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Sanghavi N, Ingrassia JP, Korem S, Ash J, Pan S, Wasserman A. Cardiovascular Manifestations in Rheumatoid Arthritis. Cardiol Rev 2024; 32:146-152. [PMID: 36729119 DOI: 10.1097/crd.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Rheumatoid arthritis (RA) is a systemic inflammatory disorder that characteristically affects the joints. RA has extra-articular manifestations that can impact multiple organ systems including the heart, lungs, eyes, skin, and brain. Cardiovascular involvement is a leading cause of mortality in RA. Cardiovascular manifestations of RA include accelerated atherosclerosis, heart failure, pericarditis, myocarditis, endocarditis, rheumatoid nodules, and amyloidosis. Inflammation is an important mediator of endothelial dysfunction and is a key driver of cardiovascular risk and complications in patients with RA. Prompt identification of cardiac pathologies in patients with RA is essential for appropriate management and treatment. Choosing the most appropriate treatment regimen is based on individual patient factors. In this article, we provide a comprehensive review of the epidemiology, pathophysiology, clinical manifestations, diagnosis, and medical management of cardiovascular manifestations of RA. We also discuss the relationship between anti-rheumatic medications, specifically non-steroidal anti-inflammatory drugs, corticosteroids, methotrexate, statins, tumor necrosis factor inhibitors, interleukin-6 inhibitors, Janus kinase inhibitors, and cardiovascular disease.
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Affiliation(s)
- Nirali Sanghavi
- From the Department of Medicine, Westchester Medical Center, Valhalla, NY
| | | | - Sindhuja Korem
- Department of Rheumatology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Julia Ash
- Department of Rheumatology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Stephen Pan
- Department of Cardiology, Westchester Medical Center/New York Medical College, Valhalla, NY
| | - Amy Wasserman
- Department of Rheumatology, Westchester Medical Center/New York Medical College, Valhalla, NY
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2
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Ahmed A, Omar A, Ghattas M, Ghaly M, Al-Shatouri M. The Use of Ultrasound for Detecting the Association Between Endothelial Dysfunction and lp13.3 Genomic Region rs646776 Polymorphism in Patients With Rheumatoid Arthritis From the Suez Canal Region. Cureus 2023; 15:e34743. [PMID: 36913212 PMCID: PMC9998107 DOI: 10.7759/cureus.34743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
Background Rheumatoid arthritis (RA) is an autoimmune disease associated with endothelial dysfunction (ED) and vascular morbidity. The study aimed to use ultrasound to assess the relationships of lp13.3 genomic region-rs646776 polymorphism with ED and subclinical cardiovascular disease (CVD) in patients with RA from the Suez Canal region in Egypt. Results This case-control study included 66 patients with RA and 66 healthy controls. Polymerase chain reaction-restriction fragment length polymorphism showed that the genotype frequencies for lp13.3 genomic region-rs646776 polymorphism in the RA group were 62.1% (n = 41), 34.8% (n = 23), and 3% (n = 2) for the AA, AG, and GG genotypes, respectively. The prevalence of the G allele was higher in the RA group than in the control group (20.5% and 7.6%, respectively; p < 0.01). Furthermore, ED was more prevalent in G allele carriers than in A allele carriers, suggesting a greater probability of ED and CVD in patients with RA with the GG genotype than in those with other genotypes. Conclusions This study indicated the validity of ultrasound in detecting the association between lp13.3 genomic region-rs646776 polymorphism and ED in Egyptian patients with RA. These findings could help identify high-risk patients with RA who may benefit from active treatment to help prevent CVD.
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Affiliation(s)
- Afaf Ahmed
- Rheumatology, Suez Canal University Hospital, Ismailia, EGY
| | - Aziza Omar
- Rheumatology, Suez Canal University Hospital, Ismailia, EGY
| | - Maivel Ghattas
- Faculty of Medicine, Port Said University, Port Said, EGY
| | - Mona Ghaly
- Rheumatology, Suez Canal University Hospital, Ismailia, EGY
| | - Mohammad Al-Shatouri
- Diagnostic and Interventional Radiology, Suez Canal University Hospital, Ismailia, EGY
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3
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Mir R, Elfaki I, Jha CK, Javid J, Babakr AT, Banu S, Mir MM, Jamwal D, Khullar N, Alzahrani KJ, Chahal SMS. Biological and clinical implications of TNF-α promoter and CYP1B1 gene variations in Coronary Artery Disease susceptibility. Cardiovasc Hematol Disord Drug Targets 2021; 21:266-277. [PMID: 34939556 DOI: 10.2174/1871529x22666211221151830] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 11/17/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Cardiovascular diseases (CVD) are important causes of death worldwide. Atherosclerosis is a chronic inflammatory disorder. It is the major cause of CVD and is manifested by ischemic heart disease or coronary artery disease (CAD). TNF-α is a pro-inflammatory cytokine that regulates immune response and promotes the development of atherosclerosis. Cytochrome p450 1B1 (CYP1B1) is an enzyme involved in the metabolism of endogenous and exogenous substrates. OBJECTIVES This study aimed at examining the association of TNF-α rs1800629 G >A and CYP1B1 rs1056827 G>T gene polymorphisms with CAD susceptibility in an Indian cohort. METHODS AS-PCR and direct DNA sequencing were used to examine the association of TNF-α rs1800629 G >A and CYP1B1 rs1056827 G>T gene polymorphism with CAD in an Indian cohort. A total of 100 clinically confirmed cases of CAD and 110 matched apparently healthy controls were genotyped. RESULTS Allelic and genotypic frequencies did not deviate from Hardy-Weinberg equilibrium in the controls (p>0.05) for TNF-α G-308A and CYP1B1 rs1056827G>A. There was no significant difference between the TNF-α rs1800629 A>G genotype distribution between cases and controls (P-value >0.05). A significant difference was observed between the CYP1B1 rs1056827 G>T genotype distribution between CAD cases and controls (P<0.0003). Our result indicated that in the codominant model, the GA genotype of the CYP1B1 rs1056827 G>T was associated with CAD with OR= 2.21(1.17 to 4.15), RR=1.38(1.07 to 1.78), and P<0.013. In the dominant model, the (GA+AA) genotype was associated with CAD with OR=2.79(1.54 to 5.05) and P<0.007. The CYP1B1 rs1056827 'A' allele was associated with CAD with OR = 2.30 (1.55 to 3.42) and P< 0.0001. Our results indicated that TNF-α 1800629 gene polymorphism was strongly associated with hypercholesteremia (P<0.0009), HDL (P<0.0001), TGL (P<0.039), hypertension (P<0.0001), and smoking (P<0.0001) in patients with Coronary Artery Disease. Similar correlations of CYP1B1 rs1056827 genotypes were reported with cholesterol (P<0.020), HDL (P<0.002), LDL (P<0.006), hypertension (P<0.03), and smoking (P<0.005). CONCLUSION It was reported that the GA genotype of the CYP1B1 rs1056827 G>T was strongly associated with susceptibility to Coronary Artery Disease with OR= 2.21(1.17 to 4.15)) and P<0.013, and similarly, its A allele was associated with predisposition to CAD with OR = 2.30(1.55 to 3.42) and P< 0.0001. Our results indicated that TNF-α 1800629 gene polymorphism is not associated with predisposition to Coronary Artery Disease. Nevertheless, these results should be taken with caution and further validated with larger-scale studies before being introduced in the clinical setting.
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Affiliation(s)
- Rashid Mir
- Department of Medical Lab Technology, Prince Fahd Bin Sultan Research Chair, Faculty of Applied Medical Sciences, University of Tabuk. Saudi Arabia
| | - Imadeldin Elfaki
- Department of Biochemistry, Faculty of Science, University of Tabuk. Saudi Arabia
| | - Chandan K Jha
- Department of Human Genetics Punjabi University, Punjab, India; 4Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah. Saudi Arabia
| | - Jamsheed Javid
- Department of Medical Lab Technology, Prince Fahd Bin Sultan Research Chair, Faculty of Applied Medical Sciences, University of Tabuk. Saudi Arabia
| | - Abdullatif Taha Babakr
- Department of Medical Biochemistry, Faculty of Medicine, Umm Al-Qura University, Makkah. Saudi Arabia
| | - Shaheena Banu
- Sri Jayadeva Institute of Cardiovascular Science and Research, Bangalore. India
| | - Mohammad Muzaffar Mir
- Department of Basic Medical Sciences, College of Medicine, University of Bisha. Saudi Arabia
| | - Dheeraj Jamwal
- Department of Human Genetics Punjabi University, Punjab. India
| | - Naina Khullar
- Department of Zoology, Mata Gujri College, Fatehgarh Sahib - 140407. India
| | - Khalid J Alzahrani
- Department of Clinical Laboratories Sciences, College of Applied Medical Sciences, University of Taif. Saudi Arabia
| | - S M S Chahal
- Department of Human Genetics Punjabi University, Punjab. India
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4
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Carbone F, Bonaventura A, Liberale L, Paolino S, Torre F, Dallegri F, Montecucco F, Cutolo M. Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents. Clin Rev Allergy Immunol 2020; 58:1-14. [PMID: 30259381 DOI: 10.1007/s12016-018-8714-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Substantial epidemiological data identified cardiovascular (CV) diseases as a main cause of mortality in patients with rheumatoid arthritis (RA). In light of this, RA patients may benefit from additional CV risk screening and more intensive prevention strategies. Nevertheless, current algorithms for CV risk stratification still remain tailored on general population and are burdened by a significant underestimation of CV risk in RA patients. Acute CV events in patients with RA are largely related to an accelerated atherosclerosis. As pathophysiological features of atherosclerosis overlap those occurring in the inflamed RA synovium, the understanding of those common pathways represents an urgent need and a leading challenge for CV prevention in patients with RA. Genetic background, metabolic status, gut microbiome, and systemic inflammation have been also suggested as additional key pro-atherosclerotic factors. The aim of this narrative review is to update the current knowledge about pathophysiology of atherogenesis in RA patients and potential anti-atherosclerotic effects of disease-modifying anti-rheumatic drugs.
