Disease Activity, Antineutrophil Cytoplasmic Antibody Type, and Lipid Levels in Antineutrophil Cytoplasmic Antibody–Associated Vasculitis

Abstract

Objective Patients with antineutrophil cytoplasmic antibody (ANCA)–associated vasculitis (AAV) have an elevated risk of cardiovascular disease (CVD). This study was undertaken to develop a clearer understanding of the association between changes in disease activity and lipid levels in AAV, which may inform CVD risk stratification in this population. Methods Lipid levels were assessed in stored serum samples (obtained at baseline and month 6) from the Rituximab for ANCA‐Associated Vasculitis (RAVE) trial, which randomized patients to receive either rituximab or cyclophosphamide followed by azathioprine. Paired t‐tests and multivariable linear regression were used to assess changes in lipid levels. Results Of the 142 patients with serum samples available, the mean ± SD age was 52.3 ± 14.7 years, 72 (51%) were male, 95 (67%) were proteinase 3 (PR3)–ANCA positive, 72 (51%) had received a new diagnosis of AAV, and 75 (53%) were treated with rituximab. Several lipid levels increased between baseline and month 6, including total cholesterol (+12.4 mg/dl [95% confidence interval (95% CI) +7.1, +21.0]), low‐density lipoprotein (+10.3 mg/dl [95% CI +6.1, +17.1]), and apolipoprotein B (+3.5 mg/dl [95% CI +1.0, +8.3]). These changes were observed among newly diagnosed and PR3‐ANCA–positive patients but not among those with relapsing disease or myeloperoxidase‐ANCA–positive patients. There was no difference in change in lipid levels between rituximab‐treated patients and cyclophosphamide‐treated patients. Changes in lipid levels correlated with changes in erythrocyte sedimentation rate but not with other inflammatory markers or glucocorticoid exposure. Conclusion Lipid levels increased during remission induction among patients with newly diagnosed AAV and those who were PR3‐ANCA positive. Disease activity and ANCA type should be considered when assessing lipid profiles to stratify CVD risk in patients with AAV.

Lipid Profiles in Anti-neutrophil Cytoplasmic Antibody-associated Vasculitis: A Cross-sectional Analysis

“…Although research concerning lipid profiles and its clinical significance in patients with AAV is scarce, a recent publication by Wallace and colleagues [14] analysed lipid levels in patients' sera from the Rituximab for ANCA-Associated Vasculitis (RAVE) trial. This study revealed that lipid levels of total and LDL cholesterol and of apolipoproteins A1 and B increase after treatment in patients with newly diagnosed AAV, implying that the decrease of lipid profiles is relevant to a higher inflammatory burden in AAV.…”

“…While the three representative diseases of MPA, GPA, and EGPA are traditionally known to comprise a group of AAV, it is increasingly understood that a distinct feature could be present according to the ANCA serostatus and the diagnosis [22,23]. In addition, it was described that total and LDL cholesterol and apolipoprotein B levels are significantly elevated following treatment in PR3-ANCApositive patients, but not in MPO-ANCA positive patients [14]. However, our observations revealed no differences in lipid profiles regarding diagnosis or ANCA serostatus.…”

Assessing Cardiovascular Risk in Patients With Antineutrophil Cytoplasmic Antibody–Associated Vasculitis: Comment on the Article by Wallace et al

“…In a post hoc analysis of the Rituximab for Antineutrophil Cytoplasmic Antibody (ANCA)-Associated Vasculitis (RAVE) trial, Wallace and colleagues evaluated changes in serum lipid levels following initiation of remission induction therapy in 142 patients with ANCA-associated vasculitis (AAV) (1). Levels of total cholesterol, low-density lipoprotein, and apolipoprotein B increased significantly from baseline to month 6.…”

Soluble Lectin-Like Oxidized Low-Density Lipoprotein Receptor 1 Is Inversely Correlated with the Activity of ANCA-Associated Vasculitis

“…Total cholesterol level could decrease in chronic inflammatory conditions; in this context, it has been reported that patients with RA have lower total cholesterol level compared to the general population. 14 Interestingly, a recent publication by Wallace, et al 15 also reported that total cholesterol levels were suppressed prior to treatment and elevated after 6 months of treatment in AAV patients, suggesting that lower total cholesterol levels are indicative of higher inflammation and disease activity. In fact, we also found that when the activity of AAV (BVAS) increases, a proportional decrease of total cholesterol level is observed (r= -0.424).…”