HDL cholesterol efflux capacity and concentration in patients with rheumatoid arthritis: a systematic review and meta-analysis

Abstract

Background: Poor cholesterol efflux capacity (CEC) has been proposed to be an independent risk factor for cardiovascular diseases. However, the current evidences in the literature are inconsistent. This meta-analysis aimed to identify whether CEC is impaired or altered by drug therapy in individuals with rheumatoid arthritis (RA).Methods: The PubMed, Embase, and Cochrane library databases were searched to identify studies on CEC in RA patients. The searches were focused on studies in human subjects that were published before 10 June 2020, without language restrictions. The primary outcomes were CEC and the high-density lipoprotein cholesterol (HDL-C) and C-reactive protein levels (CRP) levels.Results: A total of 11 eligible articles, including 6 observational and 5 intervention studies, were retrieved. The pooled results showed that CEC is not significantly lower in RA patients than in healthy controls (SMD: -0.22, 95% CI: -0.65 to 0.20), whereas the plasma HDL-C level is not significantly (WMD: -3.98, 95% CI: -8.32 to 0.37, I² = 54%, P for heterogeneity = 0.050) but is significantly decreased in the RA patients with moderate body mass index (BMI) (WMD: -5.46, 95% CI: -9.40 to -1.52, I² = 37%, P for heterogeneity = 0.175). Furthermore, in the before-after studies, the CEC of RA patients (SMD: 0.20, 95% CI: 0.03 to 0.38) increased, but the plasma HDL-C level (WMD: 3.26, 95% CI: -0.17 to 6.69) remained at a similar level after anti-rheumatic treatment compared to the baseline. In addition, stratified analysis suggested that the Disease Activity Score for 28 joints could be a potential source of heterogeneity for CEC. The funnel plot was relatively symmetric and did not suggest the presence of publication bias.Conclusion：The current meta-analysis demonstrated that HDL-mediated CEC can be improved by the early control of inflammation and anti-rheumatic treatment in RA patients, which is independent of HDL-C levels. Future research is needed to determine whether therapeutic strategies to enhance CEC in RA patients have beneficial effects for preventing CVD.