Incidence of Cardiovascular and Lipid Biomarkers in Patients with Inflammatory Arthritis

A study presented at the American College of Rheumatology (ACR) Convergence 2021 assessed cardiovascular and lipid biomarker distribution in inflammatory arthritis (IA).

“IA is associated with cardiovascular disease (CVD). Cardiac biomarkers may assist with CVD risk stratification,” wrote the authors.

The researchers analyzed patients enrolled in the University of Toronto Cardio-Rheumatology Network from 2017 to 2020. Patients had either rheumatoid arthritis (RA), or spondyloarthropathy (SpA), psoriatic arthritis or ankylosing spondylitis, with no documented history of CVD. Patients also had baseline data for five cardiac biomarkers:

  • high-sensitivity troponin T (hs-TnT; abnormal cutoff, ≥15 ng/L)
  • N-terminal prohormone BNP (NT-proBNP; ≥35 pmol/L or 100 pg/mL)
  • Apolipoprotein A1 (ApoA1; ≤1.96 g/L)
  • Apolipoprotein B (ApoB, ≥1.17g/L or ≥1.46g/L )
  • Lipoprotein a (Lp(a); ≥9.7mg/dL or ≥30mg/dL)

In total, 376 patients were included in the analysis. The incidence of RA was 58%, PsA was 33%, and AS was 9%. The mean age was 59 years and 70% of patients were female. Sixty-three percent of patients were receiving conventional synthetic disease-modifying anti-rheumatic drugs (DMARDs) and 39% were receiving biologic DMARDs. Seventy-seven percent of patients had at least one CVD risk factor, the most common being current/ever smoking (47%), obesity (35%), hypertension (33%), or dyslipidemia (27%).

At baseline, 13% of patients had elevated hs-TnT and 17% had elevated NT-proBNP. Abnormal lipid biomarkers were present in 45% of patients, primarily due to abnormal Apo A1 (90%) and abnormal Lp(a) levels (29%). An RA diagnosis was associated with an increased likelihood of abnormalities in in NT-proBNP and ApoB, but more favorable levels of HDL-c, non-HDL-c and triglyceride profiles compared to patients with a PsA/AS diagnosis. Multivariate analyses found that increasing age had a significant association with abnormal hs-TnT and NT-proBNP, but was negatively associated with ApoB. Female sex was associated with higher odds of abnormal Lp(a), and lower levels of hs-TnT and NT-proBNP.

“Abnormalities in cardiac and lipid biomarkers are common even in well-controlled IA patients with no known CVD,” wrote the authors in conclusion. “Additional research is needed to determine if biomarkers may help with CVD risk re-classification beyond traditional clinical risk score approaches. In addition, it will be important to understand whether CVD biomarkers are responsive to changes in disease activity or particular therapies, which may be another rationale for a treat-to-target approach in IA.”

Source: Kuriya B, et al. Cardiovascular and Lipid Biomarker Distributions in Inflammatory Arthritis. Arthritis Rheumatology. 2021;73(suppl 10). Presented at ACR Convergence 2021 (Virtual), Nov. 5-9, 2021.