3 concentrations were obtained by ultracentrifugation. Between-group comparisons were done using independent-sample t-tests, HDL2 concentration was compared between RA patients and healthy controls using analysis of covariance (ANCOVA) with exposure to RA (patients or controls) as independent variable, gender and age as covariates. The effect of disease activity on HDL2:HDL3 ratio was also analyzed in RA patients using ANCOVA, with age, gender, rheumatoid factor and disease duration as covariates.


HDL2 and HDL3 were significantly lower in RA patients compared to healthy controls (p=0.01 and p=0.005, respectively). Mean±SD concentrations of HDL2 were 0.5±0.3 mmol/L in RA patients, compared to 0.7±0.4 mmol/L in the control group, a mean difference of 0.2 (95%CI 0.05–0.34). HDL3 levels were 0.8±0.2 mmol/L in the RA group and 0.9±0.2 mmol/L in the control group a mean difference of 0.1 (95%CI 0.04–0.19). The HDL2:HDL3 ratio was significantly lower in the patient group (0.5±0.3 mmol/L) compared to the control group (0.7±0.4 mmol/L) with a mean difference of 0.2 (95%CI 0.01–0.31) (p=0.04). Female gender was an effect modifier, HDL2 and HDL3 levels were primarily altered in women (fig.1). The HDL2:HDL3 ratio was only significantly different between groups in females, with a mean difference of 0.2 (95%CI 0.04–0.40, p=0.02) compared to a mean difference of 0.01 (95%CI -0.2–0.1, p=0.9) in males. HDL2 and HDL3 concentrations were similar for all categories of the DAS28 (low <3.2, medium 3.2–5.1, and high >5.1). Only after correcting for confounders; age and disease duration, was the effect of disease activity on HDL2 significant (p=0.04).


HDL2:HDL3 ratio is reduced in RA women, primarily due to lower HDL2 concentrations. This may contribute to accelerated atherosclerosis and CVD reported in RA. Height of disease activity does not appear to contribute to these modifications. Our results suggest that including HDL2:HDL3 ratio in CV risk assessment of RA patients may be of great importance.

To cite this abstract, please use the following information:
Arts, Elke.E.A., Fransen, Jaap, Lemmers, Heidi, Joosten, Leo A.B., Van Riel, Piet L.C.M., Popa, Calin; High-Density Lipoprotein Subfractions HDL2 and HDL3 Are Reduced in Female Patients with Rheumatoid Arthritis and Do Not Appear to Be Affected by Disease Activity. [abstract]. Arthritis Rheum 2011;63 Suppl 10 :1180

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