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*For reference only for medical professionals, it is generally believed in the heart field that the lower the level of low-density lipoprotein cholesterol (LDL-C), the lower the risk of cardiovascular disease, but is this also true for rheumatic diseases? The 2021 American Academy of Rheumatology Annual Meeting (ACR 2021) has come to a successful conclusion.
In order to meet the desire of the majority of domestic rheumatism colleagues to learn international cutting-edge knowledge, the medical community and the Youth Committee of the Society of Rheumatology jointly launched "The Youth Committee of the Society of Rheumatology will show you ACR 2021.
"A series of live events
.
On November 14, Professor Zhang Na from the Department of Rheumatology and Immunology, General Hospital of Tianjin Medical University, shared the topic "Cardiovascular Complications of Rheumatic Diseases"
.
This topic was shared by Dr.
Jorge Plutzky from the Department of Cardiology and Dr.
Christina Charles-Schoeman from the Department of Rheumatology and Immunology from different perspectives to discuss the risk of cardiovascular disease in the management of rheumatism
.
Figure 1: Professor Zhang Na shared the topic "Cardiovascular Complications of Rheumatic Diseases" Cardiologist: The lower the level of LDL-C, the better the risk factors for predicting cardiovascular events include homocysteine and interleukin 6 (IL- 6) Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), serum soluble intercellular adhesion molecule 1 (slCAM-1), serum amyloid A (SAA), lipoprotein B, TC and high density lipoprotein (HDL-C) ratio, high sensitivity C-reactive protein (hs-CRP) and the like
.
Figure 2: Risk factors for predicting cardiovascular events.
In addition, rheumatic immune inflammatory diseases, as the degree of inflammation increases, the body's high-sensitivity troponin T (hs-cTNT) and N-terminal B-type natriuretic peptide precursor (NT) -proBNP) levels increase, which means an increase in the risk of cardiovascular disease
.
Figure 3: The relationship between the level of inflammation and the risk of cardiovascular disease.
Among the risk factors for cardiovascular disease, LDL-C has attracted much attention
.
Dr.
Jorge Plutzky listed previous large landmark clinical trials and pointed out that the lower the level of LDL-C, the lower the risk of cardiovascular disease
.
As a large clinical trial of statins proved, the more statins reduce LDL-C, the lower the incidence of cardiovascular events
.
With the application of new lipid-lowering drug proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors in recent years, the reduction of LDL-C levels has reached a new platform, and cardiovascular events in patients with coronary atherosclerosis have occurred.
The rate has also been further reduced
.
Figure 4: The lower the level of LDL-C, the better.
Finally, Dr.
Jorge Plutzky concluded: Atherosclerotic disease is currently widespread globally, and its risk factors are mostly controllable; LDL-C can increase the risk of cardiovascular disease and Incident rate, and more and more evidence shows that in a high cardiovascular risk environment, the optimal level of LDL-C is <70 mg/dl; current guidelines recommend that LDL-C levels be lowered more aggressively and considered When it comes to risk-enhancing factors including inflammation; more and more evidence is focusing on cardiovascular risk in rheumatic diseases
.
Rheumatologist: The lipid paradox, Dr.
Christina Charles-Schoeman, first elaborated on the most controversial and suspicious "blood lipid paradox"
.
A number of previous studies have shown that active rheumatoid arthritis (RA) is associated with lower cholesterol levels; at the same time, active RA is also associated with increased cardiovascular disease morbidity and mortality; one included 651 cases of rheumatoid arthritis Patient studies have shown that low or high cholesterol can increase the cardiovascular risk of RA patients; a cohort study showed that compared with the control group, LDL-C levels of RA patients were less than 70 mg/dL or more than 160 mg/dL.
There is a significant increase in the coronary artery calcification score; the maximum increase in cholesterol is related to the maximum reduction in RA disease activity and inflammation; and better RA disease control is related to reducing the risk of cardiovascular disease
.
These RA-related studies all suggest that in RA, low cholesterol level = high cardiovascular risk
.
This seems to be contradictory to the common belief in the heart field that the lower the cholesterol, the lower the cardiovascular risk
.
In order to explain this kind of phenomenon, Dr.
Christina Charles-Schoeman believes that the mechanism of cholesteryl ester catabolism should be started
.
Increased cholesteryl ester catabolism can lead to a decrease in serum cholesterol levels, and the increase in cholesteryl ester catabolism in RA patients may partly explain the decrease in TC, HDL-C and LDL-C levels
.
Figure 5: The mechanism of cholesterol ester catabolism.
