Division of Rheumatic Diseases, University of Texas Southwestern, Dallas, TX, USA.
Division of Cardiology, University of Texas Southwestern, Dallas, TX, USA.
Clin Exp Rheumatol. 2018 Nov-Dec;36(6):1031-1037. Epub 2018 Sep 17.
Patients with clinically evident autoimmune disease are at increased risk for premature cardiovascular disease (CVD). Markers of serological autoimmunity such as anti-nuclear antibodies (ANA) are found in approximately 25% of the general population. Yet, the vast majority will not develop clinical autoimmune disease. Serological autoimmunity is a risk factor for CVD death in individuals without autoimmune disease; however, the mechanisms mediating this excess CVD risk have not been elucidated.
We examined associations of ANA with traditional cardiovascular risk factors, inflammatory mediators, and vascular biomarkers in the Dallas Heart Study - a large, representative multiethnic population-based cohort. Plasma ANA were measured by enzyme linked immunosorbent assay in 3,488 Dallas Heart Study participants aged 30 to 65 years who do not have known rheumatologic disease. Associations of ANA with demographic characteristics, cardiovascular risk factors, and biomarkers were assessed using univariable and multivariable linear regression.
Factors independently associated with higher ANA include female sex, African-American race/ethnicity, soluble intracellular adhesion molecule-1, soluble CD40 ligand, chemokine CXCL-2, and Cystatin C (p<0.05 for each). ANA was not associated with traditional cardiovascular risk factors, high sensitivity C-reactive protein, coronary artery calcium scores, or aortic wall thickness.
ANA are associated with inflammatory mediators and biomarkers of vascular activation, but not with traditional cardiovascular risk factors in a multiethnic population-based cohort. These findings suggest that the cardiovascular risk associated with ANA may involve pathways distinct from traditional risk factors and include dysregulation of endothelial cells and the immune system.
患有明显自身免疫性疾病的患者发生心血管疾病（CVD）的风险增加。大约 25%的普通人群中存在抗核抗体（ANA）等血清自身免疫标志物。然而，绝大多数人不会发生临床自身免疫性疾病。血清自身免疫是无自身免疫疾病个体 CVD 死亡的危险因素；然而，介导这种 CVD 风险增加的机制尚未阐明。
我们在达拉斯心脏研究中检查了 ANA 与传统心血管危险因素、炎症介质和血管生物标志物之间的关联，这是一项大型的、具有代表性的、基于多种族的人群队列研究。在 3488 名年龄在 30 至 65 岁之间、无已知风湿性疾病的达拉斯心脏研究参与者中，通过酶联免疫吸附试验测定血浆 ANA。使用单变量和多变量线性回归评估 ANA 与人口统计学特征、心血管危险因素和生物标志物的相关性。
与较高 ANA 独立相关的因素包括女性性别、非裔美国人种族/民族、可溶性细胞间黏附分子-1、可溶性 CD40 配体、趋化因子 CXCL-2 和胱抑素 C（p<0.05 ）。ANA 与传统心血管危险因素、高敏 C 反应蛋白、冠状动脉钙评分或主动脉壁厚度无关。
在一个基于多种族的人群队列中，ANA 与炎症介质和血管激活的生物标志物相关，但与传统心血管危险因素无关。这些发现表明，与 ANA 相关的心血管风险可能涉及与传统危险因素不同的途径，包括内皮细胞和免疫系统的失调。
