1
|
Bathon JM, Centola M, Liu X, Jin Z, Ji W, Knowlton NS, Ferraz-Amaro I, Fu Q, Giles JT, Wasko MC, Stein CM, Van Eyk JE. Identification of novel biomarkers for the prediction of subclinical coronary artery atherosclerosis in patients with rheumatoid arthritis: an exploratory analysis. Arthritis Res Ther 2023; 25:213. [PMID: 37899440 PMCID: PMC10614317 DOI: 10.1186/s13075-023-03196-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 10/19/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Cardiovascular (CV) risk estimation calculators for the general population underperform in patients with rheumatoid arthritis (RA). The purpose of this study was to identify relevant protein biomarkers that could be added to traditional CV risk calculators to improve the capacity of coronary artery calcification (CAC) prediction in individuals with RA. In a second step, we quantify the improvement of this prediction of CAC when these circulating biomarkers are added to standard risk scores. METHODS A panel of 141 serum and plasma proteins, which represent a broad base of both CV and RA biology, were evaluated and prioritized as candidate biomarkers. Of these, 39 proteins were selected and measured by commercial ELISA or quantitative mass spectroscopy in 561 individuals with RA in whom a measure of CAC and frozen sera were available. The patients were randomly split 50:50 into a training/validation cohort. Discrimination (using area under the receiver operator characteristic curves) and re-classification (through net reclassification improvement and integrated discrimination improvement calculation) analyses were performed first in the training cohort and replicated in the validation cohort, to estimate the increase in prediction accuracy for CAC using the ACA/AHA (American College of Cardiology and the American Heart Association) score with, compared to without, addition of these circulating biomarkers. RESULTS The model containing ACC/AHA score plus cytokines (osteopontin, cartilage glycoprotein-39, cystatin C, and chemokine (C-C motif) ligand 18) and plus quantitative mass spectroscopy biomarkers (serpin D1, paraoxonase, and clusterin) had a statistically significant positive net reclassifications index and integrated discrimination improvement for the prediction of CAC, using ACC/AHA score without any biomarkers as the reference category. These results were confirmed in the validation cohort. CONCLUSION In this exploratory analysis, the addition of several circulating CV and RA biomarkers to a standard CV risk calculator yielded significant improvements in discrimination and reclassification for the presence of CAC in individuals with RA.
Collapse
Affiliation(s)
- Joan M Bathon
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical. Center/New York Presbyterian Hospital, New York, NY, USA
| | | | - Xiaoqian Liu
- Department of Pharmacy, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zhicheng Jin
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, USA
| | - Weihua Ji
- Mass Spectrometry Data Center Group, National Institutes of Standards and Technology, Gaithersburg, MD, USA
| | - Nicholas S Knowlton
- Department of Obstetrics and Gynecology, University of Auckland, Auckland, New Zealand
| | - Iván Ferraz-Amaro
- Division of Rheumatology, Hospital Universitario de Canarias, Tenerife, Santander, Spain.
| | - Qin Fu
- Cedars-Sinai Medical Center, Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, Los Angeles, CA, USA
| | - Jon T Giles
- Division of Rheumatology, Department of Medicine, Columbia University Irving Medical. Center/New York Presbyterian Hospital, New York, NY, USA
| | - Mary Chester Wasko
- Division of Rheumatology, Allegheny Health Network, Pittsburgh, Philadelphia, USA
| | - C Michael Stein
- Division of Rheumatology, Vanderbilt University, Nashville, TN, USA
| | - Jennifer E Van Eyk
- Cedars-Sinai Medical Center, Advanced Clinical Biosystems Research Institute, The Smidt Heart Institute, Los Angeles, CA, USA
| |
Collapse
|
2
|
Feng KM, Chien WC, Chen YH, Sun CA, Chung CH, Chen JT, Chen CL. Increased Risk of Acute Coronary Syndrome in Ankylosing Spondylitis Patients With Uveitis: A Population-Based Cohort Study. Front Immunol 2022; 13:890543. [PMID: 35757729 PMCID: PMC9226308 DOI: 10.3389/fimmu.2022.890543] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 05/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Uveitis, a sight-threatening ocular inflammatory state, is associated with autoimmune diseases and systemic inflammation. This prolonged systemic inflammation may cause plaque formation in coronary arteries, subsequently resulting in acute coronary syndrome (ACS). Methods This retrospective, population-based study (15-year period) used the Longitudinal Health Insurance Database based on the National Health Insurance Research Database in Taiwan. Chi-square and Student's t-tests were used to examine differences between the study and comparison cohorts for categorical and continuous variables, respectively. Fine and Gray's competing risk model was used to determine the hazard ratio of the risk of ACS. Furthermore, the cumulative risk of ACS was determined using Kaplan-Meier analysis. Results A total of 1,111 patients with AS and uveitis were enrolled in this study cohort, and 4,444 patients with AS without uveitis were enrolled in the comparison cohort. After adjustment for age, sex, and comorbidities, patients with AS and uveitis demonstrated an increased risk of ACS compared to those without uveitis (adjusted hazard ratio: 1.675, p<0.001). In addition, Kaplan-Meier analysis revealed that patients with AS and uveitis had a significantly higher risk of ACS than those without uveitis (p<0.001). Age, diabetes mellitus, hypertension, hyperlipidemia, chronic obstructive pulmonary disease, asthma, and systemic steroids were significant risk factors for ACS. Both anterior uveitis and posterior segment involvement were associated with an increased risk of ACS in patients with AS. All-cause mortality was higher in the uveitis group (9.81%) than in the non-uveitis group (8.10%) (p=0.015). Conclusion Our analysis revealed that uveitis could potentially be a predictor of ACS in patients with AS. However, further prospective controlled studies are required to assess the association between uveitis and ACS in patients with AS.
Collapse
Affiliation(s)
- Kathy Ming Feng
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Yi-Hao Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chien-An Sun
- Department of Public Health, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan.,Big Data Research Center, College of Medicine, Fu-Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
| | - Jiann-Torng Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Ching-Long Chen
- Department of Ophthalmology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| |
Collapse
|
3
|
Serum anti-malondialdehyde-acetaldehyde IgA antibody concentration improves prediction of coronary atherosclerosis beyond traditional risk factors in patients with rheumatoid arthritis. Sci Rep 2022; 12:10547. [PMID: 35732827 PMCID: PMC9217813 DOI: 10.1038/s41598-022-14954-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 06/15/2022] [Indexed: 01/27/2023] Open
Abstract
Patients with rheumatoid arthritis (RA) have increased atherosclerosis; oxidative stress may be a contributor. Oxidative stress produces immunogenic malondialdehyde-acetaldehyde (MAA) protein adducts and anti-MAA antibodies are detectable in human serum. We hypothesized that anti-MAA antibody concentrations are associated with coronary atherosclerosis in RA patients. Serum concentrations of anti-MAA antibodies (IgA, IgG, and IgM) were measured in 166 RA patients using ELISA cross-sectionally. Relationship between anti-MAA antibody concentrations and cardiovascular and metabolic measures and predictive accuracy of anti-MAA antibodies for presence of coronary artery calcium (CAC) and high CAC (≥ 300 Agatston units or ≥ 75th percentile) were assessed. Only serum IgA anti-MAA antibody concentration was associated with increased CAC, insulin resistance, and decreased high-density lipoprotein particle number. When added as an interaction term with ACC/AHA 10-year risk score plus high-sensitivity C-reactive protein, IgA anti-MAA antibody concentration improved the C-statistic for prediction of any CAC and high CAC compared to ACC/AHA 10-year risk score plus hs-CRP alone. IgA anti-MAA concentration is associated with multiple cardiovascular risk factors and modifies the relationship between ACC/AHA 10-year risk score and CAC in RA patients. IgA anti-MAA concentration could assist in prediction of atherosclerotic CVD and risk stratification when added to standard measures of cardiovascular risk.
Collapse
|
4
|
López-Pedrera C, Villalba JM, Patiño-Trives AM, Luque-Tévar M, Barbarroja N, Aguirre MÁ, Escudero-Contreras A, Pérez-Sánchez C. Therapeutic Potential and Immunomodulatory Role of Coenzyme Q 10 and Its Analogues in Systemic Autoimmune Diseases. Antioxidants (Basel) 2021; 10:antiox10040600. [PMID: 33924642 PMCID: PMC8069673 DOI: 10.3390/antiox10040600] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 04/06/2021] [Accepted: 04/09/2021] [Indexed: 12/14/2022] Open
Abstract
Coenzyme Q10 (CoQ10) is a mitochondrial electron carrier and a powerful lipophilic antioxidant located in membranes and plasma lipoproteins. CoQ10 is endogenously synthesized and obtained from the diet, which has raised interest in its therapeutic potential against pathologies related to mitochondrial dysfunction and enhanced oxidative stress. Novel formulations of solubilized CoQ10 and the stabilization of reduced CoQ10 (ubiquinol) have improved its bioavailability and efficacy. Synthetic analogues with increased solubility, such as idebenone, or accumulated selectively in mitochondria, such as MitoQ, have also demonstrated promising properties. CoQ10 has shown beneficial effects in autoimmune diseases. Leukocytes from antiphospholipid syndrome (APS) patients exhibit an oxidative perturbation closely related to the prothrombotic status. In vivo ubiquinol supplementation in APS modulated the overexpression of inflammatory and thrombotic risk-markers. Mitochondrial abnormalities also contribute to immune dysregulation and organ damage in systemic lupus erythematosus (SLE). Idebenone and MitoQ improved clinical and immunological features of lupus-like disease in mice. Clinical trials and experimental models have further demonstrated a therapeutic role for CoQ10 in Rheumatoid Arthritis, multiple sclerosis and type 1 diabetes. This review summarizes the effects of CoQ10 and its analogs in modulating processes involved in autoimmune disorders, highlighting the potential of these therapeutic approaches for patients with immune-mediated diseases.
Collapse
Affiliation(s)
- Chary López-Pedrera
- Rheumatology Service, Reina Sofia Hospital/Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (A.M.P.-T.); (M.L.-T.); (N.B.); (M.Á.A.); (A.E.-C.)
