Patients with PsA, lupus or other rheumatologic diseases don’t necessarily present with lower than normal levels of HDL in their blood, Dr. Husni notes. But that doesn’t reflect how well the HDL molecule actually functions in removing cholesterol from the system, which is a critical function of this protein. Thus, the HDL levels commonly measured in the basic lipid panel are not a good marker for increased cardiovascular risk in this population, and may confound cardiovascular risk assessment in patients with systemic inflammatory disease and concomitant subclinical cardiovascular disease. “The HDL level goes deeper than [the] number itself, and it is the HDL function we need to understand,” she notes.
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“HDL dysfunction as a whole is what I study,” Dr. Husni adds. Although more research is needed to identify and stratify the risk factors and develop clinical algorithms for how to respond to them in patient management, this study takes a deep dive into trying to understand potential mechanisms for HDL dysfunction. “Some of the nuance of our study is to correlate, for the first time, disease activity for psoriasis vs. PsA with these measures of systemic inflammation and cardiovascular risk.”
In time, rheumatologists will learn to be more precise in identifying patients at greater risk for CVD. “The need is to identify which PsA patients are at greatest risk, because every patient’s risk is different. That’s our hope for this research—to learn to be more precise in identifying the risk.” Armed with such precision, rheumatologists could work more closely with cardiology consultants to address such factors as hypertension, body mass index and the use of aspirin or statins.
“Eventually, to take this concept to testing and to feasibility will take a lot more research and time. But knowing we have found a mechanism for cardiovascular disease for which we can test takes us a step closer to an answer,” Dr. Husni says.
Larry Beresford is a medical journalist in Oakland, Calif.
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