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Affiliation(s)
- Federico Carbone
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Aldo Bonaventura
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Luca Liberale
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,Center for Molecular Cardiology, University of Zürich, 12 Wagistrasse, 8952, Schlieren, Switzerland
| | - Sabrina Paolino
- Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine, University of Genoa, San Martino Polyclinic Hospital, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132, Genoa, Italy
| | - Francesco Torre
- IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132, Genoa, Italy.,Clinic of Emergency Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Franco Dallegri
- First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.,IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy
| | - Fabrizio Montecucco
- IRCCS Ospedale Policlinico San Martino Genoa-Italian Cardiovascular Network, 10 Largo Benzi, 16132, Genoa, Italy.,First Clinic of Internal Medicine, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, Genoa, Italy
| | - Maurizio Cutolo
- IRCCS Ospedale Policlinico San Martino Genoa, 10 Largo Benzi, 16132, Genoa, Italy. .,Research Laboratory and Academic Division of Clinical Rheumatology, Department of Internal Medicine and Centre of Excellence for Biomedical Research (CEBR), University of Genoa, San Martino Polyclinic Hospital, Genoa, Italy.
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Arsenaki E, Georgakopoulos P, Mitropoulou P, Koutli E, Thomas K, Charakida M, Georgiopoulos G. Cardiovascular Disease in Juvenile Idiopathic Arthritis. Curr Vasc Pharmacol 2020; 18:580-591. [DOI: 10.2174/1570161118666200408121307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2019] [Revised: 03/10/2020] [Accepted: 03/19/2020] [Indexed: 01/21/2023]
Abstract
Juvenile idiopathic arthritis (JIA), is a term used to describe a group of inflammatory disorders
beginning before the age of 16 years. Although for the majority of children remission is achieved
early, those with systemic or polyarticular form of the disease may present persistent symptoms in
adulthood. Considering that there is overlap in the pathogenesis of JIA with adult rheumatic diseases,
concerns have been raised as to whether JIA patients could be at increased cardiovascular (CV) risk in
the long-term. In this review, we summarize evidence for CV involvement in JIA and present data on
CV risk factors and surrogate markers of arterial disease. We also provide information on beneficial and
harmful CV effects of anti-inflammatory medications in the context of JIA and suggest strategies for
CV screening. Overall, patients with systemic forms of JIA demonstrate an adverse lipid profile and
early arterial changes relevant to accelerated arterial disease progression. Although there is paucity of
data on CV outcomes, we recommend a holistic approach in the management of JIA patients, which
includes CV risk factor monitoring and lifestyle modification as well as use, when necessary, of antiinflammatory
therapies with documented CV safety.
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Affiliation(s)
| | - Panagiotis Georgakopoulos
- National Department of Anatomy, School of Medicine, Faculty of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | | | - Evangelia Koutli
- UCL Institute for Liver and Digestive Health, Royal Free Hospital and UCL, London, United Kingdom
| | - Konstantinos Thomas
- Joint Rheumatology Program, Clinical Immunology-Rheumatology Unit, 2nd Department of Medicine and Laboratory, Hippokration General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Marietta Charakida
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
| | - Georgios Georgiopoulos
- School of Biomedical Engineering and Imaging Sciences, King’s College, London, United Kingdom
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6
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Yuan S, Carter P, Bruzelius M, Vithayathil M, Kar S, Mason AM, Lin A, Burgess S, Larsson SC. Effects of tumour necrosis factor on cardiovascular disease and cancer: A two-sample Mendelian randomization study. EBioMedicine 2020; 59:102956. [PMID: 32805626 PMCID: PMC7452586 DOI: 10.1016/j.ebiom.2020.102956] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 07/26/2020] [Accepted: 08/03/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Tumour necrosis factor (TNF) inhibitors are used in the treatment of certain autoimmune diseases but given the role of TNF in tumour biology and atherosclerosis, such therapies may influence the risk of cancer and cardiovascular disease. We conducted a Mendelian randomization study to explore whether TNF levels are causally related to cardiovascular disease and cancer. METHODS Single-nucleotide polymorphisms associated with TNF levels at genome-wide significance were identified from a genome-wide association study of 30 912 European-ancestry individuals. Three TNF-associated single-nucleotide polymorphisms associated with higher risk of autoimmune diseases were used as instrumental variables. Summary-level data for 14 cardiovascular diseases, overall cancer and 14 site-specific cancers were obtained from UK Biobank and consortia. FINDINGS Genetically-predicted TNF levels were positively associated with coronary artery disease (odds ratio (OR) 2.25; 95% confidence interval (CI) 1.50, 3.37) and ischaemic stroke (OR 2.27; 95% CI 1.50, 3.43), and inversely associated with overall cancer (OR 0.54; 95% CI 0.42, 0.69), breast cancer (OR 0.51; 95% CI 0.39, 0.67), and colorectal cancer (OR 0.20; 95% CI 0.09, 0.45). There were suggestive associations of TNF with venous thromboembolism (OR 2.18; 95% CI 1.32, 3.59), endometrial cancer (OR 0.25; 95% CI 0.07, 0.94), and lung cancer (OR 0.45; 95% CI 0.21, 0.94). INTERPRETATION This study found evidence of causal associations of increased TNF levels with higher risk of common cardiovascular diseases and lower risk of overall and certain cancers.
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Affiliation(s)
- Shuai Yuan
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm 17177, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Paul Carter
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Maria Bruzelius
- Coagulation Unit, Department of Hematology, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Siddhartha Kar
- MRC Integrative Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Amy M Mason
- British Heart Foundation Cardiovascular Epidemiology Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; National Institute for Health Research Cambridge Biomedical Research Centre, University of Cambridge and Cambridge University Hospitals, Cambridge, United Kingdom
| | - Ang Lin
- Department of Medicine Solna, Division of Immunology and Allergy, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Stephen Burgess
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom; MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Susanna C Larsson
- Unit of Cardiovascular and Nutritional Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm 17177, Sweden; Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
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7
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Li F, Zhang Y, Li H, Lu J, Jiang L, Vigersky RA, Zhou J, Wang C, Bao Y, Jia W. TIR generated by continuous glucose monitoring is associated with peripheral nerve function in type 2 diabetes. Diabetes Res Clin Pract 2020; 166:108289. [PMID: 32615278 DOI: 10.1016/j.diabres.2020.108289] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 05/07/2020] [Accepted: 06/24/2020] [Indexed: 02/07/2023]
Abstract
AIMS Continuous glucose monitoring (CGM)-derived time-in-range (TIR) of 3.9-10 mmol/L is associated with diabetic retinopathy in type 2 diabetes (T2DM), but its relationship to peripheral nerve function has not been previously investigated. To explore the association between the TIR and nerve conduction study parameters in patients with T2DM, we performed a cross-sectional analysis. METHODS A total of 740 patients with T2DM were enrolled in this study. All of the participants were divided into tertiles according to the TIR (TIR low: ≤53%; TIR medium: 54-76%; TIR high: ≥77%). Composite Z-scores of nerve conduction velocity (CV), latency, and amplitude were calculated. The linear correlation between the TIR and composite nerve function Z-score was evaluated and risk assessment was analysed using binary logistic regression. RESULTS The composite Z-score of the CV and amplitude increased with higher TIR and the composite Z-score of latency significantly decreased as the TIR tertiles increased (all P trend < 0.05). After adjusting for age, diabetes duration, height, weight and other confounding factors, higher TIR was associated with a higher composite Z-score of CV (β = 0.230, P < 0.001), amplitude (β = 0.099, P = 0.010), and lower composite Z-score of latency (β = -0.172, P < 0.001). The risk of TIR tertiles and low composite Z-score of CV remained significant even after adjustment of HbA1c (TIR medium: OR = 0.48, P = 0.001; TIR high: OR = 0.41, P < 0.001). CONCLUSIONS Higher TIR tertiles were independently associated with better peripheral nerve function. CGM-derived TIR may be a promising approach to screen patients for further assessment of possible diabetic peripheral neuropathy.