- Correspondence: ; Tel.: +34-957-213795
| | - José Manuel Villalba
- Department of Cell Biology, Immunology and Physiology, Agrifood Campus of International Excellence, University of Córdoba, ceiA3, 14014 Córdoba, Spain; (J.M.V.); (C.P.-S.)
| | - Alejandra Mª Patiño-Trives
- Rheumatology Service, Reina Sofia Hospital/Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (A.M.P.-T.); (M.L.-T.); (N.B.); (M.Á.A.); (A.E.-C.)
| | - Maria Luque-Tévar
- Rheumatology Service, Reina Sofia Hospital/Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (A.M.P.-T.); (M.L.-T.); (N.B.); (M.Á.A.); (A.E.-C.)
| | - Nuria Barbarroja
- Rheumatology Service, Reina Sofia Hospital/Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (A.M.P.-T.); (M.L.-T.); (N.B.); (M.Á.A.); (A.E.-C.)
| | - Mª Ángeles Aguirre
- Rheumatology Service, Reina Sofia Hospital/Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (A.M.P.-T.); (M.L.-T.); (N.B.); (M.Á.A.); (A.E.-C.)
| | - Alejandro Escudero-Contreras
- Rheumatology Service, Reina Sofia Hospital/Maimonides Institute for Research in Biomedicine of Córdoba (IMIBIC), University of Córdoba, 14004 Córdoba, Spain; (A.M.P.-T.); (M.L.-T.); (N.B.); (M.Á.A.); (A.E.-C.)
| | - Carlos Pérez-Sánchez
- Department of Cell Biology, Immunology and Physiology, Agrifood Campus of International Excellence, University of Córdoba, ceiA3, 14014 Córdoba, Spain; (J.M.V.); (C.P.-S.)
| |
Collapse
|
5
|
Ewere EG, Okolie NP, Avan ED, Umoh PE. Comparative effects of ethanol leaf and stem bark extracts of Irvingia gabonensis (BUSH MANGO) on sodium arsenite-induced lipid profile perturbtions in wistar rats. CLINICAL PHYTOSCIENCE 2021. [DOI: 10.1186/s40816-020-00241-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractBackgroundExposure to arsenic orchestrates a myriad of noxious health effects, including cancer. Different parts ofIrvingia gabonensisare used as herbal remedies in traditional medicine. In this study, the comparative effects of the ethanol leaf (ELEIG) and stem bark extracts (ESEIG) ofIrvingia gabonensison sodium arsenite (SA)-induced lipid profile disturbances in Wistar rats were investigated.MethodsFifty five Wistar rats weighing between 100 g and 179 g were distributed into eleven groups (n=5). Group 1 (control) received feed and water ad libitum. Group 2 received SA at a dose of 4.1 mg/kg body weight (kgbw) for 14 days. Groups 3–11 were treated with the extracts with or without SA. Treatment was done by oral intubation for 14 days. Serum concentrations of total cholesterol (TC), triacylglycerol (TAG), high density lipoprotein cholesterol (HDL-c), low density lipoprotein cholesterol (LDL-c), very low density lipoprotein cholesterol (VLDL-c), total lipids (TL) and atherogenic index of plasma (AIP) were used to determine the lipid profile effects of the extracts.ResultsExposure to SA caused significant (p˂ 0.05) increases in all assayed parameters, relative to control. Post-treatment and simultaneous treatment with ELEIG and ESEIG mitigated the effects of SA. In addition, ELEIG alone at various doses produced results comparable with control values. However, ESEIG alone caused significant (p˂ 0.05) increases in all assayed parameters, relative to control.ConclusionThese results show that ELEIG and ESEIG ameliorate SA-induced lipid profile disturbances in Wistar rats. However, long-term administration of ESEIG alone may be discouraged.
Collapse
|
6
|
Ferreira HB, Melo T, Paiva A, Domingues MDR. Insights in the Role of Lipids, Oxidative Stress and Inflammation in Rheumatoid Arthritis Unveiled by New Trends in Lipidomic Investigations. Antioxidants (Basel) 2021; 10:antiox10010045. [PMID: 33401700 PMCID: PMC7824304 DOI: 10.3390/antiox10010045] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 12/28/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023] Open
Abstract
Rheumatoid arthritis (RA) is a highly debilitating chronic inflammatory autoimmune disease most prevalent in women. The true etiology of this disease is complex, multifactorial, and is yet to be completely elucidated. However, oxidative stress and lipid peroxidation are associated with the development and pathogenesis of RA. In this case, oxidative damage biomarkers have been found to be significantly higher in RA patients, associated with the oxidation of biomolecules and the stimulation of inflammatory responses. Lipid peroxidation is one of the major consequences of oxidative stress, with the formation of deleterious lipid hydroperoxides and electrophilic reactive lipid species. Additionally, changes in the lipoprotein profile seem to be common in RA, contributing to cardiovascular diseases and a chronic inflammatory environment. Nevertheless, changes in the lipid profile at a molecular level in RA are still poorly understood. Therefore, the goal of this review was to gather all the information regarding lipid alterations in RA analyzed by mass spectrometry. Studies on the variation of lipid profile in RA using lipidomics showed that fatty acid and phospholipid metabolisms, especially in phosphatidylcholine and phosphatidylethanolamine, are affected in this disease. These promising results could lead to the discovery of new diagnostic lipid biomarkers for early diagnosis of RA and targets for personalized medicine.
Collapse
Affiliation(s)
- Helena Beatriz Ferreira
- Mass Spectrometry Center & QOPNA/LAQV-REQUIMTE, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal;
| | - Tânia Melo
- Mass Spectrometry Center & QOPNA/LAQV-REQUIMTE, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal;
- CESAM, Centre for Environmental and Marine Studies, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
- Correspondence: (T.M.); (M.d.R.D.); Tel.: +351-234-370-698 (M.d.R.D.)
| | - Artur Paiva
- Unidade de Gestão Operacional em Citometria, Centro Hospitalar e Universitário de Coimbra (CHUC), 3004-561 Coimbra, Portugal;
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, 3000-370 Coimbra, Portugal
- Instituto Politécnico de Coimbra, ESTESC-Coimbra Health School, Ciências Biomédicas Laboratoriais, 3046-854 Coimbra, Portugal
| | - Maria do Rosário Domingues
- Mass Spectrometry Center & QOPNA/LAQV-REQUIMTE, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal;
- CESAM, Centre for Environmental and Marine Studies, Department of Chemistry, Campus Universitário de Santiago, University of Aveiro, 3810-193 Aveiro, Portugal
- Correspondence: (T.M.); (M.d.R.D.); Tel.: +351-234-370-698 (M.d.R.D.)
| |
Collapse
|
7
|
Wu XM, Broadwin R, Basu R, Malig B, Ebisu K, Gold EB, Qi L, Derby C, Park SK, Green S. Associations between fine particulate matter and changes in lipids/lipoproteins among midlife women. THE SCIENCE OF THE TOTAL ENVIRONMENT 2019; 654:1179-1186. [PMID: 30841392 PMCID: PMC6413864 DOI: 10.1016/j.scitotenv.2018.11.149] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/09/2018] [Accepted: 11/10/2018] [Indexed: 05/30/2023]
Abstract
Fine particles (PM2.5) are known to increase risks of cardiovascular diseases, but it is unclear how they affect plasma lipid levels. In this study, we examined the associations between PM2.5 exposure and lipid/lipoprotein levels from 2289 midlife women enrolled in the longitudinal Study of Women's Health Across the Nation. The average exposure to PM2.5 and gaseous co-pollutants during the prior one year, six months, 30 days, and one day were estimated for each woman based on U.S. Environmental Protection Agency ambient monitoring data. Blood samples were collected annually from 1999 to 2005 and analyzed for lipids/lipoproteins. Mixed-effect models were used to account for repeated measures for each woman, adjusted for demographic, health and behavior covariates. PM2.5 exposures, especially the long-term exposure, were negatively associated with protective lipoproteins, and positively associated with atherogenic lipoproteins. For example, each 3 μg/m3 increase of one-year PM2.5 exposure was associated with decreases of -0.7% (-1.4%, -0.1%) in high-density lipoprotein cholesterols and -0.6% (-1.1%, -0.1%) in apolipoprotein A1 (ApoA1), as well as increases of 3.8% (1.0%, 6.6%) in lipoprotein(a) and 1.4% (0.5%, 2.3%) in the ratio of apolipoprotein B (ApoB)/ApoA1. In stratified analysis, increased atherogenic lipoproteins were mainly observed in women without dyslipidemia, and both increased atherogenic lipoproteins and reduced protective lipoproteins were observed among women in perimenopause. In summary, PM2.5 exposure was associated with adverse lipid level changes, and thus, may increase cardiovascular risks in midlife women.
Collapse
Affiliation(s)
- Xiangmei May Wu
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
| | - Rachel Broadwin
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
| | - Rupa Basu
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
| | - Brian Malig
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
| | - Keita Ebisu
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA.
| | - Ellen B Gold
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA.
| | - Lihong Qi
- Department of Public Health Sciences, University of California Davis School of Medicine, Davis, CA, USA.
| | - Carol Derby
- Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA; Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY, USA.
| | - Sung Kyun Park
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA; Department of Environmental Health Sciences, School of Public Health, University of Michigan, Ann Arbor, MI, USA.
| | - Shelley Green
- Office of Environmental Health Hazard Assessment, California Environmental Protection Agency, Oakland, CA, USA
| |
Collapse
|
8
|
[Unusual cause of acute coronary syndrome: Horton's disease]. Ann Cardiol Angeiol (Paris) 2018; 67:381-387. [PMID: 30301548 DOI: 10.1016/j.ancard.2018.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/11/2018] [Indexed: 11/23/2022]
Abstract
The pathophysiology of acute coronary syndromes is in most cases due to the erosion or rupture of a plaque with consequent thrombotic obstruction of coronary artery. In a few cases, the mechanism is different, this not modifying the initial management but imposing special techniques for diagnosis and therapeutic management. We report a clinical case of a patient supported for an acute coronary syndrome, in a context of impaired general condition and biological inflammatory syndrome revealing a Horton's disease.
