Mildly Elevated Triglyceride Levels Are Associated with Increased Risk for Major Adverse Cardiovascular Events in Statin-Naive Rheumatoid Arthritis Patients-A Nationwide Cohort Study

Objectives: To investigate the association between the four components of the lipid profile at baseline and major adverse cardiovascular events (MACEs) in statin-naïve rheumatoid arthritis (RA) patients with no previous history of cardiovascular events compared to non-RA controls. Methods: This nationwide population-based cohort study was performed on a total of 15,216 statin-naïve RA patients and 60,864 non-RA controls. The end point was a composite of clinical events, including myocardial infarction (MI), stroke, coronary revascularization, and cardiovascular death. We compared the incidence of and risk for clinical events according to each lipid variable. Results: During follow-up (median 4.70 years in RA group and 5.05 years in non-RA group), the incidence of MACE per 1000 person-years was 7.27 in the RA group and 7.16 in the non-RA group. Among the four lipid components, only higher baseline triglyceride (TG) levels were significantly associated with increased risk for MACE in the RA group. The risk for MACE was significantly higher in the third (adjusted hazard ratio (HR), 1.31 [95% confidence interval (CI), 1.00-1.71]) and highest quartiles (adjusted HR, 1.71 [95%CI, 1.30-2.23]) of baseline TG level versus the lowest quartile. In contrast, higher baseline total cholesterol, TG, and low-density lipoprotein cholesterol, and lower high-density lipoprotein cholesterol levels were significantly associated with increased MACE risk in the propensity score-matched non-RA group. Conclusions: In statin-naïve RA patients, increased TG level is associated with increased risk for MACE. Therefore, screening and intervention for increased TG level may be clinically beneficial in this population. Disclosure W.Choi: None. J.Kang: None. J.Park: None. A.Hong: None. J.Yoon: None. H.Kim: None. H.Kang: None. Funding National Research Foundation of Korea (2022R1C1C1006021)