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Affiliation(s)
- Fengwen Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai 200233, China
| | - Yinan Zhang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, The Metabolic Diseases Biobank, Center for Translational Medicine, Shanghai Key Laboratory of Diabetes, Shanghai 200233, China
| | - Huizhi Li
- Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China
| | - Jingyi Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai 200233, China
| | - Lan Jiang
- Department of Electrophysiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China
| | - Robert A Vigersky
- Diabetes Institute of the Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Jian Zhou
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai 200233, China
| | - Congrong Wang
- Shanghai Jiao Tong University Affiliated Sixth People's Hospital, The Metabolic Diseases Biobank, Center for Translational Medicine, Shanghai Key Laboratory of Diabetes, Shanghai 200233, China; Department of Endocrinology, Shanghai East Hospital, Tongji University School of Medicine, Shanghai 200120, China; Shanghai East Hospital, Tongji University School of Medicine, Translational Medical Center for Stem Cell Therapy, Shanghai 200120, China.
| | - Yuqian Bao
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai 200233, China
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, Shanghai 200233, China.
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Solomon A, Stanwix AE, Castañeda S, Llorca J, Gonzalez-Juanatey C, Hodkinson B, Romela B, Ally MMTM, Maharaj AB, Van Duuren EM, Ziki JJ, Seboka M, Mohapi M, Jansen Van Rensburg BJ, Tarr GS, Makan K, Balton C, Gogakis A, González-Gay MA, Dessein PH. Points to consider in cardiovascular disease risk management among patients with rheumatoid arthritis living in South Africa, an unequal middle income country. BMC Rheumatol 2020; 4:42. [PMID: 32550295 PMCID: PMC7296622 DOI: 10.1186/s41927-020-00139-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 05/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients. Methods Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines. Results Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management (n = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs (n = 3), lipid lowering agents (n = 8), antihypertensive drugs (n = 1), low dose aspirin (n = 1) and lifestyle modification (n = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound. Conclusions Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.
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Affiliation(s)
- Ahmed Solomon
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Anne E Stanwix
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Santos Castañeda
- Rheumatology Department, Hospital de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Javier Llorca
- Universidad de Cantabria - IDIVAL, CIBER Epidemiologia y Salud Pública (CIBERESP), Santander, Spain
| | | | - Bridget Hodkinson
- Rheumatology Department, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa
| | - Benitha Romela
- Rheumatology Unit, Wilgeheuwel Hospital, Johannesburg, South Africa
| | - Mahmood M T M Ally
- Rheumatology Department, Steve Biko Academic Hospital, University of Pretoria, Pretoria, South Africa
| | - Ajesh B Maharaj
- Rheumatology Unit, Westville Hospital and University of KwaZulu-Natal, Durban, South Africa
| | - Elsa M Van Duuren
- Rheumatology Division, Department of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Joyce J Ziki
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Mpoti Seboka
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Makgotso Mohapi
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | | | - Gareth S Tarr
- Rheumatology Department, Tygerberg Hospital, Faculty of Health Sciences, Physiological Sciences Department, Stellenbosch University, Stellenbosch, Western Cape South Africa
| | - Kavita Makan
- Rheumatology Department, Chris Hani Baragwanath Hospital, Johannesburg, South Africa
| | - Charlene Balton
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa
| | - Aphrodite Gogakis
- Radiology Unit, Rivonia Road Medical Centre, Morningside, Johannesburg, South Africa
| | - Miguel A González-Gay
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Division of Rheumatology and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Hospital Universitario Marqués de Valdecilla, Instituto de Investigación Marqués de Valdecilla (IDIVAL), Spain; University of Cantabria, Santander, Spain
| | - Patrick H Dessein
- Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa.,School of Physiology and School of Clinical Medicine, Faculty Health Sciences, University of Witwatersrand, Johannesburg, South Africa.,Free University and University Hospital, Brussels, Belgium
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9
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Castañeda S, Vicente-Rabaneda EF, García-Castañeda N, Prieto-Peña D, Dessein PH, González-Gay MA. Unmet needs in the management of cardiovascular risk in inflammatory joint diseases. Expert Rev Clin Immunol 2019; 16:23-36. [DOI: 10.1080/1744666x.2019.1699058] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Santos Castañeda
- Rheumatology Division, Hospital Universitario de La Princesa, IIS-Princesa, Madrid, Spain
- Department of Medicine, Cátedra UAM-ROCHE, EPID Future, Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | | | | | - Diana Prieto-Peña
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - Patrick H. Dessein
- Honorary Research Professor, School of Physiology and School of Clinical Medicine, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
| | - Miguel A. González-Gay
- Division and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
- School of Medicine, University of Cantabria, Santander, Spain
- Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of Witwatersrand, Johannesburg, South Africa
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Pan J, Hu J, Qi X, Xu L. Association study of a functional variant of TNF-α gene and serum TNF-α level with the susceptibility of congenital heart disease in a Chinese population. Postgrad Med J 2019; 95:547-551. [PMID: 31324728 DOI: 10.1136/postgradmedj-2019-136621] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/31/2019] [Accepted: 06/23/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Congenital heart disease (CHD) is among the leading causes of infant death worldwide. Although shortage of folate has been found potentially to contribute to CHD in the embryo, the aetiology of CHD was not completely understood. Inflammation and altered immune processes are involved in all forms of cardiac malformation, including CHD. Tumour necrosis factor-α (TNF-α), was involved in the pathogenesis of multiple kinds of heart diseases. However, no studies have systematically evaluated the associations of genetic variants of TNF-α with susceptibility of CHD. METHODS A case-control study was conducted to evaluate the associations between tagSNPs of TNF-α and CHD susceptibility. Serum level of TNF-α was assessed using ELISA. The dual luciferase reporter assay was used to evaluate the functional significance of variant rs1800629 on TNF-α transcriptional activity. RESULTS We found rs1800629 was significantly correlated with increased CHD susceptibility (OR: 1.72, 95% CI 1.26 to 2.36, p=0.001). Serum levels of TNF-α were significantly higher in CHD group (9.09±1.90 pg/mL) than that in control group (6.12±1.56 pg/mL, p<0.001). The AA genotype and AG genotype of rs1800629 was associated with higher serum TNF-α level, compared with GG genotype. The dual luciferase reporter assay showed that promoter activity was significantly increased by 57% and 76% for plasmids containing the minor A allele compared with the major G allele in H9c2 and HEK 293T, respectively. CONCLUSION These results indicate that higher level of serum TNF-α increases risk of CHD, while TNF-α rs1800629 A allele might contribute to higher risk for CHD due to the increase in TNF-α expression.
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Affiliation(s)
- Jun Pan
- Pediatrics, Taihe Hospital, Shiyan, China
| | - Jiang Hu
- Oncology, Taihe Hospital, Shiyan, China
| | - Xusheng Qi
- Pediatrics, Taihe Hospital, Shiyan, China
| | - Liqin Xu
- Pediatrics, Taihe Hospital, Shiyan, China
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11
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Abstract
Purpose of review Persuasive statistics support the clinical observation that because of cardiovascular comorbidities patients with inflammatory joint disease die significantly earlier despite anti-inflammatory therapy. Recent findings The reason for this earlier death is multifactorial and involves a combination of a complex genetic background, environmental influences, classical cardiovascular risk factors and the impact of anti-inflammatory therapy. We will describe the importance of several new mechanisms, especially the diverse intercellular communication routes including extracellular vesicles and microRNAs that support the development of cardiovascular comorbidities. Summary The aim of this review is to give an updated overview about the known risk factors in the development of cardiovascular comorbidities with the latest insights about their mechanism of action. Furthermore, the impact of newly identified risk factors and significance will be discussed.
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12
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Nejati P, Naeimipour S, Salehi A, Shahbazi M. Association of tumor necrosis factor-alpha gene promoter polymorphism and its mRNA expression level in coronary artery disease. Meta Gene 2018. [DOI: 10.1016/j.mgene.2018.08.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
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13
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Schurman SH, Bravo MA, Innes CL, Jackson WB, McGrath JA, Miranda ML, Garantziotis S. Toll-like Receptor 4 Pathway Polymorphisms Interact with Pollution to Influence Asthma Diagnosis and Severity. Sci Rep 2018; 8:12713. [PMID: 30140039 PMCID: PMC6107668 DOI: 10.1038/s41598-018-30865-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/18/2018] [Indexed: 12/21/2022] Open
Abstract
Asthma is a common chronic lung disease, the incidence and severity of which may be influenced by gene-environment interactions. Our objective was to examine associations between single nucleotide polymorphisms (SNPs) and combinations of SNPs in the toll-like receptor 4 (TLR4) pathway, residential distance to roadway as a proxy for traffic-related air pollution exposure, and asthma diagnosis and exacerbations. We obtained individual-level data on genotype, residential address, and asthma diagnosis and exacerbations from the Environmental Polymorphisms Registry. Subjects (n = 2,704) were divided into three groups (hyper-responders, hypo-responders, and neither) based on SNP combinations in genes along the TLR4 pathway. We geocoded subjects and calculated distance, classified as <250 m or ≥250 m, between residence and nearest major road. Relationships between genotype, distance to road, and odds of asthma diagnosis and exacerbations were examined using logistic regression. Odds of an asthma diagnosis among hyper-responders <250 m from a major road was 2.37(0.97, 6.01) compared to the reference group (p < 0.10). Hypo-responders ≥250 m from the nearest road had lower odds of activity limitations (0.46 [0.21, 0.95]) and sleeplessness (0.36 [0.12, 0.91]) compared to neither-responders (p < 0.05). Specific genotype combinations when combined with an individual's proximity to roadways, possibly due to traffic-related air pollution exposure, may affect the likelihood of asthma diagnosis and exacerbations.