Collapse
|
9
|
Hung YM, Wang YH, Lin L, Wang PYP, Chiou JY, Wei JCC. Hydroxychloroquine may be associated with reduced risk of coronary artery diseases in patients with rheumatoid arthritis: A nationwide population-based cohort study. Int J Clin Pract 2018; 72:e13095. [PMID: 29691971 DOI: 10.1111/ijcp.13095] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 03/28/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES The aim of this study was to determine whether hydroxychloroquine (HCQ) usage is associated with incidental risk of coronary artery diseases (CAD) in patients with rheumatoid arthritis (RA). METHODS The Longitudinal Health Insurance Database in Taiwan was used. The study cohort comprised of 1104 newly diagnosed RA patients between 2001-2010, and patients were followed until 31 December 2011. Patients with history of CAD before RA diagnosis were excluded. We define as HCQ users if the usage duration of HCQ>180 days and non-users if less than 90 days. After propensity score matching of age, sex, index date and comorbidities, the study cohort was comprised of 346 patients: 173 HCQ users and 173 non-users. The study outcome was incidence of CAD. Cox regression model was used to estimate the hazard ratio (HR) of disease after controlling for demographic, other comorbidities and drugs. We also evaluate the effects of HCQ use and CAD events on different characteristics of RA patients. RESULTS Kaplan-Meier curves comparing the HCQ users and non-users revealed a statistical significant difference (P value of log-rank test <.001). The adjusted HR for HCQ users versus non-users for CAD events was 0.32 (95% CI, 0.18-0.56, P value <.01) over up to 10 years of follow-up. The adjusted HR (95% CI) of CAD for different age group, gender and other subgroups showed no effect of interaction among each subgroup analysis parameter. CONCLUSIONS This study revealed association of decreased CAD risk in RA patients taking HCQ. The protective effect of HCQ on CAD is consistent regarding subgroup analysis on age, gender and different comorbidities groups.
Collapse
Affiliation(s)
- Yao-Min Hung
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- School of Medicine, Institute of Public Health, National Yang Ming University, Taipei, Taiwan
- Yuhing Junior College of Health Care and Management, Kaohsiung, Taiwan
| | - Yu-Hsun Wang
- Department of Medical Research, Chung Shan Medical University, Taichung, Taiwan
| | - Lichi Lin
- Department of Statistics, Oklahoma state University, Oklahoma, USA
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Paul Yung Pou Wang
- Division of Nephrology, Kaiser Permanente Baldwin Park Medical Center, Baldwin Park, CA, USA
| | - Jeng-Yuan Chiou
- School of Health Policy and Management, Chung Shan Medical University, Taichung, Taiwan
| | - James Cheng-Chung Wei
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, and Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
| |
Collapse
|
10
|
Kardeş S, Karagülle M, Durak İ, Avcı A, Karagülle MZ. Association of oxidative stress with clinical characteristics in patients with rheumatoid arthritis. Eur J Clin Invest 2018; 48. [PMID: 29144558 DOI: 10.1111/eci.12858] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 11/11/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND Few studies examining the association between oxidative stress and clinical parameters or disease activity in patients with rheumatoid arthritis (RA) are available. Therefore, the objective of this study was to test whether oxidative stress has any association with clinical parameters and disease activity in patients with RA. MATERIALS AND METHODS In this post hoc cross-sectional study, 45 patients with RA treated with traditional disease-modifying antirheumatic drugs (DMARDs) ± low-dose glucocorticoids ± nonsteroidal analgesics for at least 3 months were analysed. Oxidative stress parameters were malondialdehyde (MDA), superoxide dismutase (SOD), antioxidant potential (AOP) and nonenzymatic superoxide radical scavenger activity (NSSA). Clinical parameters were pain, patient global assessment, physician global assessment, Health Assessment Questionnaire (HAQ), and disease activity score (DAS28). RESULTS Plasma NSSA levels were significantly inversely correlated with tender joints count (r = -.304; P = .042), swollen joints count (r = -.342; P = .021) and DAS28 (r = -.396; P = .009). There were no significant correlations between MDA/SOD/AOP and any of clinical parameters or DAS28 (P > .05 for all). Multiple regression analysis revealed that NSSA was an independent variable of DAS28 (β=-.243, P = .016). CONCLUSION The preliminary results demonstrate that plasma NSSA levels were inversely correlated with tender and swollen joints count and DAS28 and that NSSA was independently associated with DAS28, in patients with RA treated with traditional DMARDs; and provide initial support that NSSA may be used as a biomarker of disease activity in patients with RA.
Collapse
Affiliation(s)
- Sinan Kardeş
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - Mine Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey
| | - İlker Durak
- Department of Biochemistry, Ankara University School of Medicine, Ankara, Turkey
| | - Aslıhan Avcı
- Department of Biochemistry, Ankara University School of Medicine, Ankara, Turkey
| | - Müfit Z Karagülle
- Department of Medical Ecology and Hydroclimatology, İstanbul Faculty of Medicine, İstanbul University, Istanbul, Turkey
| |
Collapse
|
11
|
Ormseth MJ, Yancey PG, Solus JF, Bridges SL, Curtis JR, Linton MF, Fazio S, Davies SS, Roberts LJ, Vickers KC, Kon V, Michael Stein C. Effect of Drug Therapy on Net Cholesterol Efflux Capacity of High-Density Lipoprotein-Enriched Serum in Rheumatoid Arthritis. Arthritis Rheumatol 2017; 68:2099-105. [PMID: 26991245 DOI: 10.1002/art.39675] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 03/03/2016] [Indexed: 12/21/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) have an increased risk of coronary heart disease (CHD). Some RA therapies may modify this risk, but the underlying mechanisms are unclear. The cholesterol efflux capacity of high-density lipoprotein (HDL) is associated with a reduced CHD risk in non-RA populations; however, inflammation may impair the function of HDL. The aim of this study was to evaluate whether reduced inflammation resulting from treatment with methotrexate (MTX), adalimumab (ADA), or tocilizumab (TCZ) would increase the net cholesterol efflux capacity of HDL in patients with RA. METHODS A longitudinal multicenter study repository (Treatment Efficacy and Toxicity in Rheumatoid Arthritis Database and Repository) provided clinical information for and serum samples from 70 patients with RA before and 6 months after starting treatment with a new drug (MTX [n = 23], ADA [n = 22], or TCZ [n = 25]). Disease activity was measured using the Disease Activity Score in 28 joints using the erythrocyte sedimentation rate (DAS28-ESR). The net cholesterol efflux capacity was measured in paired serum samples using THP-1 macrophages, and total cellular cholesterol was measured by fluorometric assay. RESULTS The DAS28-ESR decreased with all treatments (P < 0.001). Net cholesterol efflux capacity was not significantly changed after 6 months of new RA therapy (mean ± SD 36.9 ± 17.3% units at baseline versus 38.0% ± 16.9% units at 6 months [P = 0.58]). However, change in net cholesterol efflux capacity was associated with change in the DAS28-ESR (ρ = -0.25, P = 0.04). In a post hoc analysis of patients with impaired net cholesterol efflux capacity at baseline, treatment with TCZ resulted in significant improvement in net cholesterol efflux capacity (21.9 ± 14.7% units at baseline versus 31.3% ± 12.8% units at 6 months [P < 0.02]), but this was not observed with MTX or ADA. CONCLUSION Net cholesterol efflux capacity of HDL cholesterol did not change significantly after 6 months of new RA therapy, except in patients with impaired baseline cholesterol efflux capacity who were receiving TCZ. Change in disease activity was associated with change in the net cholesterol efflux capacity.
Collapse
Affiliation(s)
| | | | - Joseph F Solus
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | | | | | - Sean S Davies
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Valentina Kon
- Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | |
Collapse
|
12
|
Quintanilla MA, Andrés M, Pascual E, Pallarés V, Fácila L, Morillas P. Inflammatory status and uricaemia determine HDL-cholesterol levels in hypertensive adults over 65: an analysis of the FAPRES register. Rheumatol Int 2017; 37:941-948. [PMID: 28293775 DOI: 10.1007/s00296-017-3683-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/18/2017] [Indexed: 10/20/2022]
Abstract
In inflammatory disease, the levels of high-density lipoprotein cholesterol (HDL-C) decrease, and the composition of HLD-C changes. Data from the "non-inflammatory" general population indicate the presence of the same phenomenon, albeit to a smaller extent. Levels of uricaemia contribute to the overall inflammatory state of patients. The aim of this study was to analyse the association between inflammatory state, levels of uricaemia, and levels of HLD-C in a hypertensive Spanish population aged 65 or older. This was a retrospective analysis of the FAPRES database. We compared lipid levels [HDL-C, low-density lipoprotein cholesterol (LDL-C), total cholesterol, and triglycerides] in terciles of patients according to their leukocyte counts and uricaemia. When we observed statistically significant differences at a 95% confidence level, we constructed a multivariable linear regression model to adjust for possible confounders. We analysed 860 patients (52.7% women) with a mean age of 72.9 years (±5.8). Participants in the highest tercile for leukocytes or uricaemia presented with significantly lower levels of HDL-C and higher levels of triglycerides, but there was no difference in total cholesterol or LDL-C. The multivariable analysis confirmed an independent and inverse association between HDL-C and both leukocytes (β = -0.001, p = 0.025) and uricaemia (β = -1.054, p = 0037) as well as an independent, direct association between triglycerides and both leukocytes (β = 0.004, p = 0.049), and uricaemia (β = 8.411, p = 0.003). In hypertensive adults aged 65 or older, inflammatory state, and uricaemia independently operate to decrease HDL-C-these findings confirm those described in studies in people with inflammatory disease. This phenomenon could help to define a proatherogenic profile in people without inflammatory disease.
