Ab0545 Association of Serum Concentrations of Remnant Cholesterol With Incident Cardiovascular Disease in Patients With Rheumatoid Arthritis: A Real-World Data From 2001 to 2022

Background: Cardiovascular disease (CVD) is the major cause of mortality among patients with rheumatoid arthritis (RA). Several studies have shown associations between elevated remnant cholesterol (RC) levels and increased risk of CVD in various general populations. However, no study reported the relationship between RC levels and the risk of incident CVD in RA patients. Objectives: To examine if the fasting levels of serum RC were prospectively associated with incident CVD risk in RA patients free of CVD at baseline. Methods: A prospective RA cardiovascular cohort was developed through the inclusion of consecutively enrolled RA patients free of CVD at baseline between January 1, 2001 and June 30, 2022 at the Department of Rheumatology, Sun Yat-Sen Memorial Hospital, Guangdong, China. Fasting serum levels of triglycerides, total cholesterol (TC), low-density (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were measured, while RC and Non-HDL-C levels were calculated. The primary exposure was RC levels. The primary outcome of this study was a composite of incident CVD, consisting of coronary heart disease, heart failure, stroke, peripheral artery disease and CVD-death. A LASSO Cox model was used to select covariates. The Fine-Gray competing risk model was used to estimate hazard ratios (HRs). Results: A total of 1,018 RA patients free of pre-existing CVD at baseline were enrolled. RA patients had a mean age of 53.9 years, and 802 (78.8%) were females. The median RA disease duration was 25 months. The median RC levels in RA patients were 0.50 (0.34, 0.69) mmol/L. RC was significantly positively correlated with disease characteristics indicators in RA patients, including RA disease duration, ESR, CRP, CDAI, HAQ-DI, and mTSS (P < 0.05 for all). By contrast, TG, TC, HDL-C, and LDL-C were statistically significantly negatively correlated with disease activity indicators, including ESR, CRP, CDAI, and HAQ-DI (P < 0.05 for all, Figure 1). After a median follow-up of 5.54 years, 131 patients developed CVD with an incidence rate of 21.6 per 1,000 person-years. Continuous and quartile-categorized RC levels were associated with incident CVD before and after multivariate adjustment and Bonferroni correction (all P < 0.001). There were no robust associations of other lipids with incident CVD. The fully adjusted HRs for RC were 2.30 (95% CI 1.58-3.35) per 1 mmol/L increase, and 2.40 (1.36-4.25) and 2.81 (1.60-4.94) for patients in the 3rd and 4th versus the 1st quartile, respectively (Figure 2). Conclusion: Circulating RC levels are positively associated with incident CVD among RA patients independent of known risk factors, implying its clinically preferable use for improving the stratification of CVD risk in RA patients. REFERENCES: NIL. Acknowledgements: We thank all subjects and medical staff who generously contributed to this study. Disclosure of Interests: None declared.