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Retinol-binding protein 4 as a biomarker of cardiometabolic risk in rheumatoid arthritis

Background Retinol-binding protein 4 (RBP4) has been implicated in the pathogenesis of cardiovascular disease. Higher circulating RBP4 concentrations have been observed in patients with previous clinical arteriosclerosis. RBP4 concentrations are positively related to the early endothelial dysfunction measured using marker flow-mediated dilation in patients with rheumatoid arthritis (RA). Aim This study was done to measure the serum RBP4 level in patients with RA and to assess its clinical relevance to cardiometabolic risk and carotid atherosclerosis in RA. Patients and methods The current study enrolled 50 patients with RA, fulfilling the American College of Rheumatology criteria for the diagnosis of RA, who were divided into three groups: group Ia (severe disease activity), group Ib (moderate disease activity), and group Ic (mild disease activity), together with 40 apparently healthy participants as a control group (group II). Clinical symptoms, disease activity using disease activity score 28, BMI, and blood pressure were assessed. RBP4 levels were measured by enzyme-linked immunosorbent assay technique. Complete blood count; C-reactive protein; fasting blood glucose; lipid profile including total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides; fasting plasma insulin level; calculation of insulin resistance by homeostatic model assessment of insulin resistance; autoantibody profiles; ECG; and carotid artery ultrasound were done. Results RBP4 levels were highly significantly increased in all patients with RA when compared with the control group (P<0.01). There was a statistically significant positive correlation between the level of RBP4 and BMI, carotid intima media thickness (CIMT) RT, CIMT LT, and mean CIMT (r=0.319, 0.292, 0.315, and 0.323 and P<0.05, 0.05, 0.05, and 0.05, respectively). Conclusion Our data suggest that the level of RBP4 was increased in patients with RA compared with control, and increased level of RBP4 is associated with presence of atherosclerosis in patients with RA as demonstrated by CIMT. RBP4 could be used as a marker for early prediction of premature atherosclerosis in patients with RA.