Nutritional Effects on Lipoproteins in Patients with Psoriatic Arthritis

Patients with psoriatic arthritis exhibit lipid metabolism alterations and are at an increased risk for metabolic syndrome (MetS) and cardiovascular diseases. These risks exist independently of traditional factors, indicating that chronic inflammation has a crucial role in atherosclerosis development. However, information on atherogenic patterns and lipoprotein subfraction burdens in these patients is limited. The goal of a new study was to evaluate HDL and LDL cholesterol plasma levels and their subfractions following a nutritional intervention in patients with psoriatic arthritis (PsA).

This randomized, placebo-controlled clinical trial was conducted over 12 weeks. Here, PsA patients were divided into three groups – the Placebo group received 1 g of soybean oil daily with no dietary intervention; the Diet + Supplementation group received an individualized diet - with 604 mg of omega-3 fatty acids three times daily; and the Diet + Placebo group received an individualized diet plus 1 g of soybean oil. LDL subfractions were classified as non-atherogenic (NAth), atherogenic (Ath), or highly atherogenic (HAth). HDL subfractions were categorized into small, medium, or large particles based on lipoprotein electrophoresis.

Overall, 91 patients were included – with 62% (n = 56) displaying an Ath or HAth profile. The main associated risk factors were male gender, longer skin disease duration, and higher BMI. Despite having LDL plasma levels <100 mg/dL, 35% exhibited a high-risk lipoprotein profile. The 12-week nutritional intervention did not alter LDL subfractions but significantly improved HDL subfractions.

In conclusion, identifying pro-atherogenic LDL subfractions may be crucial for detecting PsA patients at higher cardiovascular risk, regardless of total LDL plasma levels and disease activity. The findings revealed that a short-term nutritional intervention––combining a supervised, individualized diet with omega-3 fatty acids––positively affected HDL subfractions and improved LDLLARGE subfractions in hypercholesterolemic individuals.

Source: Scherer D, Leite BF, Morimoto MA, et al. Advances in Rheumatology. 2024 Jun 13;64(1):47.