Rheumatologists: "good" lipoproteins.
At present, it is generally believed in the heart field that there is one type of cholesterol that is "bad", that is, LDL-C; the other is "good", that is, HDL- C
.
And is HDL-C as good as ever in wind-immune diseases? Doctor Christina Charles-Schoeman speaks with evidence
.
Studies have shown that high-density lipoprotein (HDL) is closely related to disease activity.
The higher the disease activity, the more severe the deterioration of HDL function
.
The ability of cholesterol efflux of HDL in patients with high disease activity of RA is impaired
.
Paraoxonase 1 (PON-1) is an HDL-related enzyme that combines the enzyme activity with the antioxidant function of HDL by neutralizing oxidized phospholipids
.
PON1 transgenic mice showed a decrease in atherosclerosis and a decrease in the incidence of arthritis
.
In the proteomics study of RA, it was found that the level of pro-inflammatory HDL was low
.
And studies have shown that higher levels of inflammation in RA patients are associated with lower PON1 activity, and increased PON1 activity is associated with a reduced risk of cardiovascular disease in RA
.
Figure 6: The effect of PON1 in RA.
Therefore, HDL-C is still a "good" cholesterol in rheumatic diseases
.
High levels of RA disease activity and systemic inflammation are related to impaired HDL antioxidant capacity, impaired HDL-C outflow capacity and decreased PON1 activity
.
Finally, Professor Zhang Na concluded that although the current treatment methods are limited, the identification of the association mechanism between RA disease activity and increased cardiovascular disease risk may be particularly important for patients with active RA, and it is necessary to develop targeted treatment methods and Prevention strategy
.
Expert profile Zhang Na, deputy chief physician, deputy chief physician of the Department of Rheumatology and Immunology, General Hospital of Tianjin Medical University
.
Young member of Rheumatology Branch of Chinese Medical Association, Youth Member of Rheumatology and Immunology Branch of Chinese Medical Doctor Association, Member of Rheumatism-related Pulmonary Vascular/Interstitial Disease (Science Group) of Rheumatology and Immunology Branch of Chinese Medical Doctor Association, and Rheumatism Association of Cross-Strait Medicine and Health Exchange He is a member of the Ophthalmology Immunology Group of the Division of Diseases, a member of the Rheumatology Branch of the Tianjin Medical Association, and a member of the Rheumatology and Immunology Branch of the Tianjin Medical Association
.
In order to meet the desire of the majority of domestic rheumatism colleagues to learn international cutting-edge knowledge, the medical community and the Youth Committee of the Society of Rheumatology jointly launched "The Youth Committee of the Society of Rheumatology will show you ACR 2021.
"A series of live events
.
On November 14, Professor Zhang Na from the Department of Rheumatology and Immunology, General Hospital of Tianjin Medical University, shared the topic "Cardiovascular Complications of Rheumatic Diseases"
.
This topic was shared by Dr.
Jorge Plutzky from the Department of Cardiology and Dr.
Christina Charles-Schoeman from the Department of Rheumatology and Immunology from different perspectives to discuss the risk of cardiovascular disease in the management of rheumatism
.
Figure 1: Professor Zhang Na shared the topic "Cardiovascular Complications of Rheumatic Diseases" Cardiologist: The lower the level of LDL-C, the better the risk factors for predicting cardiovascular events include homocysteine and interleukin 6 (IL- 6) Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), serum soluble intercellular adhesion molecule 1 (slCAM-1), serum amyloid A (SAA), lipoprotein B, TC and high density lipoprotein (HDL-C) ratio, high sensitivity C-reactive protein (hs-CRP) and the like
.
Figure 2: Risk factors for predicting cardiovascular events.
In addition, rheumatic immune inflammatory diseases, as the degree of inflammation increases, the body's high-sensitivity troponin T (hs-cTNT) and N-terminal B-type natriuretic peptide precursor (NT) -proBNP) levels increase, which means an increase in the risk of cardiovascular disease
.
Figure 3: The relationship between the level of inflammation and the risk of cardiovascular disease.
Among the risk factors for cardiovascular disease, LDL-C has attracted much attention
.
Dr.
Jorge Plutzky listed previous large landmark clinical trials and pointed out that the lower the level of LDL-C, the lower the risk of cardiovascular disease
.
As a large clinical trial of statins proved, the more statins reduce LDL-C, the lower the incidence of cardiovascular events
.
With the application of new lipid-lowering drug proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors in recent years, the reduction of LDL-C levels has reached a new platform, and cardiovascular events in patients with coronary atherosclerosis have occurred.
