Association of apolipoprotein B/apolipoprotein Al ratio and cardiovascular events in rheumatoid arthritis: results of the CARMA study

Objective To assess the plasma apolipoprotein Blapolipoprotein Al ratio and its potential association with cardiovascular events (CVE) in patients with rheumatoid arthritis (RA). Methods A baseline analysis was made of the CARdiovascular in rheuMAtology Project (CARMA), a 10-year prospective study evaluating the presence of at least one CVE in 775 Spanish patients with RA. Of them, 29 had already experienced CVE prior to the inclusion in the study. We assessed the association between the elevation of the apoB/apoAl ratio with the presence of CVE according to a logistic regression model for possible confounding factors. We also analysed the main parameters of activity of RA and parameters related to lipid metabolism. RA patients were classified according to treatment:patients treated with disease-modifying anti-rheumatic drugs without biologics and those undergoing biologic therapy (anti-TNF-alpha, anti-IL-6 receptor, and other biologic agents). Results The apoB/apoAl ratio of patients who had experienced CVE was higher than that of patients without previous CVE (0.65 vs. 0.60). However, the difference between both subgroups did not reach statistical significance (p=0.197). It was also the case after the multi-variate analysis [OR: 1.48 (95% CI: 0.15-14.4); p=0.735]. RA patients from the group with CVE were more commonly receiving lipid-lowering treatment with statins than those without CVE history (41.4% vs. 20%, p=0.005). High HAQ and high atherogenic index were significantly associated with the presence of CVE. There was no statistical association between the type of biologic therapy used in RA and the presence of CVE. Conclusion No association between ApoB/apoAl ratioand CVE was found at the baseline visit of patients with RA from the CARMA study.