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Affiliation(s)
- Shepherd H Schurman
- Clinical Research Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, 27709, United States
| | - Mercedes A Bravo
- Children's Environmental Health Initiative, Rice University, Houston, Texas, 77005, United States
| | - Cynthia L Innes
- Clinical Research Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, 27709, United States
| | - W Braxton Jackson
- Social and Scientific Systems, Durham, North Carolina, 27703, United States
| | - John A McGrath
- Social and Scientific Systems, Durham, North Carolina, 27703, United States
| | - Marie Lynn Miranda
- Children's Environmental Health Initiative, Rice University, Houston, Texas, 77005, United States.
- Department of Statistics, Rice University, Houston, Texas, 77005, United States.
| | - Stavros Garantziotis
- Clinical Research Branch, Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, North Carolina, 27709, United States.
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Toxic Metals Increase Serum Tumor Necrosis Factor-α Levels, Modified by Essential Elements and Different Types of Tumor Necrosis Factor-α Promoter Single-nucleotide Polymorphisms. Epidemiology 2017; 28 Suppl 1:S113-S120. [DOI: 10.1097/ede.0000000000000738] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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15
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The profile of selected single nucleotide polymorphisms in patients with hypertension and heart failure with preserved and mid-range ejection fraction. Sci Rep 2017; 7:8974. [PMID: 28827564 PMCID: PMC5566797 DOI: 10.1038/s41598-017-09564-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 07/25/2017] [Indexed: 12/23/2022] Open
Abstract
The study aimed to assess the clinical significance of selected single nucleotide polymorphisms (SNPs) in patients with diastolic heart failure (HF): inflammation [-174 G/C Interleukin -6 (IL-6) rs1800795, tumor necrosis factor (TNF)-608 G/A rs1800629], fibrosis [Arg25Pro transforming growth factor β (TGF β) rs1800471], endothelial function [-786 T/C nitric oxide synthase (NOS) rs2070744], glucose and lipid metabolism [Pro12Ala peroxisome proliferator activated receptor (PPAR)γ rs1801282], and vitamin D metabolism [cytochrome P450 27B1 (CYP27B1) C-1260A].110 patients with HF with preserved and mid-range ejection fraction (HFpEF and HFmrEF) were recruited. GG homozygotes in 174 G/C of IL6 polymorphism are characterized by higher values of estimated glomerular filtration rate based on the study Modification of Diet in Renal Disease (eGFR MDRD) and C allele in the NOS polymorphism and AA profile in C-1260A of CYP27B1 polymorphism correlated with a lower eGFR (MDRD). In multivariate analysis the CG genotype for 174 G/C of IL-6 and allele A in C-1260A of CYP27B1 are the only SNPs independently associated with worse course of HFpEF and HFmrEF. These data confirm the importance of the selected SNPs in aggravation and complications of hypertension.
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Tumor necrosis factor-α -308 polymorphism in North Indian rheumatoid arthritis patients and association with mRNA and serum TNF-α. Clin Rheumatol 2017; 36:2209-2216. [DOI: 10.1007/s10067-017-3774-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Revised: 07/12/2017] [Accepted: 07/18/2017] [Indexed: 10/19/2022]
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17
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Masoud S, Lim PB, Kitas GD, Panoulas V. Sudden cardiac death in patients with rheumatoid arthritis. World J Cardiol 2017; 9:562-573. [PMID: 28824786 PMCID: PMC5545140 DOI: 10.4330/wjc.v9.i7.562] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2016] [Revised: 03/15/2017] [Accepted: 04/19/2017] [Indexed: 02/06/2023] Open
Abstract
An increased cardiovascular morbidity and mortality, including the risk of sudden cardiac death (SCD), has been shown in patients with rheumatoid arthritis (RA). Abnormalities in autonomic markers such as heart rate variability and ventricular repolarization parameters, such as QTc interval and QT dispersion, have been associated with sudden death in patients with RA. The interplay between these parameters and inflammation that is known to exist with RA is of growing interest. In this article, we review the prevalence and predictors of SCD in patients with RA and describe the potential underlying mechanisms, which may contribute to this. We also review the impact of biologic agents on arrhythmic risk as well as cardiovascular morbidity and mortality.
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18
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Zhang P, Wu X, Li G, He Q, Dai H, Ai C, Shi J. Tumor necrosis factor-alpha gene polymorphisms and susceptibility to ischemic heart disease: A systematic review and meta-analysis. Medicine (Baltimore) 2017; 96:e6569. [PMID: 28383437 PMCID: PMC5411221 DOI: 10.1097/md.0000000000006569] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND A number of studies had reported the association between tumor necrosis factor-alpha (TNF-α) gene polymorphisms and ischemic heart disease (IHD) risk. However, the results remained controversial. Therefore, we performed a systematic review with multiple meta-analyses to provide the more precise estimations of the relationship. METHODS We systematically searched electronic databases (PubMed, the Web of Science, EMBASE, Medline, Chinese National Knowledge Infrastructure, WanFang and ChongQing VIP Database) for relevant studies published up to February 2017. The odds ratios (ORs) and 95% confidence intervals (CIs) were estimated for assessing the association. The present meta-analysis was performed using STATA 12.0 software. RESULTS In total, 45 articles with 17,375 cases and 15,375 controls involved were included. Pooled ORs revealed a significant association between TNF-α -308G/A gene polymorphism and IHD (A vs. G: OR = 1.22, 95% CI = 1.10-1.35; (AA + GA) vs. GG: OR = 1.18, 95% CI = 1.03-1.36; (AA vs. (GA+GG): OR = 1.37, 95% CI = 1.08-1.75)), indicating that the TNF-α -308A allele might be an important risk factor for IHD. No association between other TNF-α gene polymorphisms and susceptibility to IHD were observed. No publication bias were found. Sensitivity analyses indicated that our results were stable. CONCLUSION The present study indicated a possible association between the TNF-α -308G/A gene polymorphism and IHD risk. However, evidence was limited to confirm the role of TNF-α -238G/A, -857C/T, -863C/A, -1031T/C and other TNF-α gene polymorphisms in the risk of IHD.
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19
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Cardiovascular disease in rheumatoid arthritis: medications and risk factors in China. Clin Rheumatol 2017; 36:1023-1029. [PMID: 28342151 DOI: 10.1007/s10067-017-3596-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 02/28/2017] [Accepted: 03/02/2017] [Indexed: 10/19/2022]
Abstract
This study aims to assess the risk factors of cardiovascular disease (CVD) and to determine the association of traditional and biologic disease-modifying anti-rheumatic drugs (DMARDs) with risk for CVD in Chinese rheumatoid arthritis (RA) patients. A cross-sectional cohort of 2013 RA patients from 21 hospitals around China was established. Medical history of CVD was documented. The patients' social background, clinical manifestations, comorbidities, and medications were also collected. Of the 2013 patients, 256 had CVD with an incidence of 12.7%. Compared with non-CVD controls, RA patients with CVD had a significantly advanced age, long-standing median disease duration, more often male and more deformity joints. Patients with CVD also had higher rates of smoking, rheumatoid nodules, interstitial lung disease, and anemia. The prevalence of comorbidities, including hypothyroidism, diabetes mellitus (DM), hypertension, and hyperlipidemia, was also significant higher in the CVD group. In contrast, patients treated with methotrexate, hydroxychloroquine (HCQ), and TNF blockers had lower incidence of CVD. The multivariate analysis showed that the use of HCQ was a protective factor of CVD, while hypertension, hyperlipidemia, and interstitial lung disease were independent risk factors of CVD. Our study shows that the independent risk factors of CVD include hypertension, hyperlipidemia, and interstitial lung disease. HCQ reduces the risk of CVD in patients with RA.
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20
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Mahmoudi M, Aslani S, Fadaei R, Jamshidi AR. New insights to the mechanisms underlying atherosclerosis in rheumatoid arthritis. Int J Rheum Dis 2017; 20:287-297. [PMID: 28205331 DOI: 10.1111/1756-185x.12999] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Rheumatoid arthritis (RA) is an inflammatory circumstance, which has been associated with increased risk of cardiovascular disease (CVD). Although RA management has been promoted, mortality rate due to CVD remains remarkable. Approximately, 50% of premature death cases in RA are attributable to CVD. RA patients develop atherosclerosis in a greater amount than the general population. Moreover, atherosclerotic lesions develop rapidly in RA patients and might be more susceptible to rupture. The inflammatory condition of RA, such as cytokines, abnormally activated immune cells, play a role in the initiation, perpetuation and exacerbation of atherosclerosis. RA and CVD have genetic and environmental contributing risk factors in common, implying to potential coincidence of both disorders. Accelerated atherosclerosis in RA is attributed to inflammation, which carries its role out both through modulation of traditional risk factors and direct effect on the vessel wall. Hence, anti-inflammatory medications in RA like tumor necrosis factor blockers might have a beneficial effect on preventing cardiovascular development. Increasing age, smoking, hypertension, male gender, hypercholesterolemia and diabetes are enumerated as traditional CVD risk factors. Hopefully, further understanding of the cardiovascular risk factors by perceiving the disease conditions behind CVD, will improve management of cardiovascular risks in patients with RA.
