Washington DC Veterans Affairs Medical Center, Georgetown University, and Howard University Hospitals, Washington, DC.
Arthritis Care Res (Hoboken). 2014 Nov;66(11):1619-26. doi: 10.1002/acr.22341.
To evaluate the association of hydroxychloroquine (HCQ) use with lipid profiles in a Veterans Affairs Rheumatoid Arthritis (VARA) cohort.
Lipid profiles in HCQ users were compared with HCQ nonusers, adjusting for potential confounders (age, sex, race, disease activity, prednisone, disease-modifying antirheumatic drugs, diabetes mellitus, and statin use). Applying current National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATP III) guidelines for reduction of cardiovascular disease (CVD) events risk, the frequency of target lipid profiles with HCQ status was evaluated. Varied periods of HCQ exposure were compared to ascertain pharmacologic associations with lipid values. CVDs were compared between HCQ users and nonusers.
In an elderly, predominantly male VARA cohort, 1,011 patients had lipid profiles; 787 patients (77.8%) were white. Statin use was recorded in 11.6% of patients, diabetes mellitus in 33.5%, and CVD in 31.2%. HCQ users (n = 150) were older, had longer rheumatoid arthritis (RA) disease duration, and had lower disease activity. Optimum lipid profiles, including total cholesterol:high-density lipoprotein (HDL) and HDL:low-density lipoprotein ratios (P ≤ 0.001), were more frequent in HCQ users, with the exception of HDL (P = 0.165), and persisted in multivariate analyses. Similarly, more HCQ users had NCEP-ATP III target levels. Varied periods of HCQ exposure suggested lipid changes to occur early, but lost within a year of drug discontinuation. HCQ users had less prevalent CVD.
In RA patients, HCQ use of at least 3 months' duration was associated with better lipid profiles irrespective of disease activity or statin use. Given the increased CVD risks in RA and the relative low cost and toxicity of HCQ, continued use, regardless of treatment regimen, should be considered.
评估羟氯喹（HCQ）在退伍军人事务部类风湿关节炎（VARA）队列中的使用与血脂谱的相关性。
比较 HCQ 使用者和非使用者的血脂谱，调整潜在的混杂因素（年龄、性别、种族、疾病活动度、泼尼松、改善病情抗风湿药、糖尿病和他汀类药物的使用）。根据当前的国家胆固醇教育计划成人治疗小组 III（NCEP-ATP III）降低心血管疾病（CVD）事件风险的指南，评估 HCQ 状态下目标血脂谱的频率。比较不同时期的 HCQ 暴露，以确定与血脂值的药物关联。比较 HCQ 使用者和非使用者的 CVD。
在一个老年、主要为男性的 VARA 队列中，有 1011 名患者的血脂谱数据；787 名患者（77.8%）为白人。11.6%的患者使用他汀类药物，33.5%的患者患有糖尿病，31.2%的患者患有 CVD。HCQ 使用者（n=150）年龄较大，类风湿关节炎（RA）疾病持续时间较长，疾病活动度较低。除高密度脂蛋白（HDL）外（P=0.165），HCQ 使用者的最佳血脂谱，包括总胆固醇：高密度脂蛋白（HDL）和 HDL：低密度脂蛋白（LDL）比值（P≤0.001）更为常见，且在多变量分析中仍存在。同样，更多的 HCQ 使用者有 NCEP-ATP III 目标水平。不同时期的 HCQ 暴露表明血脂变化可能发生较早，但在停药 1 年内消失。HCQ 使用者的 CVD 患病率较低。
在 RA 患者中，至少 3 个月的 HCQ 使用与更好的血脂谱相关，无论疾病活动度或他汀类药物的使用情况如何。鉴于 RA 患者的 CVD 风险增加，以及 HCQ 的相对低毒性和低成本，无论治疗方案如何，都应考虑继续使用。
