Disease Activity, Antineutrophil Cytoplasmic Antibody Type, and Lipid Levels in Antineutrophil Cytoplasmic Antibody-Associated Vasculitis

Arthritis Rheumatol. 2019 Nov;71(11):1879-1887. doi: 10.1002/art.41006. Epub 2019 Sep 16.


Objective: Patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) have an elevated risk of cardiovascular disease (CVD). This study was undertaken to develop a clearer understanding of the association between changes in disease activity and lipid levels in AAV, which may inform CVD risk stratification in this population.

Methods: Lipid levels were assessed in stored serum samples (obtained at baseline and month 6) from the Rituximab for ANCA-Associated Vasculitis (RAVE) trial, which randomized patients to receive either 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 patients with serum samples available, the mean ± SD age was 52.3 ± 14.7 years, 72 (51%) were male, 95 (67%) were proteinase 3 (PR3)-ANCA positive, 72 (51%) had received a new diagnosis of AAV, and 75 (53%) were treated with rituximab. Several lipid levels increased between baseline and month 6, including total cholesterol (+12.4 mg/dl [95% confidence interval (95% CI) +7.1, +21.0]), low-density lipoprotein (+10.3 mg/dl [95% CI +6.1, +17.1]), and apolipoprotein B (+3.5 mg/dl [95% CI +1.0, +8.3]). These changes were observed among newly diagnosed and PR3-ANCA-positive patients but not among those with relapsing disease or myeloperoxidase-ANCA-positive patients. There was no difference in change in lipid levels between rituximab-treated patients and cyclophosphamide-treated patients. Changes in lipid levels correlated with changes in erythrocyte sedimentation rate but not with other inflammatory markers or glucocorticoid exposure.

Conclusion: Lipid levels increased during remission induction among patients with newly diagnosed AAV and those who were PR3-ANCA positive. Disease activity and ANCA type should be considered when assessing lipid profiles to stratify CVD risk in patients with AAV.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / drug therapy
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / immunology*
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / metabolism
  • Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis / physiopathology
  • Antibodies, Antineutrophil Cytoplasmic / immunology*
  • Antirheumatic Agents / therapeutic use
  • Apolipoprotein A-I / metabolism
  • Apolipoproteins B / metabolism
  • Azathioprine / therapeutic use
  • Blood Sedimentation
  • Cardiovascular Diseases
  • Cholesterol / metabolism
  • Cholesterol, HDL / metabolism
  • Cholesterol, LDL / metabolism
  • Cyclophosphamide / therapeutic use
  • Female
  • Humans
  • Lipid Metabolism*
  • Male
  • Middle Aged
  • Myeloblastin / immunology*
  • Peroxidase / immunology*
  • Randomized Controlled Trials as Topic
  • Rituximab / therapeutic use
  • Severity of Illness Index


  • Antibodies, Antineutrophil Cytoplasmic
  • Antirheumatic Agents
  • Apolipoprotein A-I
  • Apolipoproteins B
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Rituximab
  • Cyclophosphamide
  • Cholesterol
  • Peroxidase
  • Myeloblastin
  • Azathioprine