University of Pennsylvania, Philadelphia.
Veterans Affairs Nebraska-Western Iowa Health Care System and University of Nebraska Medical Center, Omaha, Nebraska.
Arthritis Care Res (Hoboken). 2023 Apr;75(4):768-777. doi: 10.1002/acr.24885. Epub 2022 Nov 11.
To assess whether circulating levels of adiponectin, leptin, and fibroblast growth factor 21 (FGF-21) are associated with incident cardiovascular disease (CVD) in rheumatoid arthritis (RA).
Adipokines were measured using banked enrollment serum from patients with RA and dichotomized above/below the median value. Incident CVD events (coronary artery disease [CAD], stroke, heart failure [HF] hospitalization, venous thromboembolism, CVD-related deaths) were identified using administrative data and the National Death Index. Covariates were derived from medical record, biorepository, and registry databases. Multivariable Cox models were generated to quantify associations between adipokine concentrations and CVD incidence. Five-year incidence rates were predicted.
Among 2,598 participants, 639 (25%) had at least 1 CVD event over 19,585 patient-years of follow-up. High adiponectin levels were independently associated with HF hospitalization (hazard ratio [HR] 1.39 [95% confidence interval (95% CI) 1.07-1.79], P = 0.01) and CVD-related death (HR 1.49 [95% CI 1.16-1.92], P = 0.002) but not with other CVD events. High leptin was independently associated with CVD-related death (HR 1.44 [95% CI 1.05-1.97], P = 0.02). High FGF-21 levels were independently associated with lower rates of CAD (HR 0.75 [95% CI 0.58-0.97], P = 0.03). In subgroup analyses, associations between high adiponectin and leptin levels with CVD-related death were driven by strong associations in nonobese patients.
Adipokines are associated with HF hospitalization and CVD-related death in patients with RA, with stronger associations in nonobese participants. These findings suggest that adipokines effectively predict clinically important outcomes in RA perhaps through an association with body composition and metabolic health. Further study is needed to determine whether adipokine measures might augment existing tools to identify RA patients at increased risk of CVD.
评估循环脂联素、瘦素和成纤维细胞生长因子 21（FGF-21）水平是否与类风湿关节炎（RA）患者的心血管疾病（CVD）事件相关。
使用 RA 患者的银行入组血清测量脂联素，并根据中位数将其分为高于/低于中位数值。使用行政数据和国家死亡索引确定 CVD 事件（冠心病[CAD]、中风、心力衰竭[HF]住院、静脉血栓栓塞、CVD 相关死亡）。协变量来自病历、生物库和登记数据库。生成多变量 Cox 模型以量化脂联素浓度与 CVD 发生率之间的关联。预测了 5 年的发生率。
在 2598 名参与者中，有 639 名（25%）在 19585 患者年的随访中至少发生了 1 次 CVD 事件。高水平的脂联素与 HF 住院（危险比[HR]1.39[95%置信区间（95%CI）1.07-1.79]，P=0.01）和 CVD 相关死亡（HR 1.49[95%CI 1.16-1.92]，P=0.002）独立相关，但与其他 CVD 事件无关。高水平的瘦素与 CVD 相关死亡独立相关（HR 1.44[95%CI 1.05-1.97]，P=0.02）。高水平的 FGF-21 与较低的 CAD 发生率独立相关（HR 0.75[95%CI 0.58-0.97]，P=0.03）。在亚组分析中，高水平脂联素和瘦素与 CVD 相关死亡之间的关联是由非肥胖患者的强关联驱动的。
脂联素与 RA 患者的 HF 住院和 CVD 相关死亡相关，在非肥胖参与者中相关性更强。这些发现表明，脂联素可能通过与身体成分和代谢健康相关，有效地预测 RA 患者的临床重要结局。需要进一步研究以确定脂联素测量是否可以增强现有的工具来识别 CVD 风险增加的 RA 患者。
