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Heart Risk High in Arthritis Patients

Tue Aug 26, 2003

NEW YORK (Reuters Health) - When rheumatoid arthritis is active, often in the early stages, cholesterol levels shift into a danger zone where they could start causing plaque buildup in the arteries, new findings show.

Patients with rheumatoid arthritis often have levels of total cholesterol that are actually slightly below normal, Dr. M. T. Nurmohamed, from the VU University Medical Center in Amsterdam, and associates note in their article in the Annals of the Rheumatic Diseases.

The problem is that the "good" component of cholesterol (HDL) is decreased to a greater extent than the total level. So the ratio of total cholesterol to HDL, known as the "atherogenic index," is usually greater than 4, which raises the risk of atherosclerosis.

The new findings are based on a study of 47 patients with early active rheumatoid arthritis, 112 patients with long-standing rheumatoid arthritis, and another 134 patients who were enrolled in a trial comparing treatment with sulfasalazine for rheumatoid arthritis to a combination regimen containing steroids.

Patients with established arthritis, regardless of disease activity, had total cholesterol levels that were slightly increased, Nurmohamed's team found. In contrast, patients with early rheumatoid arthritis had total cholesterol levels that were on the low side of normal.

All of the patient groups had HDL-cholesterol levels that were below normal, and the lowest atherogenic index at the start of the study was 5.1.

Among the patients taking part in the treatment trial, both treatments led to an improvement in the atherogenic index. However, steroid-containing combination therapy produced a much more rapid improvement than did sulfasalazine, the researchers report.

However, steroid therapy is a two-edged sword, they point out. Ultimately, harmful cardiovascular effects from long-term steroid therapy -- for example, increased blood pressure and greater resistance to insulin -- would probably offset the improvement in atherosclerosis risk.

SOURCE: Annals of the Rheumatic Diseases, September 2003.

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