Impact of Elevated Low-Density Lipoprotein and the Risk of Acute Coronary Syndrome in Rheumatoid Arthritis: A Retrospective Study

Objective To analyze the effect of hyperlipidemia on the risk of acute coronary syndrome (ACS) in patients with rheumatoid arthritis (RA). Methods This is a retrospective cohort study from 171 hospitals in the Hospital Corporation of America database, consisting of 1,942 individuals with RA who were retrospectively followed from the year 2020 to 2023. The primary outcome was the incidence of ACS, which included ST elevation myocardial infarction, type 1 non-ST elevation myocardial infarction, and unstable angina. The primary exposure was hyperlipidemia. Odds ratios (ORs) were obtained to ascertain the relationship between ACS (ST elevation myocardial infarction, non-ST elevation myocardial infarction type 1, and unstable angina) and hyperlipidemia (low-density lipoprotein, or LDL > 100 mg/dL). Results A total of 31 patients had the primary outcome of ACS. In addition, 463 patients had the primary exposure of elevated LDL (hyperlipidemia). The risk of physician-diagnosed ACS was significantly greater in participants with RA who additionally had hyperlipidemia when compared to participants who had RA without hyperlipidemia (OR: 3.88; 95% confidence interval (CI): 1.90-7.93, p < 0.01). Conclusion Hyperlipidemia is associated with an increased risk of ACS in patients with RA.