# Association between baseline lipid profile and risk of worsening in patients with myasthenia gravis: A retrospective cohort study

## TL;DR

A study of 264 MG patients found that low lipoprotein(a) levels may increase the risk of worsening myasthenia gravis, but this link disappears at higher levels.

## Contribution

The study reveals a non-linear relationship between lipoprotein(a) levels and MG worsening, suggesting a threshold effect not previously identified.

## Key findings

- Lipoprotein(a) levels below 58 nmol/L showed a 506% increased risk of MG worsening.
- Above 58 nmol/L, lipoprotein(a) levels were not significantly linked to MG worsening.
- Other lipid parameters like cholesterol and triglycerides were not associated with MG prognosis.

## Abstract

Dyslipidemia has been implicated in autoimmunity; however, its association with myasthenia gravis (MG) prognosis is unclear. We aimed to investigate the correlation between baseline lipid profiles and risk of MG worsening.

This 7-year retrospective cohort study conducted at a Chinese hospital included 264 adult patients with MG. Data on baseline lipids, 1-year worsening, and covariates, including demographics, MG characteristics, comorbidities, and treatments were extracted.

Univariate and multivariate logistic regression analyses failed to show a significant association between the risk of 1-year MG worsening and any of the seven blood lipid-related indicators. However, the subsequent non-linear analysis revealed an inflection point in the risk curve of ln[lipoprotein(a)], at 4.06 (58 nmol/L). The lipoprotein(a) levels on the left side of the inflection point presented a positive significant correlation with the risk of MG worsening (relative risk [RR]: 6.06, 95 % confidence interval [CI]: 1.00–38.57), whereas those on the right side of the inflection point demonstrated no significant correlation (RR: 0.86, 95 % CI: 0.55–1.34).

Except for lipoprotein(a) levels being associated with worsening of myasthenia gravis, most lipid parameters were not associated with changes in the clinical course and severity of myasthenia gravis.we observed that lower levels of lipoprotein(a) were associated with a better prognosis in the interval 7–58 nml/L, whereas beyond this interval this was not observed, suggesting dyslipidemia may impact MG prognosis. Further studies are required to validate these findings.

A 7-year retrospective cohort study at a Chinese hospital involving 264 adult patients with myasthenia gravis (MG) found a non-linear correlation between baseline lipid levels and the risk of MG worsening. Although univariate and multivariate analyses did not show a significant association between blood lipid-related indicators (such as triglycerides, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, ApoA1, and ApoB) and the risk of MG worsening, non-linear analysis revealed a inflection point in the risk curve of ln[lipoprotein(a)] at 4.06 (58 nmol/L). The range below 58 nmol/L presented a significantly positive correlation, with a 506 % increase in the risk of MG worsening for each unit increase in ln[lipoprotein(a)]. In contrast, the range above 58 nmol/L demonstrated no significant correlation. These findings suggest that dyslipidemia, particularly abnormal lipoprotein(a) levels, may impact the prognosis of MG, and warrant further validation through additional studies.Image 1