Age, disease duration, diabetes, and hs-CRP were independent risk factors for carotid atherosclerosis plaques in RA patients, who also exhibited lipid metabolic abnormalities characterized by low cholesterol levels and high lipid ratios associated with inflammation and drug therapy.
Key Findings
Results
RA patients had lower absolute lipid levels but higher atherogenic lipid ratios compared to healthy controls.
TC, HDL-C, and LDL-C were all significantly lower in the RA group than healthy controls (P < 0.001, P=0.001, P < 0.001, respectively)
TC/HDL-C and LDL-C/HDL-C ratios were higher in RA patients than controls (P=0.003 and P=0.009, respectively)
Study included 216 RA patients and 214 healthy controls, all without known cardiovascular disease
CAS plaques were determined by color Doppler ultrasound
Results
In RA patients, lipid levels were negatively correlated with inflammatory markers including hs-CRP and neutrophil-to-lymphocyte ratio (NLR).
TC and HDL-C were negatively correlated with hs-CRP (r=-0.237, P=0.002; r=-0.351, P < 0.001) and NLR (r=-0.210, P=0.006; r=-0.182, P=0.018)
LDL-C was negatively correlated with NLR (r=-0.200, P=0.009)
TG was negatively correlated with erythrocyte sedimentation rate (r=-0.184, P=0.016)
TC/HDL-C was positively correlated with hs-CRP and NLR (r=0.286, P < 0.001; r=0.159, P=0.039)
LDL-C/HDL-C was positively correlated with hs-CRP (r=0.161, P=0.040)
Results
Regular treatment with conventional synthetic DMARDs (csDMARDs) was associated with a more favorable lipid profile in RA patients.
RA patients treated regularly with csDMARDs had higher HDL-C levels compared to those without csDMARDs (P=0.035)
TG levels were lower in the csDMARDs-treated group (P=0.003)
TC/HDL-C levels were lower in the csDMARDs-treated group (P=0.006)
Results
The prevalence of carotid atherosclerosis plaques in RA patients was 37.5%.
CAS plaques were detected in 37.5% of the 216 RA patients studied
Age, disease duration, prevalence of hypertension, prevalence of diabetes, LDL-C/HDL-C, homocysteine (Hcy), and hs-CRP levels were all higher in the RA with plaque group compared to RA without plaque group (all P < 0.05)
CAS plaques were determined by color Doppler ultrasound
Results
Age, disease duration, diabetes, and hs-CRP were independent risk factors for CAS plaques in RA patients on logistic regression analysis.
Age: OR=1.085 (95% CI: 1.045-1.128)
Disease duration: OR=1.008 (95% CI: 1.003-1.014)
Diabetes: OR=4.326 (95% CI: 1.606-11.655)
hs-CRP: OR=1.022 (95% CI: 1.006-1.038)
These four factors were identified as independent risk factors via logistic regression
What This Means
This research suggests that patients with rheumatoid arthritis (RA) have a distinctive pattern of abnormal blood fats (lipids) that differs from what is seen in the general population. Unlike typical cardiovascular risk profiles where high cholesterol is concerning, RA patients actually showed lower total cholesterol, LDL ('bad') cholesterol, and HDL ('good') cholesterol compared to healthy people — but they had higher ratios of total cholesterol to HDL and LDL to HDL, which are considered more dangerous for heart and vessel health. These lipid abnormalities were linked to higher levels of inflammation markers, suggesting that ongoing inflammation in RA disrupts normal fat metabolism. Patients who regularly took standard RA medications (csDMARDs) had somewhat better lipid profiles, with higher HDL and lower triglycerides.
The study also found that more than one in three RA patients (37.5%) had carotid artery plaques — fatty deposits in the neck arteries that are a sign of atherosclerosis and increased risk for stroke and heart attack. The strongest independent predictors of having these plaques were older age, longer duration of RA, having diabetes, and higher levels of hs-CRP (a blood marker of inflammation).
This research suggests that managing inflammation effectively in RA patients is important not just for controlling joint disease, but also for potentially slowing the development of artery disease. It also highlights that standard cholesterol numbers alone may be misleading in RA patients, and that cholesterol ratios and inflammatory markers should be considered when assessing cardiovascular risk in this population.
Liu J, Peng Q, Liu Y, Lan T, Long L. (2026). [Risk factors of carotid atherosclerosis in patients with rheumatoid arthritis].. Beijing da xue xue bao. Yi xue ban = Journal of Peking University. Health sciences. https://pubmed.ncbi.nlm.nih.gov/42880925/