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Affiliation(s)
- Mahdi Mahmoudi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Saeed Aslani
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Fadaei
- Biochemistry Department, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Reza Jamshidi
- Rheumatology Research Center, Tehran University of Medical Sciences, Tehran, Iran
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21
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Damen MSMA, Agca R, Holewijn S, de Graaf J, Dos Santos JC, van Riel PL, Fransen J, Coenen MJH, Nurmohamed MT, Netea MG, Dinarello CA, Joosten LAB, Heinhuis B, Popa CD. IL-32 promoter SNP rs4786370 predisposes to modified lipoprotein profiles in patients with rheumatoid arthritis. Sci Rep 2017; 7:41629. [PMID: 28134327 PMCID: PMC5278556 DOI: 10.1038/srep41629] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/22/2016] [Indexed: 01/22/2023] Open
Abstract
Patients with rheumatoid arthritis (RA) are at higher risk of developing cardiovascular diseases (CVD). Interleukin (IL)-32 has previously been shown to be involved in the pathogenesis of RA and might be linked to the development of atherosclerosis. However, the exact mechanism linking IL-32 to CVD still needs to be elucidated. The influence of a functional genetic variant of IL-32 on lipid profiles and CVD risk was therefore studied in whole blood from individuals from the NBS cohort and RA patients from 2 independent cohorts. Lipid profiles were matched to the specific IL-32 genotypes. Allelic distribution was similar in all three groups. Interestingly, significantly higher levels of high density lipoprotein cholesterol (HDLc) were observed in individuals from the NBS cohort and RA patients from the Nijmegen cohort homozygous for the C allele (p = 0.0141 and p = 0.0314 respectively). In contrast, the CC-genotype was associated with elevated low density lipoprotein cholesterol (LDLc) and total cholesterol (TC) in individuals at higher risk for CVD (plaque positive) (p = 0.0396; p = 0.0363 respectively). Our study shows a functional effect of a promoter single-nucleotide polymorphism (SNP) in IL32 on lipid profiles in RA patients and individuals, suggesting a possible protective role of this SNP against CVD.
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Affiliation(s)
- Michelle S M A Damen
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Rabia Agca
- Amsterdam Rheumatology immunology Center, Department of Rheumatology, location CU University Medical Center and Reade, Amsterdam, The Netherlands
| | | | - Jacqueline de Graaf
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Jéssica C Dos Santos
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.,Instituto de Patologia Tropical e Saúde Pública, Universidade Federal de Goiás, Brazil
| | - Piet L van Riel
- Department of Rheumatology, Bernhoven Ziekenhuis, Uden, The Netherlands
| | - Jaap Fransen
- Department of Rheumatology, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands
| | - Marieke J H Coenen
- Radboud Institute for Health Sciences, Department of Human Genetics, Radboud university medical center, Nijmegen, The Netherlands
| | - Mike T Nurmohamed
- Amsterdam Rheumatology immunology Center, Department of Rheumatology, location CU University Medical Center and Reade, Amsterdam, The Netherlands
| | - Mihai G Netea
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Charles A Dinarello
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands.,School of Medicine, Division of infectious diseases, University of Colorado Denver, Aurora, Colorado 80045, United States of America
| | - Leo A B Joosten
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Bas Heinhuis
- Department of Internal Medicine and Radboud Center for Infectious Diseases (RCI), Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Calin D Popa
- Department of Rheumatology, Bernhoven Ziekenhuis, Uden, The Netherlands.,Department of Rheumatology, Radboud University Medical Center, 6525GA Nijmegen, The Netherlands
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22
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Cardiovascular risk assessment in patients with rheumatoid arthritis: The relevance of clinical, genetic and serological markers. Autoimmun Rev 2016; 15:1013-1030. [DOI: 10.1016/j.autrev.2016.07.026] [Citation(s) in RCA: 87] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Accepted: 07/09/2016] [Indexed: 12/11/2022]
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23
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Cardiovascular disease in inflammatory rheumatic diseases. Best Pract Res Clin Rheumatol 2016; 30:851-869. [DOI: 10.1016/j.berh.2016.10.006] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 10/09/2016] [Accepted: 10/13/2016] [Indexed: 02/06/2023]
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TNFA gene variants related to the inflammatory status and its association with cellular aging: From the CORDIOPREV study. Exp Gerontol 2016; 83:56-62. [DOI: 10.1016/j.exger.2016.07.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Revised: 07/26/2016] [Accepted: 07/27/2016] [Indexed: 01/06/2023]
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25
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Nascimento H, Vieira E, Coimbra S, Catarino C, Costa E, Bronze-da-Rocha E, Rocha-Pereira P, Carvalho M, Ferreira Mansilha H, Rêgo C, Dos Santos R, Santos-Silva A, Belo L. Adipokine Gene Single-Nucleotide Polymorphisms in Portuguese Obese Adolescents: Associations with Plasma Concentrations of Adiponectin, Resistin, IL-6, IL-1β, and TNF-α. Child Obes 2016; 12:300-13. [PMID: 27159547 DOI: 10.1089/chi.2015.0235] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
BACKGROUND The genetic contribution to obesity and to circulating adipokine levels has not been completely clarified. We aimed to evaluate adipokine genes' single-nucleotide polymorphism (SNP) prevalence and its association with circulating adipokine levels and risk factors for cardiovascular disease in an obese Portuguese pediatric population. METHODS Two hundred forty-eight obese adolescents (mean age 13.4 years old; 47.2% females) participated in a cohort study. We screened 12 SNPs by direct sequencing in five adipokine genes: adiponectin (ADIPOQ: rs16861194, rs17300539, rs266729, rs2241766, rs1501299), interleukin-1β (IL-1β; rs1143627), IL-6 (IL-6; rs1800795), tumor necrosis factor-α (TNF-α; rs1800629), and resistin (RETN; rs1862513, rs3219177, rs3745367, rs3745368). Biochemical analysis included determination of circulating adipokines, C-reactive protein (CRP) levels, lipid profile, and markers of insulin resistance. RESULTS Compared to males, females presented higher circulating levels of insulin, adiponectin, IL-6, resistin, and leptin concentrations, but lower TNF-α levels. No statistically significant differences were found for genotype or allelic distributions between genders. In the whole sample population, adiponectin levels were influenced by ADIPOQ rs17300539 (c.-1138G>A; lower in subjects with GG genotype). When only males were considered, IL-1β, IL-6, and TNF-α levels were associated with ADIPOQ rs1501299 (c.214 + 62G>T; higher in GG subjects). TNF-α concentrations were modulated by TNF-α rs1800629 (c.-488G>A; lower in GG males), RETN rs1862513 (c.-216C>G; higher in CC subjects), and RETN rs3219177 (c.118 + 39C>T; higher in CC subjects). Leptin levels were influenced by IL-1β rs1143627 (c.-118C>T) presenting TT individuals' lower levels. CONCLUSIONS Our data demonstrate that in pediatric obese patients, some adipokine gene SNPs have an association with circulating adipokine levels and lipid profile.