Collapse
Affiliation(s)
- María Amparo Quintanilla
- Cardiology Service, General University Hospital of Elche, Camí de l'Almazara 11, 03203, Elche (Alicante), Spain.
| | - Mariano Andrés
- Rheumatology Unit, General University Hospital of Alicante, Alicante, Spain.,Department of Clinical Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Eliseo Pascual
- Rheumatology Unit, General University Hospital of Alicante, Alicante, Spain.,Department of Clinical Medicine, Universidad Miguel Hernández, Alicante, Spain
| | - Vicente Pallarés
- Unidad de Vigilancia de la Salud, Unión de Mutuas, Castellón, Spain
| | - Lorenzo Fácila
- Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia, Spain
| | - Pedro Morillas
- Cardiology Service, General University Hospital of Elche, Camí de l'Almazara 11, 03203, Elche (Alicante), Spain
| | | |
Collapse
|
13
|
Ormseth MJ, Yancey PG, Yamamoto S, Oeser AM, Gebretsadik T, Shintani A, Linton MF, Fazio S, Davies SS, Roberts LJ, Vickers KC, Raggi P, Kon V, Stein CM. Net cholesterol efflux capacity of HDL enriched serum and coronary atherosclerosis in rheumatoid arthritis. ACTA ACUST UNITED AC 2016; 13:6-11. [PMID: 28243578 DOI: 10.1016/j.ijcme.2016.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND/OBJECTIVES Cardiovascular (CV) risk is increased in patients with rheumatoid arthritis (RA), but not fully explained by traditional risk factors such as LDL and HDL cholesterol concentrations. The cholesterol efflux capacity of HDL may be a better CV risk predictor than HDL concentrations. We hypothesized that HDL's cholesterol efflux capacity is impaired and inversely associated with coronary atherosclerosis in patients with RA. METHODS We measured the net cholesterol efflux capacity of apolipoprotein B depleted serum and coronary artery calcium score in 134 patients with RA and 76 control subjects, frequency-matched for age, race and sex. The relationship between net cholesterol efflux capacity and coronary artery calcium score and other clinical variables of interest was assessed in patients with RA. RESULTS Net cholesterol efflux capacity was similar among RA (median [IQR]: 34% removal [28, 41%]) and control subjects (35% removal [27%, 39%]) (P=0.73). In RA, increasing net cholesterol efflux capacity was not significantly associated with decreased coronary calcium score (OR=0.78 (95% CI 0.51-1.19), P=0.24, adjusted for age, race and sex, Framingham risk score and presence of diabetes). Net cholesterol efflux capacity was not significantly associated with RA disease activity score, C-reactive protein, urinary F2-isoprostanes, or degree of insulin resistance in RA. CONCLUSIONS Net cholesterol efflux capacity is not significantly altered in patients with relatively well-controlled RA nor is it significantly associated with coronary artery calcium score.
Collapse
Affiliation(s)
| | | | | | | | | | - Ayumi Shintani
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Sergio Fazio
- Oregon Health and Science University, Portland, OR, USA
| | - Sean S Davies
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | | | | | | - Valentina Kon
- Vanderbilt University Medical Center, Nashville, TN, USA
| | | |
Collapse
|
14
|
Kryl’skiy ED, Popova TN, Kirilova EM, Safonova OA. Effect of lipoic acid on the activity of caspases and the characteristics of the immune and antioxidant statuses in rats with rheumatoid arthritis. RUSSIAN JOURNAL OF BIOORGANIC CHEMISTRY 2016. [DOI: 10.1134/s1068162016040130] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
15
|
Ormseth MJ, Solus JF, Oeser AM, Bian A, Gebretsadik T, Shintani A, Raggi P, Stein CM. Telomere Length and Coronary Atherosclerosis in Rheumatoid Arthritis. J Rheumatol 2016; 43:1469-74. [PMID: 27252422 DOI: 10.3899/jrheum.151115] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Telomeres protect against chromosomal end damage and shorten with each cell division; their length may be a marker of cardiovascular and overall biological aging. We examined the hypothesis that reduced telomere length is associated with increased coronary atherosclerosis in rheumatoid arthritis (RA). METHODS We performed a cross-sectional study in 145 patients with RA and 87 control subjects frequency-matched for age, race, and sex. Coronary artery calcium score was determined by noncontrast cardiac computed tomography. Telomere length was measured from whole blood DNA, using real-time quantitative polymerase chain reaction and expressed as telomeric product to a single-copy gene product ratio (T/S ratio). Associations between telomere length, coronary artery calcium score, and 28-joint Disease Activity Score (DAS28) were assessed with Spearman correlation, proportional odds logistic regression, and linear regression, adjusting for age, race, and sex. RESULTS Telomere length was significantly inversely correlated with age in patients with RA (ρ = -0.37, p < 0.001) and control subjects (ρ = -0.39, p = 0.001). Among patients with RA, for every interquartile range (IQR) decrease in telomere length (T/S ratio), the odds of higher coronary artery calcium score increased by 38% (95% CI: 4-60) after adjusting for age, race, and sex (p adjusted = 0.03). Telomere length was not associated with DAS28 (p adjusted = 0.17). Telomere length was not significantly different in patients with RA [median (IQR): 1.02 units (0.9-1.11)] compared to control subjects [1.05 units (0.95-1.17); p = 0.10]. CONCLUSION Telomere length is inversely associated with coronary artery calcium score, independent of age, race, and sex in patients with RA.
Collapse
Affiliation(s)
- Michelle J Ormseth
- From the departments of Medicine and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; the departments of Medicine and Radiology, Emory University, Atlanta, Georgia, USA; and the departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada.M.J. Ormseth, MD, MSCI, Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; A.M. Oeser, BS, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; A. Bian, MPH, Department of Biostatistics, Vanderbilt University Medical Center; T. Gebretsadik, MPH, Department of Biostatistics, Vanderbilt University Medical Center; A. Shintani, PhD, MPH, Department of Biostatistics, Vanderbilt University Medical Center; P. Raggi, MD, departments of Medicine and Radiology, University of Alberta; C.M. Stein, MD, Department of Medicine, Vanderbilt University Medical Center.
| | - Joseph F Solus
- From the departments of Medicine and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; the departments of Medicine and Radiology, Emory University, Atlanta, Georgia, USA; and the departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada.M.J. Ormseth, MD, MSCI, Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; A.M. Oeser, BS, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; A. Bian, MPH, Department of Biostatistics, Vanderbilt University Medical Center; T. Gebretsadik, MPH, Department of Biostatistics, Vanderbilt University Medical Center; A. Shintani, PhD, MPH, Department of Biostatistics, Vanderbilt University Medical Center; P. Raggi, MD, departments of Medicine and Radiology, University of Alberta; C.M. Stein, MD, Department of Medicine, Vanderbilt University Medical Center
| | - Annette M Oeser
- From the departments of Medicine and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; the departments of Medicine and Radiology, Emory University, Atlanta, Georgia, USA; and the departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada.M.J. Ormseth, MD, MSCI, Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; A.M. Oeser, BS, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; A. Bian, MPH, Department of Biostatistics, Vanderbilt University Medical Center; T. Gebretsadik, MPH, Department of Biostatistics, Vanderbilt University Medical Center; A. Shintani, PhD, MPH, Department of Biostatistics, Vanderbilt University Medical Center; P. Raggi, MD, departments of Medicine and Radiology, University of Alberta; C.M. Stein, MD, Department of Medicine, Vanderbilt University Medical Center
| | - Aihua Bian
- From the departments of Medicine and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; the departments of Medicine and Radiology, Emory University, Atlanta, Georgia, USA; and the departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada.M.J. Ormseth, MD, MSCI, Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; A.M. Oeser, BS, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; A. Bian, MPH, Department of Biostatistics, Vanderbilt University Medical Center; T. Gebretsadik, MPH, Department of Biostatistics, Vanderbilt University Medical Center; A. Shintani, PhD, MPH, Department of Biostatistics, Vanderbilt University Medical Center; P. Raggi, MD, departments of Medicine and Radiology, University of Alberta; C.M. Stein, MD, Department of Medicine, Vanderbilt University Medical Center
| | - Tebeb Gebretsadik
- From the departments of Medicine and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; the departments of Medicine and Radiology, Emory University, Atlanta, Georgia, USA; and the departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada.M.J. Ormseth, MD, MSCI, Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; A.M. Oeser, BS, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; A. Bian, MPH, Department of Biostatistics, Vanderbilt University Medical Center; T. Gebretsadik, MPH, Department of Biostatistics, Vanderbilt University Medical Center; A. Shintani, PhD, MPH, Department of Biostatistics, Vanderbilt University Medical Center; P. Raggi, MD, departments of Medicine and Radiology, University of Alberta; C.M. Stein, MD, Department of Medicine, Vanderbilt University Medical Center
| | - Ayumi Shintani
- From the departments of Medicine and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; the departments of Medicine and Radiology, Emory University, Atlanta, Georgia, USA; and the departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada.M.J. Ormseth, MD, MSCI, Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; A.M. Oeser, BS, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; A. Bian, MPH, Department of Biostatistics, Vanderbilt University Medical Center; T. Gebretsadik, MPH, Department of Biostatistics, Vanderbilt University Medical Center; A. Shintani, PhD, MPH, Department of Biostatistics, Vanderbilt University Medical Center; P. Raggi, MD, departments of Medicine and Radiology, University of Alberta; C.M. Stein, MD, Department of Medicine, Vanderbilt University Medical Center
| | - Paolo Raggi
- From the departments of Medicine and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; the departments of Medicine and Radiology, Emory University, Atlanta, Georgia, USA; and the departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada.M.J. Ormseth, MD, MSCI, Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; A.M. Oeser, BS, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; A. Bian, MPH, Department of Biostatistics, Vanderbilt University Medical Center; T. Gebretsadik, MPH, Department of Biostatistics, Vanderbilt University Medical Center; A. Shintani, PhD, MPH, Department of Biostatistics, Vanderbilt University Medical Center; P. Raggi, MD, departments of Medicine and Radiology, University of Alberta; C.M. Stein, MD, Department of Medicine, Vanderbilt University Medical Center
| | - C Michael Stein
- From the departments of Medicine and Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee; the departments of Medicine and Radiology, Emory University, Atlanta, Georgia, USA; and the departments of Medicine and Radiology, University of Alberta, Edmonton, Alberta, Canada.M.J. Ormseth, MD, MSCI, Department of Medicine, Vanderbilt University Medical Center; J.F. Solus, PhD, Department of Medicine, Vanderbilt University Medical Center; A.M. Oeser, BS, MLAS, CCRP, Department of Medicine, Vanderbilt University Medical Center; A. Bian, MPH, Department of Biostatistics, Vanderbilt University Medical Center; T. Gebretsadik, MPH, Department of Biostatistics, Vanderbilt University Medical Center; A. Shintani, PhD, MPH, Department of Biostatistics, Vanderbilt University Medical Center; P. Raggi, MD, departments of Medicine and Radiology, University of Alberta; C.M. Stein, MD, Department of Medicine, Vanderbilt University Medical Center
| |
Collapse
|
16
|
Sahebari M, Ayati R, Mirzaei H, Sahebkar A, Hejazi S, Saghafi M, Saadati N, Ferns GA, Ghayour-Mobarhan M. Serum Trace Element Concentrations in Rheumatoid Arthritis. Biol Trace Elem Res 2016; 171:237-245. [PMID: 26450515 DOI: 10.1007/s12011-015-0501-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2015] [Accepted: 08/31/2015] [Indexed: 01/08/2023]
Abstract
Rheumatoid arthritis (RA) is a condition that is associated with oxidative stress. Serum trace elements and their related transport proteins, e.g., albumin and ceruloplasmin, play an important role in the antioxidant defense. Trace element status may therefore be involved in the pathogenesis of RA or be affected by the disease activity of this chronic inflammatory condition. The study participants were 110 patients with RA and 100 sex- and age-matched healthy volunteers. Serum concentrations of albumin, ceruloplasmin, selenium, zinc, copper, and zinc/copper ratio were measured in all subjects. The relationship between these parameters and disease activity score was also assessed. Lower concentrations of serum Alb, Zn, and Se were independently related to disease activity index. High concentrations of serum copper were associated with the presence of RA. Serum Cu concentrations were positively related to disease activity as assessed by the disease activity score. Low serum concentrations of Zn and Se, and high serum Cu concentrations may be associated with the presence of RA or be a consequence of this condition. Of the trace elements that were investigated in the present study, only serum Cu was positively correlated with disease activity.
