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Novel risk factors for cardiovascular disease in rheumatoid arthritis

  • Etio Pathogenesis of Autoimmunity
  • Published:
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Abstract

Since cardiovascular disease (CVD) is the most common cause of mortality in patients with rheumatoid arthritis (RA), we aimed to determine factors associated with such a complication in a large series of Colombian patients. This was a cross-sectional analytical study in which 800 consecutive Colombian patients with RA were assessed for variables associated with CVD. Furthermore, a systematic literature review was performed to address the state of the art about non-traditional risk factors for CVD in RA. The preferred reporting items for systematic reviews and meta-analyses guidelines were followed in data extraction, analysis, and reporting of articles selected. Hypercholesterolemia, type 2 diabetes mellitus, abnormal body mass index, abdominal obesity, and current smoking were all traditional risk factors significantly associated with CVD in Colombians. As non-traditional risk factors, familial autoimmunity, more than 10 years of duration of the disease, patients working on household duties, use of systemic steroids, and low education level were associated with CVD in the studied population. Out of a total of 9,812 articles identified in PubMed and Scopus databases, 140 fulfilled the eligibility criteria and were included. Through this systematic review, several factors and outcomes related to CVD were confirmed and identified. These were categorized into genetics, RA-related, and others. Traditional risk factors do not completely explain the high rates of CVD in patients with RA; thus, novel risk factors related to autoimmunity are now recognized predicting the presence of CVD as strong as traditional risk factors. Our results may assist health professionals and policymakers in making decisions about CVD in patients with RA.

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Abbreviations

aCL:

Anti-cardiolipin antibodies

ACR:

American College of Rheumatology

AD:

Autoimmune disease

ANAs:

Anti-nuclear antibodies

anti-ApoA-1:

Anti-apolipoprotein A-1 antibodies

anti-CCP:

Anti-cyclic citrullinated peptide antibodies

anti-CK18:

Anti-cytokeratin 18 antibodies

anti-MCV:

Anti-modified citrullinated vimentin antibodies

anti-oxLDL:

Anti-oxidized low-density lipoprotein antibodies

anti-PC:

Anti-phosphorylcholine antibodies

AORS:

Adjusted odds ratios

BMI:

Body mass index

CAD:

Coronary artery disease

CHF:

Congestive heart disease

CIs:

Confidence intervals

CRP:

C-reactive protein

CV:

Cardiovascular

CVD:

Cardiovascular disease

DAS-28:

Disease activity score-28

DMARDs:

Disease-modifying anti-rheumatic drugs

EAMs:

Extra-articular manifestations

ESR:

Erythrocyte sedimentation rate

FA:

Familial autoimmunity

FDRs:

First-degree relatives

HAQ:

Health Assessment Questionnaire

HDL:

High-density lipoprotein cholesterol

IHD:

Ischemic heart disease

IMT:

Intima-medial thickness

IQR:

Interquartile range

JIA:

Juvenile idiopathic arthritis

LDL:

Low-density lipoprotein cholesterol

LEL:

Low educational level

MAS:

Multiple autoimmune syndrome

MBL:

Mannose-binding lectin

MetS:

Metabolic syndrome

MI:

Myocardial infarction

MTX:

Methotrexate

OPG:

Osteoprotegerin

OPN:

Osteopontin

RA:

Rheumatoid arthritis

RF:

Rheumatoid factor

SD:

Standard deviation

SES:

Socioeconomic status

sPTX-3:

Serum pentraxin 3

SUA:

Serum uric acid

T2DM:

Type 2 diabetes mellitus

TgAb:

Anti-thyroglobulin antibodies

TGL:

Triglycerides

TPOAb:

Anti-thyroperoxidase enzyme antibodies

WHR:

Waist-to-hip ratio

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Acknowledgments

The authors are grateful to Catalina Herrera-Díaz and all the members of the Center for Autoimmune Diseases Research (CREA) for their fruitful discussions and contributions to this paper. This work was supported by The School of Medicine and Health Sciences of Universidad del Rosario in Bogotá, Colombia.

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The authors have no conflicting financial interest.

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  1. Center for Autoimmune Diseases Research (CREA), School of Medicine and Health Sciences, Universidad del Rosario, Carrera 24 No. 63C-69, Bogotá, Colombia

    Jenny Amaya-Amaya, Juan Camilo Sarmiento-Monroy, Ruben-Dario Mantilla, Ricardo Pineda-Tamayo, Adriana Rojas-Villarraga & Juan-Manuel Anaya

  2. Art-Medica, Calle 32F No. 75C-90, Medellín, Colombia

    Ricardo Pineda-Tamayo

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  1. Jenny Amaya-Amaya
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Amaya-Amaya, J., Sarmiento-Monroy, J.C., Mantilla, RD. et al. Novel risk factors for cardiovascular disease in rheumatoid arthritis. Immunol Res 56, 267–286 (2013). https://doi.org/10.1007/s12026-013-8398-7

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