This article is more than 5 years old. Information may no longer be current.
Sex predictive of CVD, respiratory-related mortality in patients with RA
Click Here to Manage Email Alerts
A patient’s sex could be important in preclinical biomarker associations with rheumatoid arthritis and cardiovascular disease mortality, as well as respiratory death, according to findings published in Clinical and Experimental Rheumatology following a 41-year community-based study.
“To my knowledge, the community-based 1974 cohort, from which the RA cases and matched comparison subjects were derived, has the longest duration of follow-up,” Alfonse T. Masi, MD, DrPH, of the University of Illinois College of Medicine at Peoria, told Healio Rheumatology.
To determine how sex can provide preclinical serum biomarker links among RA and its subsequent mortality, the researchers conducted a community-based, case-control cohort study. Among the patients who entered the cohort in 1974, 54 had RA onset between 1977 and 1995. In addition, the 216 participants grouped in the control cohort were individually matched to patients with RA.
“The baseline 1974 sera were analyzed in national referral laboratories for a panel of inflammatory, immunological, hormonal and steroid compounds, adjusted for demographic factors, including education and smoking history,” Masi said. “Mortality of RA patients was also analyzed by three categories of responses to therapy — mainly methotrexate — assigned by the rheumatologist in 1995.”
The researchers followed all participants from 1995 through 2015 to report on survival. They then analyzed preclinical z-score ranks within each set of one patient with RA and their four matched controls, reporting on associations with incident RA and mortality.
“The new onset incident RA cases were identified from 1974 to 1995 and their mortality follow-up was from 1995 to 2015,” Masi said in an interview. “All RA cases were confirmed by the sole community-based rheumatologist and none of the [control] subjects were in his practice.”
According to the researchers, preclinical serum IgG rheumatoid factor z-score ranks were associated with RA in men, whereas cigarette smoking, androstenedione, pregnenolone and sIL-2R ranks were associated with RA females. Preclinical hsCRP (P = .028) and sIL-2R (P = .03) ranks were independently associated with 140 total deaths. In addition, preclinical sTNF-R1 (P = .003) and hsCRP (P = .005) ranks were associated with 50 cardiovascular disease deaths, and these links were significant in females.
In addition, total mortality was greater among patients with RA, after adjusting for baseline demographic covariates, compared with controls (HR = 1.66, 95% CI, 1.12-2.46), and equivalently increased in females with RA (69.4%) vs. controls (49.3%), and in males with RA (72.2%) vs. controls (43.1%).
Respiratory-related causes of death (HR = 2.69, 95% CI, 1.02-7.14) were also higher in patients with RA, but only in females (P = .009). Among patients with RA, response to therapy in 1995 significantly predicted total mortality (P = .004). Baseline CRP and sTNF-R1 biomarker values were associated with total cardiovascular deaths.
“In males, incident RA was associated with preclinical IgG rheumatoid factor z-score ranks,” Masi said. “In females, incident RA was associated with greater cigarette smoking, lower serum androstenedione and higher serum pregninolone levels, and higher sIL-2R levels. Total percentile mortality was equivalently increased in females and males, but respiratory causes of death were only greater in female cases. The significant association of CRP and sTNF-R1 with cardiovascular disease deaths was found only in females.” – by Jason Laday
Disclosure: Masi reports no relevant financial disclosures.
Collapse
Masi A, et al. Clin Exp Rheumatol. 2017;Dec 12;35(6): 0966-0974.
Click Here to Manage Email Alerts