Collapse
Affiliation(s)
- Maryam Sahebari
- Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Razie Ayati
- Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hamed Mirzaei
- Department of Medical Biotechnology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Sepideh Hejazi
- Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Massoud Saghafi
- Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Nayyereh Saadati
- Rheumatic Diseases Research Center, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Gordon A Ferns
- Division of Medical Education, Brighton and Sussex Medical School, Falmer, Brighton, Sussex, BN1 9PH, UK
| | - Majid Ghayour-Mobarhan
- Biochemistry of Nutrition Research Center, Cardiovascular Research Centre, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran, 99199-91766.
| |
Collapse
|
17
|
Oxidative Stress Relevance in the Pathogenesis of the Rheumatoid Arthritis: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2016; 2016:6097417. [PMID: 27340664 PMCID: PMC4906181 DOI: 10.1155/2016/6097417] [Citation(s) in RCA: 187] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Revised: 03/15/2016] [Accepted: 04/03/2016] [Indexed: 12/29/2022]
Abstract
Rheumatoid arthritis (RA) is an autoimmune inflammatory disease whose pathogenic mechanisms remain to be elucidated. The oxidative stress and antioxidants play an important role in the disease process of RA. The study of oxidants and antioxidants biomarkers in RA patients could improve our understanding of disease pathogenesis; likely determining the oxidative stress levels in these patients could prove helpful in assessing disease activity and might also have prognostic implications. To date, the usefulness of oxidative stress biomarkers in RA patients is unclear and the evidence supporting them is heterogeneous. In order to resume and update the information in the status of oxidants and antioxidants and their connection as biomarkers in RA, we performed a systematic literature search in the PubMed database, including clinical trials published in the last five years using the word combination "rheumatoid arthritis oxidative stress". In conclusion, this review supports the fact that the oxidative stress is an active process in RA pathogenesis interrelated to other better known pathogenic elements. However, some controversial results preclude a definite conclusion.
Collapse
|
18
|
López-Pedrera C, Barbarroja N, Jimenez-Gomez Y, Collantes-Estevez E, Aguirre MA, Cuadrado MJ. Oxidative stress in the pathogenesis of atherothrombosis associated with anti-phospholipid syndrome and systemic lupus erythematosus: new therapeutic approaches. Rheumatology (Oxford) 2016; 55:2096-2108. [PMID: 27018059 DOI: 10.1093/rheumatology/kew054] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2015] [Revised: 02/18/2016] [Indexed: 12/25/2022] Open
Abstract
Atherothrombosis is a recurrent complication in APS and SLE patients. Oxidative stress has been suggested as a key player underlying this process. Autoantibodies have been pointed to as the main contributors to abnormality in the oxidative status observed in APS and SLE patients, promoting the increased production of oxidant species and the reduction of antioxidant molecules. This imbalance causes vascular damage through the activation of immune cells, including monocytes, lymphocytes and neutrophils, causing the expression of pro-inflammatory and procoagulant molecules, the formation of neutrophil extracellular traps and the adhesion of these cells to the endothelium; the induction of cellular apoptosis and impaired cell clearance, which in turn enhances autoantibody neogeneration; and cytotoxicity of endothelial cells. This review describes the mechanisms underlying the role of oxidative stress in the pathogenesis of atherothrombosis associated with APS and SLE, focused on the effect of autoantibodies, the different cell types involved and the diverse effectors, including cytokines, procoagulant proteins and their main modulators, such as oxidant/antioxidant species and intracellular pathways in each pathology. We further discuss new therapies aimed at restoring the oxidative stress balance and subsequently to tackle atherothrombosis in APS and SLE.
Collapse
Affiliation(s)
- Chary López-Pedrera
- Maimonides Institute for Research in Biomedicine of Cordoba, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Nuria Barbarroja
- Maimonides Institute for Research in Biomedicine of Cordoba, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Yolanda Jimenez-Gomez
- Maimonides Institute for Research in Biomedicine of Cordoba, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Eduardo Collantes-Estevez
- Maimonides Institute for Research in Biomedicine of Cordoba, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Ma Angeles Aguirre
- Maimonides Institute for Research in Biomedicine of Cordoba, Reina Sofia University Hospital, University of Cordoba, Cordoba, Spain
| | - Ma Jose Cuadrado
- Rheumatology Service, St Thomas Hospital, Lupus Research Unit, London, UK
| |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW Patients with rheumatoid arthritis (RA) have accelerated atherosclerosis despite the appearance of having a less atherogenic lipid profile; however, lipoprotein function rather than concentration may be a better indicator of atherosclerotic risk. The purpose of this review is to summarize recent findings concerning HDL function in patients with RA. RECENT FINDINGS Two major activities of HDL, its antioxidant and cholesterol efflux functions have been examined in RA. HDL antioxidant capacity is inversely associated with inflammation and RA disease activity; however, there is no clear consensus if antioxidant capacity is altered significantly in RA compared with control study participants. Moreover, despite numerous studies there is no consensus whether HDL cholesterol efflux capacity is significantly altered in RA compared with control study participants or influenced by inflammation or disease activity. SUMMARY Additional studies will be valuable to consolidate existing data and find consensus. Moreover, studies evaluating the impact of various HDL functions on cardiovascular disease in RA are needed.
Collapse
|
20
|
Ungprasert P, Srivali N, Thongprayoon C. Association between psoriasis and chronic obstructive pulmonary disease: A systematic review and meta-analysis. J DERMATOL TREAT 2015; 27:316-21. [DOI: 10.3109/09546634.2015.1107180] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
|
21
|
Ungprasert P, Wijarnpreecha K, Ahuja W, Spanuchart I, Thongprayoon C. Coronary artery disease in primary biliary cirrhosis: A systematic review and meta-analysis of observational studies. Hepatol Res 2015; 45:1055-61. [PMID: 25689394 DOI: 10.1111/hepr.12452] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 11/05/2014] [Accepted: 11/16/2014] [Indexed: 02/08/2023]
Abstract
AIM To investigate the association between primary biliary cirrhosis (PBC) and risk of coronary artery disease (CAD). METHODS We conducted a systematic review and meta-analysis of published observational studies that reported relative risks, odd ratios, hazard ratios or standardized incidence ratios with 95% confidence intervals (CI) comparing CAD risk in patients with PBC versus non-PBC controls. Pooled risk ratios and 95% confidence intervals were combined using a random-effect model and generic inverse variance of DerSimonian and Laird methods. RESULT Four studies with 3362 patients with PBC were identified and included in our data analysis. The pooled risk ratio of CAD in patients with PBC was 1.57 (95% CI, 1.21-2.06). The statistical heterogeneity was low with an I(2) of 38%. CONCLUSION Our study demonstrated a statistically significant increased risk of CAD among patients with PBC.
Collapse
Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Karn Wijarnpreecha
- Cardiac Electrophysiology Unit, Department of Physiology, Chiang Mai University, Chiang Mai, Thailand
| | - Wasin Ahuja
- Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Ittikorn Spanuchart
- Department of Internal Medicine, John A. Burns School of Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
22
|
Pontiki E, Hadjipavlou-Litina D, Patsilinakos A, Tran TM, Marson CM. Pteridine-2,4-diamine derivatives as radical scavengers and inhibitors of lipoxygenase that can possess anti-inflammatory properties. Future Med Chem 2015; 7:1937-51. [PMID: 26423719 PMCID: PMC5462101 DOI: 10.4155/fmc.15.104] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Reactive oxygen species are associated with inflammation implicated in cancer, atherosclerosis and autoimmune diseases. The complex nature of inflammation and of oxidative stress suggests that dual-target agents may be effective in combating diseases involving reactive oxygen species. RESULTS A novel series of N-substituted 2,4-diaminopteridines has been synthesized and evaluated as antioxidants in several assays. Many exhibited potent lipid antioxidant properties, and some are inhibitors of soybean lipoxygenase, IC50 values extending down to 100 nM for both targets. Several pteridine derivatives showed efficacy at 0.01 mmol/kg with little tissue damage in a rat model of colitis. 2-(4-methylpiperazin-1-yl)-N-(thiophen-2-ylmethyl)pteridin-4-amine (18f) at 0.01 mmol/kg exhibited potent anti-inflammatory activity (reduction by 41%). CONCLUSION The 2,4-diaminopteridine core represents a new scaffold for lipoxygenase inhibition as well as sustaining anti-inflammatory properties.
Collapse
Affiliation(s)
- Eleni Pontiki
- Christopher Ingold Laboratories, Department of Chemistry, University College London, 20 Gordon Street, London WC1H OAJ, UK
- Department of Pharmaceutical Chemistry, Faculty of Health Sciences, School of Pharmacy, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - Dimitra Hadjipavlou-Litina
- Department of Pharmaceutical Chemistry, Faculty of Health Sciences, School of Pharmacy, Aristotle University of Thessaloniki, Thessaloniki, 54124, Greece
| | - Alexandros Patsilinakos
- Rome Center for Molecular Design, Dipartimento di Chimica e Tecnologie del Farmaco, Sapienza University of Rome, 00185 Rome, Italy
| | - Trang M Tran
- Christopher Ingold Laboratories, Department of Chemistry, University College London, 20 Gordon Street, London WC1H OAJ, UK
| | - Charles M Marson
- Christopher Ingold Laboratories, Department of Chemistry, University College London, 20 Gordon Street, London WC1H OAJ, UK
| |
Collapse
|
23
|
Ungprasert P, Thongprayoon C, Kittanamongkolchai W, Srivali N, Cheungpasitporn W. Peripheral arterial disease in patients with giant cell arteritis: a meta-analysis. Int J Rheum Dis 2015. [PMID: 26218931 DOI: 10.1111/1756-185x.12631] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
AIM To investigate the association between giant cell arteritis (GCA) and risk of peripheral arterial disease (PAD). METHODS We conducted a systematic review and meta-analysis of observational cohort studies that reported relative risks, hazard ratios or standardized incidence ratios with 95% confidence comparing PAD risk in patients with GCA versus non-GCA subjects. Pooled risk ratios and 95% confidence intervals were calculated using a random-effect, generic inverse variance of DerSimonian and Laird. RESULTS Four studies with 9789 patients with GCA and 236 728 controls were identified and included in our data analysis. The pooled risk ratio of PAD among patients with GCA compared with controls was 1.88 (95% CI 1.04-3.41). The statistical heterogeneity was high with an I(2) of 89%. CONCLUSION Our study demonstrated a statistically significant increased risk of PAD among patients with GCA.
