Atherogenic Index and High-Density Lipoprotein Cholesterol as Cardiovascular Risk Determinants in Rheumatoid Arthritis: The Impact of Therapy with Biologicals
Cardiovascular (CV) diseases are a serious concern in rheumatoid arthritis (RA), accounting for approximately one-third to one-half of all RA-related deaths. Besides the attempts to identify new risk factors, the proper management of traditional CV risk factors such as dyslipidemia should become a priority in the periodic evaluation of every RA patient. Atherogenic index has been suggested to be less susceptible to disease activity variation during large periods of time, making him more attractive to be used in CV risk prediction in this group of patients as compared to individual lipids concentrations. Nevertheless, inflammation may negatively impact HDL antiatherogenic properties, suggesting that HDL function assessment is of particular importance when predicting CV risk in these patients. A tight control of inflammation becomes therefore crucial for a successful CV risk management. The present paper debates these hypotheses focusing on the effects of therapy with biologicals on the above mentioned parameters. 1. Introduction Cardiovascular (CV) diseases are a serious concern in patients with chronic inflammatory diseases. For patients with rheumatoid arthritis (RA), it represents the leading cause of death, accounting for approximately one third to one half of all RA-related deaths [1, 2]. In order to decrease this incidence, risk factors need to be identified in the first place. Intriguingly, previous studies have suggested that the augmented CV burden found in RA patients seems not to be fully explained by traditional CV risk factors, such as dyslipidemia, hypertension, smoking, and physical inactivity [3]. Consequently, factors leading or deriving from the chronic inflammation have been suggested to be responsible for the augmented risk [4–6]. Until nowadays, however, no such factor is proved to solidly confirm this hypothesis. Recently, several studies have suggested that it might have been enough room to improve the cardiovascular profile of RA patients only by focusing on the traditional risk factors. Impaired during the periods of active disease, physical activity could be importantly improved by a better disease control as suggested in the recent international guidelines, consequently improving CV profile [7]. Using different methods to assess the risk of developing CVD, Toms et al. have recently reported that between 2% and 25% of RA patients who should receive a lipid-lowering drug (statin) according to their calculated risk do not actually use this medication [8]. The percentages may even increase from 7% to 30% if the 1.5 multiplier
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