The rate has also been further reduced
.
Figure 4: The lower the level of LDL-C, the better.
Finally, Dr.
Jorge Plutzky concluded: Atherosclerotic disease is currently widespread globally, and its risk factors are mostly controllable; LDL-C can increase the risk of cardiovascular disease and Incident rate, and more and more evidence shows that in a high cardiovascular risk environment, the optimal level of LDL-C is <70 mg/dl; current guidelines recommend that LDL-C levels be lowered more aggressively and considered When it comes to risk-enhancing factors including inflammation; more and more evidence is focusing on cardiovascular risk in rheumatic diseases
.
Rheumatologist: The lipid paradox, Dr.
Christina Charles-Schoeman, first elaborated on the most controversial and suspicious "blood lipid paradox"
.
A number of previous studies have shown that active rheumatoid arthritis (RA) is associated with lower cholesterol levels; at the same time, active RA is also associated with increased cardiovascular disease morbidity and mortality; one included 651 cases of rheumatoid arthritis Patient studies have shown that low or high cholesterol can increase the cardiovascular risk of RA patients; a cohort study showed that compared with the control group, LDL-C levels of RA patients were less than 70 mg/dL or more than 160 mg/dL.
There is a significant increase in the coronary artery calcification score; the maximum increase in cholesterol is related to the maximum reduction in RA disease activity and inflammation; and better RA disease control is related to reducing the risk of cardiovascular disease
.
These RA-related studies all suggest that in RA, low cholesterol level = high cardiovascular risk
.
This seems to be contradictory to the common belief in the heart field that the lower the cholesterol, the lower the cardiovascular risk
.
In order to explain this kind of phenomenon, Dr.
Christina Charles-Schoeman believes that the mechanism of cholesteryl ester catabolism should be started
.
Increased cholesteryl ester catabolism can lead to a decrease in serum cholesterol levels, and the increase in cholesteryl ester catabolism in RA patients may partly explain the decrease in TC, HDL-C and LDL-C levels
.
Figure 5: The mechanism of cholesterol ester catabolism.
Rheumatologists: "good" lipoproteins.
At present, it is generally believed in the heart field that there is one type of cholesterol that is "bad", that is, LDL-C; the other is "good", that is, HDL- C
.
And is HDL-C as good as ever in wind-immune diseases? Doctor Christina Charles-Schoeman speaks with evidence
.
Studies have shown that high-density lipoprotein (HDL) is closely related to disease activity.
The higher the disease activity, the more severe the deterioration of HDL function
.
The ability of cholesterol efflux of HDL in patients with high disease activity of RA is impaired
.
Paraoxonase 1 (PON-1) is an HDL-related enzyme that combines the enzyme activity with the antioxidant function of HDL by neutralizing oxidized phospholipids
.
PON1 transgenic mice showed a decrease in atherosclerosis and a decrease in the incidence of arthritis
.
In the proteomics study of RA, it was found that the level of pro-inflammatory HDL was low
.
And studies have shown that higher levels of inflammation in RA patients are associated with lower PON1 activity, and increased PON1 activity is associated with a reduced risk of cardiovascular disease in RA
.
Figure 6: The effect of PON1 in RA.
Therefore, HDL-C is still a "good" cholesterol in rheumatic diseases
.
High levels of RA disease activity and systemic inflammation are related to impaired HDL antioxidant capacity, impaired HDL-C outflow capacity and decreased PON1 activity
.
Finally, Professor Zhang Na concluded that although the current treatment methods are limited, the identification of the association mechanism between RA disease activity and increased cardiovascular disease risk may be particularly important for patients with active RA, and it is necessary to develop targeted treatment methods and Prevention strategy
.
Expert profile Zhang Na, deputy chief physician, deputy chief physician of the Department of Rheumatology and Immunology, General Hospital of Tianjin Medical University
.
Young member of Rheumatology Branch of Chinese Medical Association, Youth Member of Rheumatology and Immunology Branch of Chinese Medical Doctor Association, Member of Rheumatism-related Pulmonary Vascular/Interstitial Disease (Science Group) of Rheumatology and Immunology Branch of Chinese Medical Doctor Association, and Rheumatism Association of Cross-Strait Medicine and Health Exchange He is a member of the Ophthalmology Immunology Group of the Division of Diseases, a member of the Rheumatology Branch of the Tianjin Medical Association, and a member of the Rheumatology and Immunology Branch of the Tianjin Medical Association
.
