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Rheumatoid factor positivity, not anti-CCP positivity, linked with CV risk
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Rheumatoid factor positivity, rather than anticyclic citrullinated peptide antibody positivity, appears to be associated with 10-year risk of cardiovascular disease in patients with rheumatoid arthritis, according to recently published findings.
esearchers evaluated data from the Nijmegen early rheumatoid arthritis (RA) inception cohort to study 929 patients. At diagnosis, patients underwent various clinical assessments. Blood samples were taken to determine anticyclic citrullinated peptide (CCP) status, rheumatoid factor and erythrocyte sedimentation rate. Researchers determine patients’ global assessment of disease activity and DAS28. Patient charts were reviewed to determine baseline smoking habits, alcohol use, family history of cardiovascular disease (CVD), comorbidities and treatment information.
The first (nonfatal or fatal) CVD event was the outcome of interest. This information was extracted from physician diagnosis by medical chart review and electronic patient files. CVD events included deaths related to CVD.
Researchers found 628 patients were positive for anti-CCP, 697 were RF positive and 232 were RF-negative at baseline. During a median follow up of 7.5 years, 162 CV events occurred. Of these, 15 were fatal. There did not appear to be any difference in the amount of disease activity with time, as indicated by the mean time-averaged DAS28, between anti-CCP-positive (3.7 ±1.2) and anti-CCP-negative patients (3.8 ±1.1). No difference was seen in baseline DAS28 between the groups.
CV event in 5,828 patient-years vs. 50 patients (cumulative proportion at 10 years; 22%) who experienced a CV event in the anti-CCP negative group in 2,457 patient-years. After applying the Cox regression model, this equaled a crude hazard ratio (HR) of 0.91.
Among the 339 patients with available anti-CCP titers, a CV event occurred in 97 patients (28.6%). The crude HR was 0.99. Adjustment for confounders revealed the HR was unchanged. RF had a crude HR of 1.44 on occurrence of CV events, and this HR was not significant. After adjusting for the same confounders as those analyzed in relation to anti-CCP positivity, investigators found the HR of RF was 1.52. In both the crude model and the adjusted model of anti-CCP, RF, and the interaction between the two, the effect (HR) of RF appeared to be larger than that of anti-CCP on CVD, although the interaction term was in a “protective” direction and was not statistically significant.
anti-CCP-negative patients (HR = 2.16). Likewise, an analysis of four subgroups according to RF and anti-CCP status showed the lowest risk in the reference group (all HR-positive), and the highest HR was seen in the group that was RF-positive and anti-CCP-negative.
“This suggests that anti-CCP should not be considered an extra CVD risk factor in RA, irrespective of age at onset of disease,” the researchers wrote. The involvement of RF as a predictive factor for occurrence of CVD in RA is still quite unclear.” – by Jennifer Byrne
Disclosures: The researchers report no relevant disclosures.
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