‘Lipid paradox’ may obscure cardiovascular risk in patients with inflammatory disease
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AUSTIN, Texas — Providers should carefully consider the “lipid paradox” when monitoring cardiovascular risks in patients with rheumatic inflammatory diseases, noted a presenter at the 2023 Rheumatology Nurses Society annual conference.
According to Kathryn Dao, MD, FACP, FACR, of the University of Texas Southwestern Medical Center, patients with active inflammatory disease, including rheumatoid arthritis, demonstrate altered lipid catabolism.
“And then there is something called the lipid paradox. I don’t know if you know this, but patients who have active RA, active inflammatory disease, have altered lipid catabolism. They may represent and have a lipid profile of low HDL and low LDL -- those are the patients you have to be aware of. We usually think of low LDL as favorable for cardiovascular risk, but in a patient with active inflammatory disease, that is actually a red flag.”
“Be careful about the lipid paradox,” she added. “Just because their LDL is really low, if they have really active disease, that does not mean that their risk for cardiac events is low.”
Dao stressed that providers caring for patients with RA should be wary of all the cardiovascular risks involved the disease.
“Rheumatoid arthritis itself can predispose a patient to cardiovascular disease,” she said. “Rheumatoid arthritis is a pro-inflammatory state, and it has been associated with accelerated atherosclerosis, endothelial dysfunction, as well as microvascular disease.”
As far as choosing therapies for patients who are at risk of enduring cardiovascular events, Dao suggested providers limit NSAIDs and glucocorticoid therapies in terms of doses and duration.
“Keep steroids to a minimum with regards to amount and duration,” she said. “Because, remember: Cumulative amounts of steroids also matter. Try to use more of your DMARDs.”
In addition to using therapies that may reduce the likelihood of cardiovascular events, Dao recommended assessing patients’ risk factors on a regular basis.
“Assess the patient’s cardiovascular risk factors regularly,” she said. “And you want to weigh the benefits of JAK inhibitors vs. active RA disease in patients with increased cardiovascular risk.”
Editor’s note: This story has been edited to correct the wording of a quote from Dr. Dao’s presentation. The editors regret the error.
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Dao K. CVD and RA. Presented at: Rheumatology Nurses Society annual conference; August 2-5, 2023 (hybrid meeting).
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