Collapse
Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,Department of medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Charat Thongprayoon
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Narat Srivali
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wisit Cheungpasitporn
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
24
|
Ormseth MJ, Chung CP, Oeser AM, Connelly MA, Sokka T, Raggi P, Solus JF, Otvos JD, Stein CM. Utility of a novel inflammatory marker, GlycA, for assessment of rheumatoid arthritis disease activity and coronary atherosclerosis. Arthritis Res Ther 2015; 17:117. [PMID: 25956924 PMCID: PMC4445500 DOI: 10.1186/s13075-015-0646-x] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 05/01/2015] [Indexed: 01/05/2023] Open
Abstract
Introduction GlycA is a novel inflammatory biomarker measured using nuclear magnetic resonance (NMR). Its NMR signal primarily represents glycosylated acute phase proteins. GlycA was associated with inflammation and development of cardiovascular disease in initially healthy women. We hypothesized that GlycA is a biomarker of disease activity and is associated with coronary artery atherosclerosis in patients with rheumatoid arthritis (RA). Methods We conducted a cross-sectional study of 166 patients with RA and 90 control subjects. GlycA was measured from an NMR signal originating from N-acetylglucosamine residues on circulating glycoproteins. The relationship between GlycA and RA disease activity (Disease Activity Score based on 28 joints (DAS28)) and coronary artery calcium score was determined. Results GlycA concentrations were higher in patients with RA (median (interquartile range): 398 μmol/L (348 to 473 μmol/L)) than control subjects (344 μmol/L (314 to 403 μmol/L) (P < 0.001). In RA, GlycA was strongly correlated with DAS28 based on erythrocyte sedimentation rate (DAS28-ESR) and DAS28 based on C-reactive protein (DAS28-CRP) and their components, including tender and swollen joint counts, global health score, ESR and CRP (all P < 0.001). The area under the receiver operating characteristic curve for GlycA’s ability to differentiate between patients with low versus moderate to high disease activity based on DAS28-CRP was 0.75 (95 % confidence interval (CI): 0.68, 0.83). For each quartile increase in GlycA, the odds of having coronary artery calcium increased by 48 % (95 % CI: 4 %, 111 %), independent of age, race and sex (P = 0.03). Conclusion GlycA is a novel inflammatory marker that may be useful for assessment of disease activity and is associated with coronary artery atherosclerosis in patients with RA.
Collapse
Affiliation(s)
- Michelle J Ormseth
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T-3113 MCN, Nashville, TN, 37212, USA.
| | - Cecilia P Chung
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T-3113 MCN, Nashville, TN, 37212, USA.
| | - Annette M Oeser
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T-3113 MCN, Nashville, TN, 37212, USA.
| | | | - Tuulikki Sokka
- Department of Rheumatology, University of Eastern Finland, Jyvaskyla Central Hospital, 40620, Jyvaskyla, Finland.
| | - Paolo Raggi
- Department of Medicine, University of Alberta, 4A7.050, 8440 - 112 Street, Edmonton, AB, T6G 2B7, Canada.
| | - Joseph F Solus
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T-3113 MCN, Nashville, TN, 37212, USA.
| | | | - C Michael Stein
- Department of Medicine, Vanderbilt University Medical Center, 1161 21st Avenue South, T-3113 MCN, Nashville, TN, 37212, USA.
| |
Collapse
|
25
|
Sagun G, Oguz A, Mesci B, Isbilen B, Kavala M, Keskin H, Takir M, Aydin SZ. Levels of F2 isoprostane in Behcet's disease: Correlation with cardiometabolic risk factors. Redox Rep 2015; 20:223-7. [PMID: 25867971 DOI: 10.1179/1351000215y.0000000008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE Behcet's disease (BD) is a chronic inflammatory disease and recent findings suggest a role of oxidative stress in the pathogenesis of BD. Free radical-induced oxidative stress is also involved in the pathogenesis of cardiovascular and other rheumatic diseases. Oxidative stress may be detected in vivo by measuring F2 isoprostanes. Here, we measured plasma levels of F2 isoprostane in patients with BD and evaluated the correlation of F2 isoprostane with cardiometabolic risk factors. METHODS Forty-three patients with BD in remission and 37 age- and sex-matched controls were recruited for the study. Blood samples were obtained to determine F2 isoprostane, C-reactive protein levels, erythrocyte sedimentation rate, and other biochemical parameters. Homeostasis model assessment insulin resistance and body mass index were calculated. Systolic blood pressure, diastolic blood pressure, and waist circumference were measured. RESULTS Plasma F2 isoprostane, fasting plasma glucose, triglyceride, and C-reactive protein levels were significantly higher in patients with BD compared with healthy controls, whereas high-density lipoprotein cholesterol levels were significantly lower in patients with BD. F2 isoprostane levels did not correlate with cardiometabolic risk factors, C-reactive protein levels, or erythrocyte sedimentation rate. CONCLUSION High levels of F2 isoprostane in patients with BD indicate oxidative stress. Antioxidant therapeutic approaches could potentially affect the course of this disease.
Collapse
|
26
|
Ungprasert P, Srivali N, Kittanamongkolchai W. Risk of coronary artery disease in patients with ankylosing spondylitis: a systematic review and meta-analysis. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:51. [PMID: 25861606 DOI: 10.3978/j.issn.2305-5839.2015.02.05] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 01/22/2015] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To investigate the association between coronary artery disease (CAD) and ankylosing spondylitis (AS). METHODS We conducted a systematic review and meta-analysis of observational studies that reported relative risks, hazard ratios, standardized prevalence ratio or standardized incidence ratios with 95% confidence comparing CAD risk in patients with AS versus non-AS controls. Pooled risk ratios and 95% confidence intervals (CIs) were calculated using a random-effect, generic inverse variance of DerSimonian and Laird. RESULTS Out of 229 potentially relevant articles, ten studies (five retrospective cohort studies and five cross-sectional studies) were identified and included in our data analysis. The overall pooled risk ratio of CAD in patients with AS was 1.41 (95% CI: 1.29-1.54). The pooled risk ratios for cross-sectional and cohort studies were 2.08 (95% CI: 1.28-3.40) and 1.36 (95% CI: 1.31-1.41), respectively. The statistical heterogeneity of this meta-analysis was moderate with an I(2) of 56%. CONCLUSIONS Our study demonstrated a statistically significant increased CAD risk among patients with AS with 41% excess risk.
Collapse
Affiliation(s)
- Patompong Ungprasert
- 1 Division of Rheumatology, Department of Internal Medicine, 2 Division of Pulmonary and Critical Care, Department of Medicine, 3 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Narat Srivali
- 1 Division of Rheumatology, Department of Internal Medicine, 2 Division of Pulmonary and Critical Care, Department of Medicine, 3 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Wonngarm Kittanamongkolchai
- 1 Division of Rheumatology, Department of Internal Medicine, 2 Division of Pulmonary and Critical Care, Department of Medicine, 3 Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
27
|
Paccou J, Mentaverri R, Renard C, Liabeuf S, Fardellone P, Massy ZA, Brazier M, Kamel S. The relationships between serum sclerostin, bone mineral density, and vascular calcification in rheumatoid arthritis. J Clin Endocrinol Metab 2014; 99:4740-8. [PMID: 25222755 DOI: 10.1210/jc.2014-2327] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
CONTEXT Recent data indicate that the secreted glycoprotein sclerostin may be involved in vascular calcification (VC). OBJECTIVE The objective of the study was to establish whether serum sclerostin levels are associated with VC in patients with rheumatoid arthritis (RA). DESIGN This was a cross-sectional study. SETTING The study was conducted with ambulatory care. PATIENTS We compared 75 RA patients with 75 age- and gender-matched control participants. INTERVENTION Coronary artery calcification (CAC) and abdominal aortic calcification (AAC) scores were evaluated by computed tomography. MAIN OUTCOME MEASURE Serum sclerostin levels (determined with an ELISA) were assessed. A statistical analysis was performed to identify the determinants of serum sclerostin and VC. RESULTS AAC and CAC were more prevalent and more severe in patients with RA than in controls. Higher levels of AAC (P = .02) and a higher lumbar bone mineral density (BMD; P = .03) were identified as independent determinants of higher serum sclerostin levels in RA patients, whereas male gender (P = .03), higher lumbar BMD (P < .0001), and low estimated glomerular rate (P < .001) were identified as determinants in controls. In RA patients, a multivariate logistic regression analysis indicated that older age [P < .01, with an odds ratio (OR) per year 1.10] and male gender (P = .02, OR 6.79) were independent determinants of CAC and that older age (P < .001, OR 1.16) were independent determinants of AAC. In controls, the independent determinants were older age (P < .01, OR 1.19), hypertension (P < .01, OR 7.31), and lumbar BMD (P = .03, OR per 30 mg/cm(2) increment of 1.14) for CAC and older age (P = .01, OR 1.11) for AAC. CONCLUSIONS Serum sclerostin levels were significantly and independently associated with AAC in RA patients.
