Chang Ching-Kun, Li Yi-Chen, Chen Po-Ku, Chang Shih-Hsin, Chen Der-Yuan
Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan.
College of Medicine, China Medical University, Taichung, Taiwan.
Front Cardiovasc Med. 2024 Sep 9;11:1449219. doi: 10.3389/fcvm.2024.1449219. eCollection 2024.
The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) remains inadequately defined. Consequently, this study aims to evaluate the predictive value of remnant cholesterol (RC) for assessing CVD risk in RA patients.
Plasma RC levels were measured in 114 RA patients and 41 healthy controls, calculated as total cholesterol minus HDL-C and LDL-C. These levels were further analyzed using H-NMR lipid/metabolomics. Meanwhile, the 28-joint Disease Activity Score (DAS28) assessed RA activity.
RC levels were significantly elevated in RA patients (19.0 mg/dl, < 0.001) compared to healthy controls (14.5 mg/dl). Furthermore, RC levels were significantly elevated at 37.4 mg/dl in patients who experienced cardiovascular event (CVE) compared to 17.4 mg/dl in those without CVE ( < 0.001). To enhance the precision and reliability of RC measurements, RC concentrations were further validated using H-NMR spectroscopy. Additionally, a positive correlation was observed between RC levels and DAS28. Multivariate analysis identified RC as a significant predictor of CVE (odds ratio = 1.82, = 0.013). ROC curve analysis revealed superior predictive capability of RC for CVE (AUC = 0.919, < 0.001) compared to LDL-C (AUC = 0.669, = 0.018), with a high sensitivity of 94.7% and a specificity of 82.1%.
Elevated RC levels demonstrate greater accuracy in predicting CVE occurrence in RA patients compared to traditional measures such as LDL-C. These findings suggest that elevated RC levels may serve as a novel predictor for occurrence of CVE in RA patients, facilitating early intervention strategies based on the risk stratification.
类风湿关节炎（RA）患者的心血管疾病（CVD）风险仍未得到充分界定。因此，本研究旨在评估残余胆固醇（RC）对评估RA患者CVD风险的预测价值。
测量了114例RA患者和41例健康对照者的血浆RC水平，计算方法为总胆固醇减去高密度脂蛋白胆固醇（HDL-C）和低密度脂蛋白胆固醇（LDL-C）。使用氢核磁共振（H-NMR）脂质/代谢组学对这些水平进行了进一步分析。同时，采用28个关节疾病活动评分（DAS28）评估RA活动度。
与健康对照者（14.5mg/dl）相比，RA患者的RC水平显著升高（19.0mg/dl，P<0.001）。此外，发生心血管事件（CVE）的患者RC水平显著升高至37.4mg/dl，而未发生CVE的患者为17.4mg/dl（P<0.001）。为提高RC测量的准确性和可靠性，使用H-NMR光谱对RC浓度进行了进一步验证。此外，观察到RC水平与DAS28之间存在正相关。多变量分析确定RC是CVE的显著预测因子（比值比=1.82，P=0.013）。ROC曲线分析显示，与低密度脂蛋白胆固醇（LDL-C，AUC=0.669，P=0.018）相比，RC对CVE具有更高的预测能力（AUC=0.919，P<0.001），灵敏度为94.7%，特异性为82.1%。
与LDL-C等传统指标相比，升高的RC水平在预测RA患者CVE发生方面具有更高的准确性。这些发现表明，升高的RC水平可能作为RA患者CVE发生的一种新的预测指标，有助于基于风险分层的早期干预策略。
