Rheumatoid arthritis-related autoimmunity alone does not increase cardiovascular risk
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The mere presence of rheumatoid factor or anti-citrullinated protein antibodies, without rheumatoid arthritis clinical disease, does not increase cardiovascular risk, according to data published in Arthritis Research & Therapy.
“In recent years, several studies suggested that RA with positive [rheumatoid factor (RF)] and/or [anti-citrullinated protein antibodies (ACPA)] presents a higher [cardiovascular (CV)] risk,” Hélène Gouze, MD, of the Public Assistance Hospital of Paris, and colleagues wrote. “Thus, one may think that RF and ACPA could influence CV risk independently from RA. However, evidence that CV disease may be linked to the presence of autoantibodies, independently from the occurrence of RA, is scarce.”
To further investigate whether RA-specific autoimmunity is associated with an increased risk for cardiovascular events, as well as clinically diagnosed RA, Gouze and colleagues conducted a statistical analysis of the GAZEL cohort, which began recording data in 1989 and included 20,625 employees of the Electricité de France-Gaz de France utility. The GAZEL study recorded new cardiovascular events, including myocardial infarction, stroke and death among these employees.
Plasma was collected in 2000 and 2005, and was available for 1,618 patients, enabling the measurement of rheumatoid factor and anti-citrullinated protein antibodies. At inclusion, women in the GAZEL cohort were aged 35 to 50 years while men were aged 40 to 50 years. Gouze and colleagues included all respondents who self-reported RA in a 2010 screening survey. Included patients were then contacted by phone and interviewed about their experiences by a rheumatologist. The researchers used a piecewise exponential Poisson regression to determine any connection between cardiovascular events and the presence of RA or RA-specific autoimmunity without RA.
In all, 13,960 patients responded to the survey in 2010. Among those, 421 self-reported RA, while diagnoses were confirmed in 42 of those patients. According to the researchers, RA was “significantly associated” with increased incidence of cardiovascular events in the univariable and multivariable analyses (HR = 3.03; 95% CI, 1.13-8.11). There was no association made between cardiovascular events and ACPA positivity (HR = 1.52, 95% CI, 0.47-4.84) or rheumatoid factor positivity (HR = 1.15; 95% CI, 0.55-2.4).
“These data suggest that CV risk in RA may rather be dependent on the inflammatory disease itself, while the mere presence of RA-related autoimmunity may not be associated, alone, with CV disease,” the researchers wrote. “Thus, the higher risk for CV events in autoantibody-positive RA may be related to a more severe and chronic course of the disease rather than direct effects of autoantibodies on the vessels.”
Perspective
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Chronic, uncontrolled inflammation is a risk factor for many comorbidities. In rheumatoid arthritis, cardiovascular events can be directly associated with inflammation. Studies have been done looking at whether the presence of RA-related autoimmunity has a direct effect on the vessels, or if that was related to a more severe and chronic course of the disease. In the study by Gouze, et al., the researchers reached the conclusion that inflammation is the primary villain in CV events.
We spend a great deal of time working with the patients to get their inflammation under control. It’s a never-ending battle for some and we need to continue to focus on maintaining control. The nasty effects of chronic inflammation are widespread throughout the body and, for our patients with RA, effective control can help decrease the risk of myocardial ischemia and heart failure.
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