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Affiliation(s)
- Henrique Nascimento
- 1 IBMC-Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto , Porto, Portugal .,2 Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto , Porto, Portugal .,3 UCIBIO\REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto , Porto, Portugal
| | - Emília Vieira
- 4 Molecular Genetics Unit, Medical Genetics Center Dr. Jacinto de Magalhães , Porto Hospital Centre, Porto, Portugal
| | - Susana Coimbra
- 3 UCIBIO\REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto , Porto, Portugal .,5 CESPU, Institute of Research and Advanced Training in Health Sciences and Technologies (IINFACTS) , Gandra-PRD, Portugal
| | - Cristina Catarino
- 1 IBMC-Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto , Porto, Portugal .,2 Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto , Porto, Portugal .,3 UCIBIO\REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto , Porto, Portugal
| | - Elísio Costa
- 1 IBMC-Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto , Porto, Portugal .,2 Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto , Porto, Portugal .,3 UCIBIO\REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto , Porto, Portugal
| | - Elsa Bronze-da-Rocha
- 1 IBMC-Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto , Porto, Portugal .,2 Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto , Porto, Portugal .,3 UCIBIO\REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto , Porto, Portugal
| | | | - Márcia Carvalho
- 7 FP-ENAS, CEBIMED, Fundação Ensino e Cultura Fernando Pessoa , Porto, Portugal
| | - Helena Ferreira Mansilha
- 8 Childhood and Adolescence Department of CMIN (Centro Materno-Infantil do Norte), Porto Hospital Centre, ICBAS (Instituto de Ciências Biomédicas Abel Salazar), University of Porto , Porto, Portugal
| | - Carla Rêgo
- 9 Children and Adolescent Centre, CUF Hospital, Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto , Porto, Portugal
| | - Rosário Dos Santos
- 4 Molecular Genetics Unit, Medical Genetics Center Dr. Jacinto de Magalhães , Porto Hospital Centre, Porto, Portugal
| | - Alice Santos-Silva
- 1 IBMC-Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto , Porto, Portugal .,2 Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto , Porto, Portugal .,3 UCIBIO\REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto , Porto, Portugal
| | - Luís Belo
- 1 IBMC-Instituto de Biologia Molecular e Celular (Institute for Molecular and Cell Biology), Universidade do Porto , Porto, Portugal .,2 Instituto de Investigação e Inovação em Saúde (Institute for Research and Innovation in Health), Universidade do Porto , Porto, Portugal .,3 UCIBIO\REQUIMTE, Department of Biological Sciences, Laboratory of Biochemistry, Faculty of Pharmacy, University of Porto , Porto, Portugal
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Rodríguez-Carrio J, López-Mejías R, Alperi-López M, López P, Ballina-García FJ, González-Gay MÁ, Suárez A. Paraoxonase 1 Activity Is Modulated by the rs662 Polymorphism and IgG Anti-High-Density Lipoprotein Antibodies in Patients With Rheumatoid Arthritis: Potential Implications for Cardiovascular Disease. Arthritis Rheumatol 2016; 68:1367-76. [DOI: 10.1002/art.39609] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/19/2016] [Indexed: 01/06/2023]
Affiliation(s)
| | | | | | | | | | - Miguel Á. González-Gay
- Hospital Universitario Marqués de Valdecilla, Santander, Spain, and Clinical University Hospital of Santiago de Compostela; Santiago de Compostela Spain
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Zegkos T, Kitas G, Dimitroulas T. Cardiovascular risk in rheumatoid arthritis: assessment, management and next steps. Ther Adv Musculoskelet Dis 2016; 8:86-101. [PMID: 27247635 DOI: 10.1177/1759720x16643340] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Rheumatoid arthritis (RA) is associated with increased cardiovascular (CV) morbidity and mortality which cannot be fully explained by traditional CV risk factors; cumulative inflammatory burden and antirheumatic medication-related cardiotoxicity seem to be important contributors. Despite the acknowledgment and appreciation of CV disease burden in RA, optimal management of individuals with RA represents a challenging task which remains suboptimal. To address this need, the European League Against Rheumatism (EULAR) published recommendations suggesting the adaptation of traditional risk scores by using a multiplication factor of 1.5 if two of three specific criteria are fulfilled. Such guidance requires proper coordination of several medical specialties, including general practitioners, rheumatologists, cardiologists, exercise physiologists and psychologists to achieve a desirable result. Tight control of disease activity, management of traditional risk factors and lifestyle modification represent, amongst others, the most important steps in improving CV disease outcomes in RA patients. Rather than enumerating studies and guidelines, this review attempts to critically appraise current literature, highlighting future perspectives of CV risk management in RA.
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Affiliation(s)
- Thomas Zegkos
- First Cardiology Department, AHEPA University Hospital, Thessaloniki, Greece
| | - George Kitas
- Arthritis Research UK Epidemiology Unit, School of Translational Medicine, University of Manchester, Manchester, UK
| | - Theodoros Dimitroulas
- Fourth Department of Internal Medicine, Hippokratio Hospital, 49 Konstantinoupoleos Str, 54642 Thessaloniki, Greece
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Totoson P, Maguin-Gaté K, Prigent-Tessier A, Monnier A, Verhoeven F, Marie C, Wendling D, Demougeot C. Etanercept improves endothelial function via pleiotropic effects in rat adjuvant-induced arthritis. Rheumatology (Oxford) 2016; 55:1308-17. [PMID: 27053636 DOI: 10.1093/rheumatology/kew062] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To determine the effect of etanercept on endothelial dysfunction and on traditional cardiovascular (CV) risk factors in the adjuvant-induced arthritis (AIA) rat model. METHODS At the first signs of arthritis, etanercept (10 mg/kg/3 days, s.c.) or saline was administered for 3 weeks in AIA rats. Body weights and arthritis scores were monitored daily. Endothelial function was studied in aortic rings relaxed with acetylcholine (Ach) with or without inhibitors of nitric oxide synthase (NOS), cyclo-oxygenase (COX-2), arginase, endothelium-derived hyperpolarizing factor and superoxide anions (O2 (-)°) production. Aortic expression of endothelial nitic oxide synthase (eNOS), Ser1177-phospho-eNOS, COX-2, arginase-2, p22(phox) and p47(phox) was evaluated by western blotting analysis. Blood pressure, heart rate and blood levels of triglycerides, cholesterol and glucose were measured. RESULTS Etanercept significantly reduced arthritis score (P < 0.001). It improved Ach-induced relaxation (P < 0.05) as a result of increased NOS activity, decreased COX-2/arginase activities and decreased O2 (-)° production. These functional effects relied on increased eNOS expression and phosphorylation, and decreased COX-2, arginase-2 and p22(phox) expressions. No correlation was found between arthritis score and Ach-induced relaxation. The treatment did not change triglycerides, cholesterol and glucose levels, but significantly increased systolic blood pressure and heart rate (P < 0.05). CONCLUSION Our data demonstrated that efficient dosage of etanercept on inflammatory symptoms improved endothelial function in AIA. This beneficial effect on endothelial function is disconnected from its impact on CV risk factors and relates to pleiotropic effects of etanercept on endothelial pathways. These results suggest that etanercept could be a good choice for patients with rheumatoid arthritis at high risk of CV events.
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Affiliation(s)
- Perle Totoson
- EA 4267 FDE, FHU INCREASE, University of Bourgogne Franche-Comté, Besancon
| | - Katy Maguin-Gaté
- EA 4267 FDE, FHU INCREASE, University of Bourgogne Franche-Comté, Besancon
| | | | - Alice Monnier
- INSERM U1093, University of Bourgogne Franche-Comté, Dijon
| | - Frank Verhoeven
- EA 4267 FDE, FHU INCREASE, University of Bourgogne Franche-Comté, Besancon Service de Rhumatologie, CHRU Besançon
| | | | - Daniel Wendling
- Service de Rhumatologie, CHRU Besançon EA 4266, University of Bourgogne Franche-Comté, Besancon, France
| | - Céline Demougeot
- EA 4267 FDE, FHU INCREASE, University of Bourgogne Franche-Comté, Besancon
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Pujades-Rodriguez M, Duyx B, Thomas SL, Stogiannis D, Rahman A, Smeeth L, Hemingway H. Rheumatoid Arthritis and Incidence of Twelve Initial Presentations of Cardiovascular Disease: A Population Record-Linkage Cohort Study in England. PLoS One 2016; 11:e0151245. [PMID: 26978266 PMCID: PMC4792375 DOI: 10.1371/journal.pone.0151245] [Citation(s) in RCA: 274] [Impact Index Per Article: 34.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 02/25/2016] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION While rheumatoid arthritis is an established risk factor for cardiovascular disease (CVD), our knowledge of how the pattern of risk varies for different cardiovascular phenotypes is incomplete. The association between rheumatoid arthritis and the initial presentation of 12 types of CVDs were examined in a contemporary population of men and women of a wide age range. METHODS CALIBER data, which links primary care, hospital and mortality data in England, was analysed. A cohort of people aged ≥18 years and without history of CVD was assembled and included all patients with prospectively recorded rheumatoid arthritis from January 1997, until March 2010, matched with up to ten people without rheumatoid arthritis by age, sex and general practice. The associations between rheumatoid arthritis and the initial presentation of 12 types of CVDs were estimated using multivariable random effects Poisson regression models. RESULTS The analysis included 12,120 individuals with rheumatoid arthritis and 121,191 comparators. Of these, 2,525 patients with and 18,146 without rheumatoid arthritis developed CVDs during a median of 4.2 years of follow-up. Patients with rheumatoid arthritis had higher rates of myocardial infarction (adjusted incidence ratio [IRR] = 1.43, 95%CI 1.21-1.70), unheralded coronary death (IRR = 1.60, 95%CI 1.18-2.18), heart failure (IRR = 1.61, 95%CI 1.43-1.83), cardiac arrest (HR = 2.26, 95%CI 1.69-3.02) and peripheral arterial disease (HR = 1.36, 95%CI 1.14-1.62); and lower rates of stable angina (HR = 0.83, 95%CI 0.73-0.95). There was no evidence of association with cerebrovascular diseases, abdominal aortic aneurysm or unstable angina, or of interactions with sex or age. CONCLUSIONS The observed associations with some but not all types of CVDs inform both clinical practice and the selection of cardiovascular endpoints for trials and for the development of prognostic models for patients with rheumatoid arthritis.
