Disease Activity, ANCA-Type, and Lipid Levels in ANCA-Associated Vasculitis.

OBJECTIVE Patients with ANCA-associated vasculitis (AAV) are at elevated risk for cardiovascular disease (CVD). A clearer understanding of the association between changes in disease activity and lipid levels in AAV would inform CVD risk stratification in this population. METHODS Lipid levels were assessed using baseline and month 6 stored serum samples from the Rituximab for ANCA-associated Vasculitis (RAVE) trial which randomized subjects to 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 subjects with samples available, the mean age was 52.3 (±14.7) years, 72 (51%) were male, 95 (67%) were proteinase (PR3)-ANCA+, 72 (51%) had a new diagnosis of AAV, and 75 (53%) were treated with rituximab. Levels of several lipid levels increased between baseline and month 6, including total cholesterol (+12.4mg/dL, [+7.1, +21.0]), low-density lipoprotein (+10.3 mg/dL, [+6.1, +17.1]), and apolipoprotein B (+3.5 mg/dL, [+1.0, +8.3]). These changes were observed among newly-diagnosed and PR3-ANCA+ subjects but not among those with relapsing disease or myeloperoxidase (MPO)-ANCA+ subjects. There was no difference in changes in lipid levels between rituximab- and cyclophosphamide-treated patients. Changes in lipids correlated with changes in ESR, but not with other inflammatory markers or glucocorticoid exposure. CONCLUSION Lipid levels increase during remission induction among patients with AAV with newly-diagnosed disease and those who are PR3-ANCA+. Disease activity and ANCA type should be considered when assessing lipid profiles to stratify CVD risk in patients with AAV. This article is protected by copyright. All rights reserved.