Relationships Between Lipoprotein And Metabolite Nmr Measures With Cardiometabolic Risk Factors In Rheumatoid Arthritis

Background. An emerging method of improving cardiometabolic (CM) risk assessment is nuclear magnetic resonance (NMR)-mediated quantification of lipoproteins (LP) and metabolites. In the Supervised Weight loss and Exercise Training (SWET) study, rheumatoid arthritis (RA) patients had improved CM health markers, including metabolic syndrome z-scores (MSSc). Purpose. To assess relationships among changes in NMR and CM risk measures to examine underlying effects of weight loss and exercise in RA CM health. Methods. Older overweight/obese adults with RA (n=20) were randomized to 16 weeks of SWET or lifestyle counseling. Pre- and post-intervention measures and procedures were MSSc, body composition, isometric strength, cardiopulmonary exercise testing, and fasting phlebotomy. LP and metabolites were quantified by NMR. Spearman correlations assessed parameter change associations. Results. MSSc improvements associated with large low-density lipoprotein (LDL) and large high-density lipoprotein (HDL)-cholesterol reductions and ketone bodies and beta-hydroxybutyrate increases (Table 1). Fat mass reductions associated with HDL, ApoA-I, and HDL particle reductions. Lean mass increases associated with small triglyceride-rich lipoproteins (TRLP) increases. Knee extension peak torque increases associated with very small TRLP increases. Absolute and relative VO2 peak improvements associated with ApoB and small TRLP reductions. Conclusion. Favorable MSSc, body composition, and fitness changes were not consistently associated with favorable LP subclass and metabolite changes. Ketones may promote better lipid handling that improves MSSc. Fat mass reductions associated with less favorable changes. Improved cardiorespiratory fitness associated with favorable changes. Lean mass and strength associations were unknown to be favorable/unfavorable. More research is needed to know how weight loss and exercise impact RA lipid metabolism and CM risk.