Collapse
Affiliation(s)
- J Paccou
- Department of Rheumatology (J.P., P.F.), INSERM Unité 1088 (J.P., R.M., C.R., S.L., P.F., Z.A.M., M.B., S.K.), "Pathophysiological mechanisms and consequences of cardiovascular calcification: role of cardiovascular and bone remodelling," Department of Endocrine and Bone Biology (R.M., M.B., S.K.), and Clinical Research Center (S.L.), Division of Clinical Pharmacology, Amiens University Medical Center, F-80054 Amiens, France; and Department of Nephrology (Z.A.M.), and Amboise Paré University Medical Center, Assistance Publique-Hôpitaux de Paris, F-92100 Boulogne Billancourt, France
| | | | | | | | | | | | | | | |
Collapse
|
28
|
Ungprasert P, Koster MJ, Warrington KJ. Coronary artery disease in giant cell arteritis: a systematic review and meta-analysis. Semin Arthritis Rheum 2014; 44:586-591. [PMID: 25434528 DOI: 10.1016/j.semarthrit.2014.10.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 10/14/2014] [Accepted: 10/24/2014] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To investigate the association between giant cell arteritis (GCA) and risk of coronary artery disease (CAD). METHODS We conducted a systematic review and meta-analysis of observational studies that reported relative risks, hazard ratios, or standardized incidence ratios with 95% confidence interval comparing CAD risk in patients with GCA versus non-GCA controls. Pooled risk ratios and 95% confidence intervals were calculated using a random-effect, generic inverse variance of DerSimonian and Laird. RESULT Six studies with 10,868 patients with GCA and 245,323 controls were identified and included in our data analysis. The pooled risk ratio of CAD in patients with GCA was 1.51 and did not achieve statistical significance (95% CI: 0.88-2.61). The statistical heterogeneity was high with an I(2) of 97%. CONCLUSION In contrast to other chronic systemic inflammatory disorders, our meta-analysis did not show any statistically significant increased risk of CAD among patients with GCA.
Collapse
Affiliation(s)
- Patompong Ungprasert
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905.
| | - Matthew J Koster
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Kenneth J Warrington
- Division of Rheumatology, Department of Medicine, Mayo Clinic, 200 First St SW, Rochester, MN 55905
| |
Collapse
|
29
|
Risk of coronary artery disease in patients with idiopathic inflammatory myopathies: A systematic review and meta-analysis of observational studies. Semin Arthritis Rheum 2014; 44:63-7. [DOI: 10.1016/j.semarthrit.2014.03.004] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2014] [Revised: 02/19/2014] [Accepted: 03/03/2014] [Indexed: 01/11/2023]
|
30
|
Urinary eicosanoid metabolites in HIV-infected women with central obesity switching to raltegravir: an analysis from the women, integrase, and fat accumulation trial. Mediators Inflamm 2014; 2014:803095. [PMID: 24991090 PMCID: PMC4058804 DOI: 10.1155/2014/803095] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 05/10/2014] [Accepted: 05/11/2014] [Indexed: 11/25/2022] Open
Abstract
Chronic inflammation is a hallmark of HIV infection. Eicosanoids reflect inflammation, oxidant stress, and vascular health and vary by sex and metabolic parameters. Raltegravir (RAL) is an HIV-1 integrase inhibitor that may have limited metabolic effects. We assessed urinary F2-isoprostanes (F2-IsoPs), prostaglandin E2 (PGE-M), prostacyclin (PGI-M), and thromboxane B2 (TxB2) in HIV-infected women switching to RAL-containing antiretroviral therapy (ART). Thirty-seven women (RAL = 17; PI/NNRTI = 20) with a median age of 43 years and BMI 32 kg/m2 completed week 24. TxB2 increased in the RAL versus PI/NNRTI arm (+0.09 versus −0.02; P = 0.06). Baseline PGI-M was lower in the RAL arm (P = 0.005); no other between-arm cross-sectional differences were observed. In the PI/NNRTI arm, 24-week visceral adipose tissue change correlated with PGI-M (rho = 0.45; P = 0.04) and TxB2 (rho = 0.44; P = 0.005) changes, with a trend seen for PGE-M (rho = 0.41; P = 0.07). In an adjusted model, age ≥ 50 years (N = 8) was associated with increased PGE-M (P = 0.04). In this randomized trial, a switch to RAL did not significantly affect urinary eicosanoids over 24 weeks. In women continuing PI/NNRTI, increased visceral adipose tissue correlated with increased PGI-M and PGE-M. Older age (≥50) was associated with increased PGE-M. Relationships between aging, adiposity, ART, and eicosanoids during HIV-infection require further study.
Collapse
|
31
|
Manavathongchai S, Bian A, Rho YH, Oeser A, Solus JF, Gebretsadik T, Shintani A, Stein CM. Inflammation and hypertension in rheumatoid arthritis. J Rheumatol 2013; 40:1806-11. [PMID: 23996293 DOI: 10.3899/jrheum.130394] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Hypertension (HTN), a common modifiable cardiovascular risk factor, is more common in patients with rheumatoid arthritis (RA), but the underlying mechanisms are unclear. We examined the hypothesis that mediators of inflammation and markers of cardiovascular risk are associated with HTN in RA. METHODS We compared measures of inflammation [serum C-reactive protein (CRP), tumor necrosis factor alpha (TNF-α), interleukin 6 (IL-6), homocysteine, and leptin concentrations] and insulin resistance [homeostasis model assessment index (HOMA)] in RA patients with (n = 90) and without HTN (n = 79). HTN was defined as blood pressure ≥ 140/90 mm Hg or treatment with antihypertensive therapy. The independent association of markers of interest with HTN was examined using multivariable logistic regression. RESULTS Patients with HTN were significantly older and had longer disease duration than those without HTN (both p < 0.001). Concentrations of homocysteine [11.1 (8.5-13.5) μmol/l vs 9.3 (7.8-11.0) μmol/l] were significantly higher in patients with HTN (p < 0.001). After adjustment for age, sex, race, smoking, body mass index, and corticosteroid and nonsteroidal antiinflammatory drugs (NSAID) use, increased concentrations of homocysteine (OR 2.9, 95% CI: 1.5-5.5, p = 0.001), and leptin (OR 2.0, 95% CI: 1.0-3.8, p = 0.046) were significantly associated with HTN, but the 28-joint Disease Activity Score, IL-6, CRP, TNF-α, and HOMA index were not (all p > 0.05). CONCLUSION HTN in patients with RA is not associated with generalized systemic inflammation or insulin resistance, but is associated with increasing concentrations of homocysteine and leptin. The pathogenesis of HTN in RA may involve pathways more regularly associated with fat and vascular homeostasis.
Collapse
Affiliation(s)
- Siriporn Manavathongchai
- From the Divisions of Clinical Pharmacology and Rheumatology, Departments of Medicine and Pharmacology; Department of Biostatistics; Vanderbilt University, Nashville, Tennessee, USA
| | | | | | | | | | | | | | | |
Collapse
|
32
|
Shi Q, Abusarah J, Baroudi G, Fernandes JC, Fahmi H, Benderdour M. Ramipril attenuates lipid peroxidation and cardiac fibrosis in an experimental model of rheumatoid arthritis. Arthritis Res Ther 2012; 14:R223. [PMID: 23079082 PMCID: PMC3580534 DOI: 10.1186/ar4062] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2011] [Accepted: 08/31/2012] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION Recent studies revealed that co-morbidity and mortality due to cardiovascular disease are increased in patients with rheumatoid arthritis (RA) but little is known about factors involved in these manifestations. This study aimed at characterizing the impact of arthritis on oxidative stress status and tissue fibrosis in the heart of rats with adjuvant-induced arthritis (AIA). METHODS AIA was induced with complete Freund's adjuvant in female Lewis rats. Animals were treated by oral administration of vehicle or angiotensin-converting enzyme inhibitor ramipril (10 mg/kg/day) for 28 days, beginning 1 day after arthritis induction. Isolated adult cardiomyocytes were exposed to 10 μM 4-hydroxynonenal (HNE) for 24 hours in the presence or absence of 10 μM ramipril. RESULTS Compared to controls, AIA rats showed significant 55 and 30% increase of 4-HNE/protein adducts in serum and left ventricular (LV) tissues, respectively. Cardiac mitochondrial NADP+-isocitrate dehydrogenase (mNADP-ICDH) activity decreased by 25% in AIA rats without any changes in its protein and mRNA expression. The loss of mNADP-ICDH activity was correlated with enhanced accumulation of HNE/mNADP-ICDH adducts as well as with decrease of glutathione and NADPH. Angiotensin II type 1 receptor (AT1R) expression and tissue fibrosis were induced in LV tissues from AIA rats. In isolated cardiomyocytes, HNE significantly decreased mNADP-ICDH activity and enhanced type I collagen and connective tissue growth factor expression. The oral administration of ramipril significantly reduced HNE and AT1R levels and restored mNADP-ICDH activity and redox status in LV tissues of AIA rats. The protective effects of this drug were also evident from the decrease in arthritis scoring and inflammatory markers. CONCLUSION Collectively, our findings disclosed that AIA induced oxidative stress and fibrosis in the heart. The fact that ramipril attenuates inflammation, oxidative stress and tissue fibrosis may provide a novel strategy to prevent heart diseases in RA.
Collapse
|
33
|
Kahlenberg JM, Kaplan MJ. Mechanisms of premature atherosclerosis in rheumatoid arthritis and lupus. Annu Rev Med 2012; 64:249-63. [PMID: 23020882 DOI: 10.1146/annurev-med-060911-090007] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE), the two most common systemic autoimmune disorders, have both unique and overlapping manifestations. One feature they share is a significantly enhanced risk of atherosclerotic cardiovascular (CV) disease that significantly contributes to morbidity and mortality. The primary mechanisms that drive CV damage in these diseases remain to be fully characterized, but recent discoveries indicate that distinct inflammatory pathways and immune dysregulation characteristic of RA and SLE likely play prominent roles. This review focuses on analyzing the major mechanisms and pathways potentially implicated in the acceleration of atherothrombosis and CV risk in SLE and RA, as well as in the identification of putative preventive strategies that may mitigate vascular complications in systemic autoimmunity.
Collapse
Affiliation(s)
- J Michelle Kahlenberg
- Division of Rheumatology, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109-5680, USA.
| | | |
Collapse
|
34
|
Paccou J, Brazier M, Mentaverri R, Kamel S, Fardellone P, Massy ZA. Vascular calcification in rheumatoid arthritis: prevalence, pathophysiological aspects and potential targets. Atherosclerosis 2012; 224:283-90. [PMID: 22703866 DOI: 10.1016/j.atherosclerosis.2012.04.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Revised: 03/29/2012] [Accepted: 04/13/2012] [Indexed: 12/23/2022]
Abstract
Individuals with rheumatoid arthritis (RA) are at increased risk for morbidity and mortality from cardiovascular disease. Excess cardiovascular mortality in RA patients cannot be fully explained by conventional cardiovascular risk factors. The purpose of this review is to discuss recent progress concerning the prevalence and pathophysiological aspects of vascular calcification in RA. RA patients have early-onset diffuse calcification involving multiple vascular beds compared to age and sex-matched controls. Pathogenesis of vascular calcification in RA patients is not fully understood, but specific mediators such as proinflammatory cytokines and not global inflammation could be involved. The possible link between osteoporosis and vascular calcification in RA will not be discussed. Finally, potential targets to reduce vascular calcification in RA will be discussed.
