Divergence of Cardiovascular Biomarkers of Lipids and Subclinical Myocardial Injury Among Rheumatoid Arthritis Patients with Increased Inflammation

BACKGROUND Patients with rheumatoid arthritis (RA) have a 1.5x excess risk of cardiovascular (CV) disease attributed to chronic inflammation. A decrease in inflammation in RA is associated with increased LDL-C. This study evaluated the changes in lipid levels prospectively among RA patients experiencing changes in inflammation and determined the association with concomitant temporal patterns in markers of myocardial injury. METHODS We studied 196 patients in a longitudinal RA cohort with blood samples and hsCRP measured annually, who experienced either a significant increase or decrease in inflammation, defined as hsCRP ≥10 mg/L, in 2 consecutive annual visits. Routine and advanced lipids, markers of inflammation (IL-6, hsCRP, sTNFR2), and markers of subclinical myocardial injury (hs-cTnT, NT-proBNP) were measured RESULTS: The mean age was 59 years, 81% female, with mean RA disease duration of 17.9 years. The average hsCRP increase was 36 mg/dl, associated with significant reductions in LDL-C, TG, TC, apoB and apoA1. At baseline in the increase cohort, 45.6% (47/103) had detectable circulating hs-cTnT which further increased during inflammation (p=0.02). In the decrease cohort, hs-cTnT levels remained stable despite a reduction in inflammation. In both cohorts, levels of hs-cTnT associated with overall estimated cardiovascular risk. CONCLUSION Among RA patients experiencing an increase in inflammation, routine lipids, including LDL-C, were significantly decreased while increases in markers of subclinical myocardial injury were observed. These findings highlight the divergence in biomarkers of CV risk and suggest a role in future studies examining the utility of including hs-cTnT for CV risk stratification in RA.