the study was conducted at srm medical college hospital and research centre , srm nagar , potheri , tamil nadu . thirty subjects with sero - positive rheumatoid arthritis of both genders with the age group between 25 and 80 years were considered as cases . patients with history of diabetes , hypertension , obesity , renal failure , liver failure and family history of hyperlipidemia , those who were on treatment with lipid - lowering agents , smoking and alcohol use were excluded from the study . fasting blood samples were collected from healthy subjects and patients with the sero - positive rheumatoid arthritis . lp ( a ) was analyzed by immunoturbidimetry using merk micro lab 300 semi - auto analyzer , elitech group , eli tech group , 9 2800 puteaux , france . serum total cholesterol ( tc ) ( cholesterol oxidase method ) , tg ( glycerol phosphate oxidase - peroxidase method ) and hdl - c ( precipitation assay method ) were estimated by using standard enzyme kits in olympus au 400 auto analyzer ( wendenstrabe hamburg , germany ) on the same day of collection . ldl - c , very low density lipoprotein - cholesterol ( vldl - c ) were calculated by friedewald 's formula . comparisons were made between the rheumatoid arthritis patients and healthy subjects by using un - paired student 's t - test . correlation of lp ( a ) and lipid profile were calculated by pearson 's correlation . all the statistical analyses were performed using spss for microsoft windows , version 17.0 , ibm , international . comparisons were made between the rheumatoid arthritis patients and healthy subjects by using un - paired student 's t - test . correlation of lp ( a ) and lipid profile were calculated by pearson 's correlation . all the statistical analyses were performed using spss for microsoft windows , version 17.0 , ibm , international . table 1 shows a comparison of serum lp ( a ) and serum lipid profile in rheumatoid arthritis patients and healthy subjects . the mean  sd of serum lp ( a ) levels in rheumatoid arthritis patients was significantly higher than that of healthy subjects ( p < 0.001 ) . there was a statistically significant reduction in the concentration of serum hdl - c between rheumatoid arthritis patients and healthy subjects ( p < 0.05 ) . there was no statistically significant difference ( p > 0.05 ) were observed in parameters such as serum tc , tg , ldl - c , vldl - c between the rheumatoid arthritis patients and healthy subjects . comparison of meansd of serum lp ( a ) and lipid profile in sero - positive rheumatoid arthritis patients and healthy subjects in our study , the ratios of tc / hdl - c and ldl - c / hdl - c were significantly higher ( p < 0.05 ) in rheumatoid arthritis patients than healthy subjects . serum lp ( a ) correlated negatively with hdl - c , ( r = 0.435 ) ( p = 0.0016 ) . in our study , the serum concentration of lp ( a ) was significantly increased in patients with rheumatoid arthritis . as an increased concentration of lp ( a ) lp ( a ) was an important cause of cardiovascular disease in patients with rheumatoid arthritis . rantap - dahlqvist et al . found that the lp ( a ) level in rheumatoid arthritis patients was higher than in healthy subjects . it was suggested that increased synthesis and/or decreased destruction of lp ( a ) or changes in lp ( a ) distribution between intravascular and extravascular regions may cause dyslipoproteinemia in rheumatoid arthritis . since the lipid contents of lp ( a ) and ldl - c were similar , they might have similar mechanisms in atherosclerosis . it is suggested that the reticulo - endothelial system became over stimulated in active rheumatoid arthritis and then the lipid elimination by scavenger receptors of macrophages increased . for that reason , dyslipoproteinemia in rheumatoid arthritis includes lower hdl - c , higher lp ( a ) , and higher tg and is related to atherosclerosis . our study also showed that lower hdl - c , higher lp ( a ) and higher tg in rheumatoid arthritis . established that hdl - c levels were lower in rheumatoid arthritis patients having antilipoprotein antibodies . in our study also , there was a significant ( p < 0.05 ) reduction in serum hdl - c level in rheumatoid arthritis patients . this significant difference in hdl - c level between rheumatoid arthritis patients and healthy subjects might be due to physical inactivity in the former . due to our rheumatoid arthritis patients had active - phase rheumatoid arthritis with various degrees of physical inactivity , in our study there was a significant reduction in serum hdl - c level . lakatos et al . found that there were higher serum tc and ldl - c levels and lower hdl - c and tg levels in rheumatoid arthritis patients than in healthy subjects . lipoprotein ( a ) binds pro - inflammatory - oxidized phospholipids and is a preferential carrier of oxidized phospholipids . apo ( a ) component of lp ( a ) inhibits the key positive feedback step involving conversion of plasmin - mediated glu - plasminogen to lys - plasminogen . the prothrombotic , antifibrinolytic actions of apo ( a ) are expressed on one hand as inhibition of fibrinolysis with enhancement of clot stabilization and on the other as enhanced coagulation via the inhibition of tissue factor pathway inhibitor . a reduction in cardio protective hdl - c and increase in ldl - c exposes rheumatoid arthritis patients to higher risk of cvd . our study has also shown significant reduction in serum hdl - c level in rheumatoid arthritis patients . however in our study , we did not get a significant difference in serum total cholesterol , tgs , ldl - c and vldl - c . if we do this study in a large population and long - term study , this may give valuable observation . inflammation of rheumatoid arthritis begins with cardiovascular damage that is the early diagnosis for the increased risk of cvd . lp ( a ) with high ldl - c strongly correlated with risk of coronary heart disease . elevated lp ( a ) level with high ldl - c , low hdl - c and hypertension increased cardiovascular risk . increased risk of atherosclerosis in rheumatoid arthritis patients has an ultrasonic marker for early atherosclerosis . rheumatoid arthritis patients were found to have high levels of small dense ldl particles , and this was related to acute phase response . high circulating levels of small dense ldl particles constitute another characteristic feature of the metabolic syndrome . furthermore , the acute phase response contributes to atherosclerosis through endothelial activation and interaction with pro - coagulant factor . rheumatoid - factor ( rf ) positive were having higher risk of heart failure than rf negative . rheumatoid arthritis patients with heart failure are related to diastolic dysfunction than without heart failure . the higher rates of heart failure in rheumatoid arthritis are due to preserved ejection fraction . inflammatory process of rheumatoid arthritis simultaneously initiates cardiovascular damage and hence early diagnosis of rheumatoid arthritis is important along with the recognition of increased risk of cardiovascular disease . lp ( a ) level may be used as a screening tool to define cardiovascular risk among this population . inclusion of the samples from various geographical distribution and large sample size will give more information on lipid profileslong - term follow - up study will give more validated results . inclusion of the samples from various geographical distribution and large sample size will give more information on lipid profiles long - term follow - up study will give more validated results . inclusion of the samples from various geographical distribution and large sample size will give more information on lipid profileslong - term follow - up study will give more validated results . inclusion of the samples from various geographical distribution and large sample size will give more information on lipid profiles long - term follow - up study will give more validated results .
background : rheumatoid arthritis is a chronic and systemic inflammatory disorder , in which lipoprotein ( a ) [ lp ( a ) ] increases plaque formation and thus promotes atherosclerosis . coronary artery disease is one of the co - morbidity in rheumatoid arthritis patients.aim:the aim of this study is to evaluate lp ( a ) as a cardiovascular risk factor in patients with rheumatoid arthritis . 
 this was a comparative study in which lp ( a ) and lipid profile were compared in rheumatoid arthritis patients and controls.materials and methods : the study included 30 sero - positive rheumatoid arthritis patients and 30 normal healthy subjects with an age and sex matched group of 2580 years . 
 statistical analysis was performed using spss version 17.results:serum lp ( a ) concentration was significantly increased ( p < 0.001 ) in rheumatoid arthritis patients compared with controls . 
 serum high - density lipoprotein - cholesterol was significantly lowered ( p < 0.05 ) in patients as compared to controls . 
 there was no significant difference in serum total cholesterol , triglycerides , and very low density lipoprotein - cholesterol between patients and controls.conclusion:the findings indicate that the patients with rheumatoid arthritis are at high risk of developing cardiovascular disease in future due to the increased level of lp ( a ) . 
 in addition to conventional lipid profile , estimation of lp ( a ) can prove to be a valuable tool in risk assessment of population in general and management of disease in particular .