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Affiliation(s)
- Mar Pujades-Rodriguez
- Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, United Kingdom.,Leeds Institute of Biomedical and Clinical Sciences, MRC Medical Bioinformatics Centre, Worsley Building, University of Leeds, Leeds LS2 9JT, United Kingdom
| | - Bram Duyx
- Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Sara L Thomas
- Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Dimitris Stogiannis
- Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
| | - Anisur Rahman
- Centre of Rheumatology Research, Division of Medicine, Faculty of Medical Sciences, University College London, London WC1E 6JF, United Kingdom
| | - Liam Smeeth
- Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, United Kingdom.,Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom
| | - Harry Hemingway
- Farr Institute of Health Informatics Research, University College London, 222 Euston Road, London NW1 2DA, United Kingdom
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Vitamin D receptor GATG haplotype association with atherosclerotic disease in patients with rheumatoid arthritis. Atherosclerosis 2016; 245:139-42. [DOI: 10.1016/j.atherosclerosis.2015.12.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 10/27/2015] [Accepted: 12/07/2015] [Indexed: 12/31/2022]
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Dessein PH, Corrales A, Lopez-Mejias R, Solomon A, Woodiwiss AJ, Llorca J, Norton GR, Genre F, Blanco R, Pina T, Gonzalez-Juanatey C, Tsang L, Gonzalez-Gay MA. The Framingham Score and the Systematic Coronary Risk Evaluation at Low Cutoff Values Are Useful Surrogate Markers of High-risk Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis. J Rheumatol 2016; 43:486-94. [DOI: 10.3899/jrheum.150510] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2015] [Indexed: 11/22/2022]
Abstract
Objective.We determined the performance of the Framingham score and the Systematic COronary Risk Evaluation (SCORE) in assessing high-risk atherosclerosis in patients with rheumatoid arthritis (RA).Methods.We assembled 330 cases without established cardiovascular disease (CVD), diabetes, and moderate or severe chronic kidney disease among 451 consecutive Spanish patients who underwent CVD risk screening and carotid ultrasound-determined plaque assessment. The findings were validated in 90 black and 97 white African patients.Results.When sensitivity for the Framingham score was set at 80% in receiver-operator curve analysis [area under the curve (AUC) = 0.799], the corresponding cutoff value and specificity were 7.3% and 63%, respectively. At a specificity of 80%, the cutoff value and sensitivity were 10.8% and 65%, respectively. When sensitivity for SCORE (AUC = 0.747) was set at 80%, the cutoff value and specificity were 0.5% and 58%, respectively. At a specificity of 80%, the cutoff value and sensitivity were 1.5% and 50%, respectively. Upon applying a cutoff value of 7.3% for the Framingham and 0.5% for SCORE in African white patients with RA, the corresponding sensitivities and specificities were 67% and 72%, and 67% and 55%, respectively. CVD risk equations did not discriminate between black African patients with and without plaque (AUC = 0.544 and 0.549 for Framingham score and SCORE, respectively).Conclusion.The Framingham score and SCORE at markedly low cutoff values of 7.3% to 10.8% and 0.5% to 1.5%, respectively, can usefully estimate plaque presence in RA. Effective population-specific CVD risk assessment strategies are needed in black African patients with RA.
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Tarnowski M, Paradowska-Gorycka A, Dąbrowska-Zamojcin E, Czerewaty M, Słuczanowska-Głąbowska S, Pawlik A. The effect of gene polymorphisms on patient responses to rheumatoid arthritis therapy. Expert Opin Drug Metab Toxicol 2015; 12:41-55. [PMID: 26609565 DOI: 10.1517/17425255.2016.1121233] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Rheumatoid arthritis (RA) is a systemic disease leading to joint destruction. The therapy of RA is mainly based on disease-modifying anti-rheumatic drugs (DMARDs) and biological drugs. The response to treatment is different among patients. Therefore, we have searched for factors that may predict the efficacy and toxicity during therapy in individual patients. AREAS COVERED This review presents the role of genetic polymorphisms as predictors of the efficacy and toxicity during the therapy of RA patients with DMARDs (methotrexate, leflunomide, sulfasalazine) and biological drugs (anti-TNF-alpha antagonists, Tocilizumab, Rituximab). EXPERT OPINION Despite studies having shown an association between genetic polymorphisms and response to therapy in RA patients, the majority of these findings are still inconclusive and inconsistent. We are still far from applying pharmacogenetic tests in routine clinical practice that can predict the outcome of treatment. Several factors, such as small sample size with low statistical power, variability in the outcome definitions and the heterogeneity of the cohorts, limited number of tested single nucleotide polymorphisms (SNPs), small effect for the selected variant, and a lack of consideration of epigenetic factors, may contribute to the inconsistency observed and may lead to limited success in personalizing therapy.
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Affiliation(s)
- Maciej Tarnowski
- a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland
| | - Agnieszka Paradowska-Gorycka
- b Department of Biochemistry and Molecular Biology , National Institute of Geriatrics, Rheumatology and Rehabilitation , 02-637 Warszawa , Poland
| | | | - Michal Czerewaty
- a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland
| | | | - Andrzej Pawlik
- a Department of Physiology , Pomeranian Medical University , 70-111 Szczecin , Poland
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Rodríguez-Carrio J, Alperi-López M, López P, Ballina-García FJ, Abal F, Suárez A. Antibodies to high-density lipoproteins are associated with inflammation and cardiovascular disease in rheumatoid arthritis patients. Transl Res 2015; 166:529-39. [PMID: 26279255 DOI: 10.1016/j.trsl.2015.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 07/01/2015] [Accepted: 07/23/2015] [Indexed: 11/17/2022]
Abstract
Several lines of evidence suggest that chronic inflammation and immune dysregulation are related to altered lipid profiles in rheumatoid arthritis (RA), but the actual mechanisms are still unclear. We wondered whether the development of antibodies against high-density lipoprotein (HDL) can be found in RA patients linked to clinical and cardiovascular (CV) risk factors. To this end, immunoglobulin G (IgG) anti-HDL antibodies and total IgG serum levels were quantified in 212 RA patients, 131 sex- and age-matched healthy controls (HC), and 52 subjects with traditional CV risk factors (tCVRs). A subgroup of 13 RA patients was prospectively followed on TNFα-blockade. TNFα, interferon (IFN)α, MIP1α, IFNγ, IL-8, VEGF, GM-CSF, IL-17, MCP-1, SDF-1α, resistin, and leptin serum levels were quantified by immunoassays. IgG anti-HDL levels were higher in RA patients compared with HC (P < 0.0001) and tCVR subjects (P = 0.015). Differences with HC remained after correction for total IgG levels (P < 0.003). Anti-HDL/IgG were negatively associated with HDL levels in RA (-1.182 [-1.823 to -0.541], P = 0.0003) after adjusting for demographical, clinical, inflammatory parameters, and treatments. RA patients with high levels of anti-HDL/IgG (n = 40, 18.8%) were more likely to have experienced a CV event (P < 0.0001) and exhibited increased levels of several proinflammatory mediators (C-reactive protein, IFNα, MIP1α, IFNγ, IL-8, GM-CSF, IL-17 and MCP-1). Finally, change in anti-HDL antibodies on TNFα-blockade was independently associated with increasing HDL levels. Overall, IgG anti-HDL antibodies are increased in RA independently of tCVRs and associated with a proinflammatory milieu and impaired lipid blood profile, which may contribute to the increased rate of CV events in these patients.
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Affiliation(s)
- Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Asturias, Spain
| | - Mercedes Alperi-López
- Department of Rheumatology, Hospital Universitario Central de Asturias, Oviedo, Spain
| | - Patricia López
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Asturias, Spain
| | | | - Francisco Abal
- Centro de Salud Sariego, Servicio de Salud del Principado de Asturias, Pola de Siero, Spain
| | - Ana Suárez
- Area of Immunology, Department of Functional Biology, University of Oviedo, Oviedo, Asturias, Spain.
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Dimitroulas T, Sandoo A, Hodson J, Smith J, Douglas KM, Kitas GD. Associations between asymmetric dimethylarginine, homocysteine, and the methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism (rs1801133) in rheumatoid arthritis. Scand J Rheumatol 2015; 45:267-73. [PMID: 26599798 DOI: 10.3109/03009742.2015.1086433] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES The aim of our study was to determine whether asymmetric dimethylarginine (ADMA) levels are associated with homocysteine (Hcy) and methylenetetrahydrofolate reductase (MTHFR) C677T (rs1801133) gene variants in patients with rheumatoid arthritis (RA). METHOD Serum ADMA and Hcy levels were measured in 201 RA individuals [155 (77.1%) females, median age 67 years (interquartile range 59-73)]. The MTHFR C677T polymorphism was assessed by using the LightCyclerTM System. Initially, ADMA was compared across the categories of MTHFR using a one-way analysis of variance (ANOVA), followed by a multivariate model, which accounted for Hcy, age, erythrocyte sedimentation rate (ESR), and homeostatic model assessment (HOMA). RESULTS In univariable analysis, ADMA differed significantly across the categories of MTHFR (p = 0.037). Patients with the MTHFR 677TT genotype had the highest ADMA levels, with a mean of 0.62 (SE = 0.03), significantly higher than either those patients carrying the MTHFR 677CT (0.55, SE = 0.01) or the MTHFR 677CC (0.55, SE = 0.01) genotype (p = 0.042) in both cases. In the multivariable model, Hcy (p = 0.022) and ESR (p < 0.001) were found to have significant positive associations with ADMA but the relationship between MTHFR gene variants and ADMA was found to be non-significant (p = 0.102). CONCLUSIONS Hcy and ADMA are significantly associated in RA. It is plausible that abnormal Hcy metabolism plays an important role in premature atherosclerosis in RA by promoting ADMA accumulation and leading to the derangement of vascular haemostasis.
