CardiovascularLipid Profiles in Patients with Rheumatoid Arthritis: Mechanisms and the Impact of Treatment
Section snippets
Methods
A PubMed literature search was undertaken for studies published between 1990 and May 2007, using the search terms “rheumatoid arthritis” AND “lipid” OR “lipoprotein” OR “cholesterol,” and including all relevant drug treatment terms for glucocorticoids, disease-modifying antirheumatic drugs, and biologics. Preference was given to clinical studies (including randomized clinical studies), meta-analyses, and guidelines. Review articles focused on lipid abnormalities in RA were evaluated and the
Risk Factors for Coronary Heart Disease
Cardiovascular risk factors may be classified as modifiable (lipid levels, blood pressure, smoking, obesity, sedentary lifestyle) or nonmodifiable (age, gender, family history). The effects of these factors on risk are additive, and therefore, the National Cholesterol Education Program Adult Treatment Panel III guidelines for modifying lipid levels grade the intensity of treatment to the number of risk factors (13). National Cholesterol Education Program Adult Treatment Panel III guidelines
Discussion
Clearly, more research is needed to elucidate fully the relationship between inflammation and atherosclerosis in RA, and the nature of the effect of RA on lipoprotein profiles. For example, it is now understood that the structure and function of lipoproteins differ, even within the subclasses of LDL and HDL, and that density and size of lipoprotein particles change their cellular effect. Small, dense LDL particles are more atherogenic than large ones (53, 66), whereas small, dense HDL particles
Acknowledgments
Catherine Colebourn contributed to the writing and editing of this article. Financial support for the development of this manuscript was provided by Hoffmann-La Roche Inc., Nutley, NJ.
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