Collapse
Affiliation(s)
- J Paccou
- Department of Rheumatology, University Hospital of Amiens, FR-80054 Amiens, France.
| | | | | | | | | | | |
Collapse
|
35
|
Erbel R, Budoff M. Improvement of cardiovascular risk prediction using coronary imaging: subclinical atherosclerosis: the memory of lifetime risk factor exposure. Eur Heart J 2012; 33:1201-13. [PMID: 22547221 DOI: 10.1093/eurheartj/ehs076] [Citation(s) in RCA: 89] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Deaths from diseases of the heart are decreasing. Cardiovascular diseases (CVD) will be the main cause of morbidity and mortality in 2015 according to a WHO report. The main problem is related to the long-time delay between the start of the development of atherosclerosis in young adults and the manifestation many decades later. Despite a recent decline in a CVD mortality rate in men and women, the main problem is related to the acute manifestation as the acute coronary syndrome, which leads 30-50% of subjects to sudden and fatal outcomes. In addition, about 20% of first and recurrent acute myocardial infarctions are silent. The lifetime risk of coronary artery disease after 40 years is 49% for men and 32% for women. That means, we are confronted with a major health care problem. This is even more obvious, when the rate of coronary heart disease deaths out of the hospital are taken into account which amount to 70% in 2007. These data are confirmed for Europe despite a strong decline of hospital deaths. Another problem is related to the fact that the number of sudden cardiac death amounts to >300 000 in the general US population. It is about 10 times higher than in those patients who are defined as prone to sudden death due to low ejection fraction, ventricular arrhythmias, and acute myocardial infarction. For cardiologists, this general topic becomes even more obvious, because even well-known cardiologists experienced early (≤65 years) sudden cardiac deaths such as RW Campbell, JM Isner, PA Poole-Wilson, H Drexler, and recently the paediatric cardiologist from Hannover, A Wessels. These events underline again what has been emphasized 15 years ago by the MONICA study that two-thirds of patients die outside the hospital and that we have to concentrate on primary and secondary prevention, also in memory of these colleagues. This review will demonstrate the potential value of coronary artery calcification screening which can be used as a sign of subclinical coronary arteriosclerosis for improved risk prediction, the first step to prevention. Subclinical atherosclerosis represents the vessel memory of risk factor exposure.
Collapse
Affiliation(s)
- Raimund Erbel
- Department of Cardiology, West-German Heart Center Essen, University Duisburg Essen, Hufelandstrasse 55, Essen, Germany.
| | | |
Collapse
|
36
|
Minhas U, Das P, Bhatnagar A. Role of reactive intermediates in the immunopathogenesis of the pristane-induced Balb/c model of lupus. Lupus 2012; 20:1421-5. [PMID: 22095888 DOI: 10.1177/0961203311418791] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pristane-induced lupus in Balb/c mice represents an environmentally induced lupus model which is widely used for unravelling the mystery of the pathogenesis of the disease. An intraperitoneal innate immune reaction to pristane is primarily accountable for the development of the systemic lupus erythematosus-like disease in the model. In this study, reactive oxygen species (ROS) and nitric oxide (NO) levels were assessed (as a measure of chronic inflammation) in the peritoneum of the Balb/c model of SLE-like disease 6 months after a single intraperitoneal injection of pristane. Levels of ROS in peritoneal macrophages were significantly enhanced (mean fluorescence value ± SD: 648 ± 100.9) in pristane-treated mice (PT) as compared with control mice (mean fluorescence value ± SD: 79 ± 7.8) treated with phosphate buffer saline (PBST). An immunofluorescence study reveal the localization of ROS within nuclei, suggesting oxidative damage. Similarly, levels of NO were also markedly raised in PT mice (34.71 µmol/l ± 8.48) as compared with PBST mice (1.36 nmol/l ± 0.14). These new findings lead to speculation about the role of reactive intermediates in the development of disease. This study proposes that the sustained production of reactive intermediates during chronic intraperitoneal inflammation might reduce antioxidant defences and lead to a condition of oxidative stress, which might further be responsible for this autoimmune condition.
Collapse
Affiliation(s)
- U Minhas
- Department of Biochemistry, Basic Medical Sciences Block, Panjab University, Chandigarh, India
| | | | | |
Collapse
|
37
|
|
38
|
Boger MS, Bian A, Shintani A, Milne GL, Morrow JD, Erdem H, Mitchell V, Haas DW, Hulgan T. Sex differences in urinary biomarkers of vascular and endothelial function in HIV-infected persons receiving antiretroviral therapy. Antivir Ther 2011; 17:485-93. [PMID: 22293574 DOI: 10.3851/imp1990] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/16/2011] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cardiovascular disease (CVD) risk can be underestimated in HIV-infected patients receiving antiretroviral therapy (ART). Novel CVD risk markers in this population are needed. We hypothesized that eicosanoid metabolite production is increased with metabolic complications of ART. Our objective was to determine relationships between urine eicosanoids and traditional CVD risk factors in a cohort of HIV-infected persons receiving ART. METHODS Cross-sectional analysis of 107 individuals from a prospective cohort study with urine eicosanoids (isoprostane [15-F(2t)-IsoP], prostaglandin-E metabolite [PGE-M], thromboxane metabolite [11dTxB(2)], prostacyclin metabolite [PGI-M]) determined by gas or liquid chromatography-mass spectrometry. RESULTS 15-F(2t)-IsoP was higher (P=0.003), 11dTxB(2) tended to be higher (P=0.07) and PGE-M was lower (P=0.003) in females than in males. The overall median Framingham score was 4 (IQR 1-7). In multivariable analyses adjusting for age, CD4(+) T-cells, smoking status, non-steroidal anti-inflammatory drug use, aspirin use and body mass index (BMI), associations included: higher 15-F(2t)-IsoP with female sex (P=0.004) and current smoking (P=0.04), lower PGE-M with female sex (P=0.005) and higher BMI (P=0.03), higher 11dTxB(2) with increasing age (P=0.02) and current smoking (P=0.04), lower 11dTxB(2) with higher BMI (P=0.02), and higher PGI-M with current smoking (P=0.04). CONCLUSIONS In this pilot study of predominantly virologically suppressed HIV-infected individuals on ART, there were sex-specific differences in urinary eicosanoids, with females having more risk-associated parameters despite a low Framingham score. Eicosanoids might be useful CVD biomarkers in ART-treated, HIV-infected patients. Future studies should examine eicosanoids while assessing effects of specific ART regimens and targeted interventions on CVD outcomes.
Collapse
Affiliation(s)
- Michael S Boger
- Department of Medicine, Division of Infectious Diseases, Medical University of South Carolina, Charleston, SC, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
39
|
Affiliation(s)
- Ginger L Milne
- Division of Clinical Pharmacology, Vanderbilt University, Nashville, Tennessee 37232-6602, USA.
| | | | | | | | | |
Collapse
|
40
|
HASSAN SZ, GHEITA TA, KENAWY SA, FAHIM AT, EL-SOROUGY IM, ABDOU MS. Oxidative stress in systemic lupus erythematosus and rheumatoid arthritis patients: relationship to disease manifestations and activity. Int J Rheum Dis 2011; 14:325-331. [DOI: 10.1111/j.1756-185x.2011.01630.x] [Citation(s) in RCA: 110] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
41
|
Abstract
PURPOSE OF REVIEW To assess factors that promote atherogenesis and cardiovascular disease (CVD) in rheumatoid arthritis (RA). Also, to determine how control of inflammation with conventional and biological antirheumatic drugs affects cardiovascular risk. RECENT FINDINGS An excess risk of CVD occurs early in the RA disease course and indeed may predate disease onset. Inflammation is a key driver of CVD risk as it adversely affects body composition, glucose handling and lipid function, especially the atheroprotective role of high-density lipoprotein. Therapies for RA, especially hydroxychloroquine and methotrexate (MTX) have positive effects on cardiovascular risk factors such as glycaemic control and reverse cholesterol transport. MTX and antitumour necrosis factor-alpha drugs also appear to have beneficial effect on CVD event risk, although the data on MTX appears more consistently to favour such a benefit. SUMMARY Future work needs to understand which aspects of the inflammatory state contribute most to CVD risk and whether specific anti-inflammatory agents, either alone or in combination, afford maximal CVD protection in RA.
Collapse
Affiliation(s)
- Hoda Mirjafari
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Sciences Centre, The University of Manchester
| | | | | |
Collapse
|
42
|
Abstract
During recent years atherosclerosis, the major cause of cardiovascular disease (CVD), has been recognised as a chronic inflammatory condition in which rupture of atherosclerotic lesions appears to play a major role. The risk of CVD is raised in many rheumatic diseases. This risk is high in systemic lupus erythematosus - as much as a 50-times increase among middle-aged women has been reported. Studies on CVD and atherosclerosis in rheumatic disease could thus provide interesting information about CVD and atherosclerosis in addition to being an important clinical problem. A combination of traditional and nontraditional risk factors accounts for the increased risk of CVD and atherosclerosis in rheumatic disease. One interesting possibility is that atherosclerotic lesions in rheumatic disease are more prone to rupture than normal atherosclerotic lesions. It is also likely that increased risk of thrombosis may play an important role, not least in systemic lupus erythematosus. Further, it is not clear whether an increased risk of CVD is a general feature of rheumatic disease, or whether this only occurs among subgroups of patients. It should be emphasised that there is an apparent lack of treatment studies where CVD in rheumatic disease is the end point. Control of disease activity and of traditional risk factors, however, appears to be well founded in relation to CVD in rheumatic disease. Further studies are needed to determine the exact role of lipid-lowering drugs as statins. Hopefully novel therapies can be developed that target the causes of the inflammation in atherosclerotic lesions both in rheumatic patients and in the general population.
Collapse
Affiliation(s)
- Johan Frostegård
- Institute of Environmental Medicine, Unit of Immunology and Chronic Disease, Karolinska Institutet, 171 77 Stockholm, Sweden.
| |
Collapse
|