Atherogenic lipid profile and high sensitive C-reactive protein in patients with rheumatoid arthritis Harsh Vardhan Singh a , Amit Kumar Shrivastava b, ⁎, Arun Raizada c , Sanjeev Kumar Singh d , Aparna Pandey e , Neelima Singh d , Devendra Yadav c , Hemant Sharma f a Biochemist, Department of Pathology, Hindu Rao Hospital, Delhi 110007, India b Department of Biochemistry, Sudha Rustagi College of Dental Sciences & Research, Faridabad 121001, India c Department of Pathology and Laboratory Medicine, Medanta-The Medicity, Gurgaon 122001, India d Department of Biochemistry, G. R. Medical College, Gwalior 474009, India e Department of Biochemistry, Narsinhbhai Patel Dental College and Hospital, Visnagar 384315, India f Department of Rheumatology, Hindu Rao Hospital, Delhi 110007, India abstract article info Article history: Received 3 January 2013 Received in revised form 6 March 2013 Accepted 18 March 2013 Available online 9 April 2013 Keywords: Atherogenic lipid profile High sensitive C-reactive protein Rheumatoid arthritis Inflammation Objectives: The objective of this study was to investigate the lipid profile and high sensitive C-reactive protein (hs-CRP) levels in rheumatoid arthritis (RA) patients, and compare them with healthy controls, and also compare the different patterns of these parameters during active RA between male and female patients. Design and methods: We studied 60 RA patients and 65 controls matched by age and sex. All cases were selected from the Rheumatology Department of a tertiary care hospital, Delhi, India and fulfilled the 1987 American College of Rheumatology revised criteria for RA. Results: We found that male RA patients had significantly higher levels of hs-CRP (p b 0.001), low den- sity lipoprotein cholesterol (LDL-C)/high density lipoprotein cholesterol (HDL-C) (p b 0.001), total cholester- ol (TC)/HDL-C (p b 0.05), and lower level of HDL-C (p b 0.01), than male controls. The mean levels of HDL-C and TC were high (p b 0.05), and LDL-C, LDL-C/HDL-C (p b 0.01), and hs-CRP (p b 0.001) were low in healthy females as compared to female RA patients. Between RA patients, females had significantly high level of HDL-C (p b 0.001), and low levels of TC/HDL-C and LDL-C/HDL-C (p b 0.001) as compared to RA males. Mean levels of TC and HDL-C were higher in healthy females (p b 0.05) and triglyceride (TG) was lower (p b 0.05) than in healthy males. Conclusions: Results demonstrate that the RA patients have high levels of inflammatory marker hs-CRP and altered lipid profile, and these are affected by the gender of the RA patients. Lipid levels should be monitored and managed in patients with RA to minimize the long-term risk of cardiovascular disease. © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved. Introduction Rheumatoid arthritis (RA) is a chronic inflammatory joint disease of unknown etiology, affects approximately 1% of the general population and characterized by polyarthritis with often progressive joint damage and disability, immunological abnormalities, systemic inflammation, increased morbidity, and premature mortality [1]. Many studies have suggested that there is increased cardiovascular disease (CVD) and mor- tality among patients with RA as compared to the general population [2]. RA specifically increases the risk of coronary heart disease [3], heart fail- ure [4], and possibly also cerebrovascular disease [5]. Further, patients with RA have been found to be significantly more likely to experience silent myocardial ischemic episodes and present with collapse and sudden cardiac death compared to persons without RA [6]. A large pro- spective study showed that the risk of myocardial infarction (MI) is in- creased up to 3-fold among patients with RA compared to those without RA [3]. There are a number of possible explanations for the in- creased cardiovascular mortality following the onset of inflammatory polyarthritis in general and RA in particular. One is that the inflammato- ry disease burden associated with RA may promote atherosclerosis in these patients [7]. Another explanation for increased CVD risk is the pos- sibility that RA and CVD share the same risk factors. Some epidemiolog- ical studies have detected many determinants for RA that are also risk factors for CVD, e.g. low intake of polyunsaturated fats, low serum levels of antioxidants, smoking, overweight, hypertension, dyslipidemia, and diabetes mellitus [8]. Dyslipidemia may be responsible for the increased cardiovascular risk in RA patients. Several investigators have shown that active RA is associated with an unfavorable lipid profile. In general, and with Clinical Biochemistry 46 (2013) 1007–1012 ⁎ Corresponding author at: Department of Biochemistry, Sudha Rustagi College of Dental Sciences and Research, Kheri More, Faridabad, 121001, India. Fax: +91 129 4230010. E-mail address: amitbc83@gmail.com (A.K. Shrivastava). 0009-9120/$ – see front matter © 2013 The Canadian Society of Clinical Chemists. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.clinbiochem.2013.03.023 Contents lists available at SciVerse ScienceDirect Clinical Biochemistry journal homepage: www.elsevier.com/locate/clinbiochem