Infection & Inflammation, UMR 1173, Inserm, UVSQ/Paris Saclay, 78180, Montigny-le-Bretonneux, France.
Service de Rhumatologie, Hôpital Ambroise Paré, AP-HP-Paris Saclay, 92100, Boulogne, France.
Arthritis Res Ther. 2022 Feb 24;24(1):56. doi: 10.1186/s13075-022-02722-z.
Rheumatoid arthritis (RA) is characterized by increased cardiovascular (CV) mortality. CV events are particularly high in patients with RA-specific autoimmunity, including rheumatoid factor (RF) and anti-citrullinated protein antibodies (ACPA), raising the question whether RA-specific autoimmunity itself is associated with CV events.
New CV events (myocardial infarction, stroke or death by CV cause) were recorded in 20,625 subjects of the Electricité de France - Gaz de France (GAZEL) cohort. Self-reported RA cases in the GAZEL cohort were validated by phone interview on the basis of a specific questionnaire. In 1618 subjects, in whom plasma was available, RF and ACPA were measured. A piecewise exponential Poisson regression was used to analyze the association of CV events with presence of RA as well as RA-specific autoimmunity (without RA).
CV events in GAZEL were associated with age, male sex, smoking, hypertension, hyperlipidemia, and diabetes mellitus (HR from 1.06 to 1.87, p < 0.05). Forty-two confirmed RA cases were identified. Confirmed RA was significantly associated with CV risk increase (HR of 3.03; 95% CI: 1.13-8.11, p = 0.03) independently of conventional CV risk factors. One hundred seventy-eight subjects showed RF or ACPA positivity without presence of RA. CV events were not associated with ACPA positivity (HR: 1.52, 95% CI: 0.47-4.84, p = 0.48) or RF positivity (HR: 1.15, 95% CI: 0.55-2.40, p = 0.70) in the absence of RA.
RA, as a clinical chronic inflammatory disease, but not mere positivity for RF or ACPA in the absence of clinical disease is associated with increased CV risk.
类风湿关节炎（RA）的特征是心血管（CV）死亡率增加。RA 特异性自身免疫患者的 CV 事件尤其高，包括类风湿因子（RF）和抗瓜氨酸蛋白抗体（ACPA），这引发了一个问题，即 RA 特异性自身免疫本身是否与 CV 事件相关。
在法国电力公司-法国燃气（GAZEL）队列的 20625 名受试者中记录了新的 CV 事件（心肌梗死、中风或 CV 原因导致的死亡）。GAZEL 队列中的自身报告的 RA 病例通过基于特定问卷的电话访谈进行了验证。在 1618 名可提供血浆的受试者中，测量了 RF 和 ACPA。分段指数泊松回归用于分析 CV 事件与 RA 存在以及 RA 特异性自身免疫（无 RA）的关联。
GAZEL 中的 CV 事件与年龄、男性、吸烟、高血压、高血脂和糖尿病有关（HR 从 1.06 到 1.87，p<0.05）。确定了 42 例确诊 RA 病例。确诊 RA 与 CV 风险增加显著相关（HR 为 3.03；95%CI：1.13-8.11，p=0.03），独立于传统的 CV 危险因素。178 名受试者表现出 RF 或 ACPA 阳性而无 RA。在无 RA 的情况下，CV 事件与 ACPA 阳性（HR：1.52，95%CI：0.47-4.84，p=0.48）或 RF 阳性（HR：1.15，95%CI：0.55-2.40，p=0.70）无关。
RA 作为一种临床慢性炎症性疾病，但不是单纯的 RF 或 ACPA 阳性而无临床疾病，与 CV 风险增加相关。
