Poor cholesterol efflux capacity (CEC) has been proposed to be an independent risk factor for cardiovascular diseases. However, current evidence is inconsistent, especially in rheumatoid arthritis (RA) patients. This meta-analysis aims to identify whether CEC is impaired or altered by drug therapy in RA. The PubMed/MEDLINE, Embase, Cochrane Library and ClinicalTrials.gov databases were browsed to identify studies on CEC in RA patients. The searches mainly focused on studies in human subjects that were published before November 14, 2020, without any language restrictions. The effect size was pooled by the standardized mean differences and mean differences (SMD & MD) as well as the corresponding 95% confidence intervals (CIs) in a random or fixed effect model. Heterogeneity across the studies was tested using Cochran’s Q test and I2 statistic. Newcastle-Ottawa Scale and the Downs and Black scale (D&B) were applied to evaluate the quality of included studies. The GRADE-system with its 4-grade evidence scale was used to assess the quality of evidence. A total of 11 eligible articles, including 6 observational and 5 interventional studies, were retrieved. The pooled results showed that in patients with RA, CEC was not significantly different than in healthy controls (SMD: -0.34, 95% CI: − 0.83 to 0.14), whereas the plasma HDL-C levels was significantly lower (MD: -3.91, 95% CI: − 7.15 to − 0.68). Furthermore, in the before-after studies, the CEC of RA patients (SMD: 0.20, 95% CI: 0.02 to 0.37) increased, but the plasma HDL-C levels (MD: 3.63, 95% CI: − 0.13 to 7.39) remained at a comparable quantity after anti-rheumatic treatment comparing with the baseline. In addition, the funnel plot of included studies displayed a lightly asymmetry, while Egger’s and Begg’s test did not suggest the existence of publication bias. The quality of evidence was rated according to GRADE as moderate to very low. The current meta-analysis demonstrated that HDL-mediated CEC can be improved by the early control of inflammation and anti-rheumatic treatment in RA patients, which is independent of the plasma HDL-C levels. However, the results should be interpreted with caution because of low-quality and limited quantity of evidence. Future randomized controlled trials are needed to determine whether therapeutic strategies to enhance CEC in RA patients have beneficial effects for preventing CVD.

中文翻译：

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类风湿性关节炎患者 HDL 胆固醇流出能力和浓度的荟萃分析


胆固醇流出能力（CEC）不良已被认为是心血管疾病的独立危险因素。然而，目前的证据并不一致，特别是在类风湿性关节炎（RA）患者中。这项荟萃分析旨在确定 RA 药物治疗是否会损害或改变 CEC。浏览 PubMed/MEDLINE、Embase、Cochrane Library 和 ClinicalTrials.gov 数据库以确定 RA 患者 CEC 的研究。检索主要集中于2020年11月14日之前发表的人类受试者研究，没有任何语言限制。效应大小通过随机或固定效应模型中的标准化均值差和均值差（SMD 和 MD）以及相应的 95% 置信区间 (CI) 进行汇总。使用 Cochran 的 Q 检验和 I2 统计量测试了研究之间的异质性。采用纽卡斯尔-渥太华量表和唐斯和布莱克量表（D＆B）来评估纳入研究的质量。 GRADE 系统及其 4 级证据量表用于评估证据质量。共检索到 11 篇符合条件的文章，其中包括 6 篇观察性研究和 5 篇干预性研究。汇总结果显示，RA 患者的 CEC 与健康对照相比没有显着差异（SMD：-0.34，95% CI：− 0.83 至 0.14），而血浆 HDL-C 水平显着降低（MD：-3.91） ，95% CI：− 7.15 至− 0.68）。此外，在前后研究中，RA患者的CEC（SMD：0.20，95％CI：0.02至0.37）增加，但血浆HDL-C水平（MD：3.63，95％CI：−0.13至7.39）与基线相比，抗风湿治疗后仍保持在相当的数量。 此外，纳入研究的漏斗图显示出轻微的不对称性，而Egger's和Begg's检验并未表明存在发表偏倚。证据质量根据 GRADE 评定为中度至极低。目前的荟萃分析表明，HDL介导的CEC可以通过早期控制RA患者的炎症和抗风湿治疗来改善，且与血浆HDL-C水平无关。然而，由于证据质量低且数量有限，应谨慎解释结果。未来需要进行随机对照试验来确定增强 RA 患者 CEC 的治疗策略是否对预防 CVD 具有有益作用。