Dyslipidaemia, statins and rheumatoid arthritis.

DYSLIPIDAEMIA IN ESTABLISHED AND FUTURE PATIENTS WITH RA Several investigators have indeed demonstrated dyslipidaemia, definedashigher total cholesterol and/or triglycerides and/or lower high-density lipoprotein (HDL) cholesterol levels in comparison to control subjects, in RA and thisappears tobethe consequence of systemic release of inflammatory cytokines such as tumour necrosis factor (TNF)a, interleukin (IL)1 and IL6, leading to a proatherogenic state with insulin resistance, endothelial cell activation and hypercoagulation as other consequences. The dyslipidaemia in RA is dependent on disease activity, ie, a higher disease activity is associated with lower total cholesterol levels and even more depressed HDL cholesterol levels, leading to a higher (ie, unfavourable) atherogenic index. Moreover, it appears that dyslipidaemia is already present in early RA and the question arises whether or not this phenomenon starts in the preclinical phase of RA. Hence, we investigated the lipid profile over time and its relationship with inflammation and serological markers, in subjects who later developed RA. The lipid profile was determined in 1078 serial blood bank samples, of 79 blood donors who later developed RA. These samples were compared with 1071 control samples of unselected blood donors, matched for age and sex. The samples of future patients with RA displayed, on average, 4% higher total cholesterol, 9% lower HDL cholesterol and 17% higher triglyceride levels compared to matched controls (p(0.05), at least 10 years before the onset of RA symptoms. Although the differences in the various lipid values were small they may have clinical relevance, in the light of results from other studies. For instance, in a placebo-controlled study with fibrates, the differences of the lipid values between the active treatment and the placebo group were similar to the observed differences in our study and the individuals treated with fibrates had ultimately a more than 20% risk reduction for cardiovascular disease.