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Affiliation(s)
- T Dimitroulas
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK
| | - A Sandoo
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK.,b School of Sport, Health and Exercise Sciences , Bangor University , Bangor , Gwynedd, Wales , UK
| | - J Hodson
- c Wolfson Computer Laboratory , University Hospital Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham , UK
| | - J Smith
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK
| | - K M Douglas
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK
| | - G D Kitas
- a Department of Rheumatology , Dudley Group of Hospitals NHS Trust, Russells Hall Hospital , Dudley , West Midlands , UK.,d Arthritis Research UK Epidemiology Unit , University of Manchester , Manchester , UK
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Li L, Liu B, Lu J, Jiang L, Zhang Y, Shen Y, Wang C, Jia W. Serum albumin is associated with peripheral nerve function in patients with type 2 diabetes. Endocrine 2015; 50:397-404. [PMID: 25860885 DOI: 10.1007/s12020-015-0588-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 03/27/2015] [Indexed: 12/16/2022]
Abstract
The aim of this study is to investigate the association between serum albumin concentrations and nerve conduction (NC) parameters in Chinese patients with type 2 diabetes (T2DM). A total of 409 T2DM patients were enrolled between October 2010 and April 2014. All participants underwent nerve conduction studies. The composite Z scores for NC parameters including conduction velocity (CV), amplitude, and latency were calculated as well. Serum albumin was measured by Bromcresol Green dye-binding method. The composite Z scores of CV and amplitude increased with the increasing albumin tertiles (test for trend, both P < 0.001), while the composite Z score of latency decreased with increasing albumin tertiles (test for trend, P < 0.001). After adjusting for age, sex, duration, and HbA1c, higher serum albumin concentrations were associated with higher composite Z scores of CV (β = 0.314, P < 0.001), amplitude (β = 0.279, P < 0.001), and lower composite Z score of latency (β = -0.279, P < 0.001). When participants were stratified into albuminuria and normoalbuminuria group, we found the associations of serum albumin with composite Z scores of NC parameters remained significant only in the albuminuria group (CV Z score: β = 0.253, P = 0.002; amplitude Z score: β = 0.233, P = 0.006; latency Z score: β = -0.217 P = 0.013) after further adjustment for urinary albumin to creatinine ratio. The optimal cutoff point of serum albumin to indicate abnormal peripheral nerve function was 36.75 g/L in T2DM patients with albuminuria, with a sensitivity of 65.6 % and a specificity of 78.0 %. Serum albumin was independently associated with peripheral nerve function in T2DM patients, especially in those with albuminuria. Serum albumin could be a potential biomarker for diabetic peripheral neuropathy.
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Affiliation(s)
- Lu Li
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Bo Liu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Jinshan Branch, Shanghai, People's Republic of China
| | - Jingyi Lu
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai, 200233, People's Republic of China
| | - Lan Jiang
- Department of Electrophysiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yinan Zhang
- Center for Translational Medicine, Shanghai Key Laboratory of Diabetes Mellitus, The Metabolic Diseases Biobank, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, People's Republic of China
| | - Yingdi Shen
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital Jinshan Branch, Shanghai, People's Republic of China
| | - Congrong Wang
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai, 200233, People's Republic of China.
| | - Weiping Jia
- Department of Endocrinology and Metabolism, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai Diabetes Institute, Shanghai Key Laboratory of Diabetes Mellitus, Shanghai Clinical Center for Diabetes, 600 Yishan Road, Shanghai, 200233, People's Republic of China
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Eder L, Wu Y, Chandran V, Cook R, Gladman DD. Incidence and predictors for cardiovascular events in patients with psoriatic arthritis. Ann Rheum Dis 2015; 75:1680-6. [DOI: 10.1136/annrheumdis-2015-207980] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 09/26/2015] [Indexed: 12/15/2022]
Abstract
ObjectiveTo assess the incidence and risk factors of cardiovascular events in patients with psoriatic arthritis (PsA).MethodsA cohort analysis was conducted involving patients recruited and followed over the period from 1978 to 2013 in a large PsA clinic. The participants were assessed at 6 to 12-month intervals according to a standard protocol. The collected information included demographics, lifestyle habits, medical history, medications use and PsA-related outcomes. The primary outcome was a composite major cardiovascular end point comprising myocardial infarction, ischaemic stroke, revascularisation or cardiovascular death. The association between the features of disease activity and the occurrence of cardiovascular events was assessed using Cox proportional hazard models.ResultsA total of 1091 patients with PsA were analysed. During the follow-up period, 104 cardiovascular events occurred. A considerable proportion of patients developed a cardiovascular event (19.8% of the patients by the age of 70 years and 30.1% of patient by the age of 80 years). No trend in the risk of developing cardiovascular events was observed over the decades from 1978 to 2013 (p=0.73). In multivariate analysis, the following variables were independent predictors of major cardiovascular events: hypertension (relative risk (RR) 1.81, p=0.015), diabetes (RR 2.72, p<0.001) and the number of dactylitic digits (RR 1.20, p<0.001). Sedimentation rate was a significant predictor only among women (RR 1.83, p=0.02).ConclusionA significant proportion of patients with PsA develop cardiovascular events during the course of their disease. Increased cardiovascular risk is associated with a combination of traditional cardiovascular risk factors and disease activity.
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Peluso I, Palmery M. The relationship between body weight and inflammation: Lesson from anti-TNF-α antibody therapy. Hum Immunol 2015; 77:47-53. [PMID: 26472017 DOI: 10.1016/j.humimm.2015.10.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2014] [Revised: 10/08/2015] [Accepted: 10/11/2015] [Indexed: 01/23/2023]
Abstract
Obesity is associated with many pathological conditions. Tumor Necrosis Factor-α (TNF-α) is one of the key mediators of inflammation involved in the obesity-related insulin resistance development. We aim to review the human evidence useful to clarify the relationship between inflammation and body weight, with particular reference to TNF-α. Genetic polymorphisms and epigenetic factors, such as diet, could affect TNF-α activity. TNF-α is associated with obesity, but also with anorexia and cachexia. Despite the role of TNF-α in obesity-related diseases, anti-TNF-α antibody therapy is associated with an increase in adiposity. In conclusion the reviewed results suggest that inflammation is more likely a consequence rather than a cause of obesity.
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Affiliation(s)
- Ilaria Peluso
- Center of Nutrition, Council for Agricultural Research and Economics (CREA-NUT), Via Ardeatina 546, 00178 Rome, Italy
| | - Maura Palmery
- Department of Physiology and Pharmacology "V. Erspamer", "Sapienza" University of Rome, P.le Aldo Moro 5, 00185 Rome, Italy.
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Hong J, Maron DJ, Shirai T, Weyand CM. Accelerated atherosclerosis in patients with chronic inflammatory rheumatologic conditions. ACTA ACUST UNITED AC 2015; 10:365-381. [PMID: 27042216 DOI: 10.2217/ijr.15.33] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Atherosclerosis is a complex inflammatory disease involving aberrant immune and tissue healing responses, which begins with endothelial dysfunction and ends with plaque development, instability and rupture. The increased risk for coronary artery disease in patients with rheumatologic diseases highlights how aberrancy in the innate and adaptive immune system may be central to development of both disease states and that atherosclerosis may be on a spectrum of immune-mediated conditions. Recognition of the tight association between chronic inflammatory disease and complications of atherosclerosis will impact the understanding of underlying pathogenic mechanisms and change diagnostic and therapeutic approaches in patients with rheumatologic syndromes as well as patients with coronary artery disease. In this review, we provide a summary of the role of the immune system in atherosclerosis, discuss the proposed mechanisms of accelerated atherosclerosis seen in association with rheumatologic diseases, evaluate the effect of immunosuppression on atherosclerosis and provide updates on available risk assessment tools, biomarkers and imaging modalities.
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Affiliation(s)
- Jison Hong
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - David J Maron
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Tsuyoshi Shirai
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
| | - Cornelia M Weyand
- Department of Medicine, Stanford University, Stanford, CA 94305, USA
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González-Gay MA, Llorca J, González-Juanatey C, Martín-Martínez MA, Castañeda S. Why is Rheumatoid Arthritis Mortality Still High Despite the Advent of New Therapies? Comment on the Article by Widdifield et al. Arthritis Care Res (Hoboken) 2015; 68:726-7. [PMID: 26414613 DOI: 10.1002/acr.22731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 09/08/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Miguel A González-Gay
- Hospital Universitario Marqués de Valdecilla, and Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, IDIVAL, Santander, Spain
| | - Javier Llorca
- School of Medicine, University of Cantabria, IDIVAL, and CIBER Epidemiologíay Salud Pública (CIBERESP), Santander, Spain
| | | | | | - Santos Castañeda
- Hospital Universitario de la Princesa, IIS-IPrincesa, Madrid, Spain
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Ibrahim I, Humphreys J, Mokhtar I, Marshall T, Verstappen S, Symmons D, Viatte S, Barton A, Plant D. Association of chemokine CXC ligand 12 gene polymorphism (rs1746048) with cardiovascular mortality in patients with rheumatoid arthritis: results from the Norfolk Arthritis Register: Table 1. Ann Rheum Dis 2015; 74:2099-102. [DOI: 10.1136/annrheumdis-2015-207851] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Accepted: 08/12/2015] [Indexed: 11/04/2022]
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Noguchi T, Ebina K, Hirao M, Kawase R, Ohama T, Yamashita S, Morimoto T, Koizumi K, Kitaguchi K, Matsuoka H, Kaneshiro S, Yoshikawa H. Progranulin plays crucial roles in preserving bone mass by inhibiting TNF-α-induced osteoclastogenesis and promoting osteoblastic differentiation in mice. Biochem Biophys Res Commun 2015; 465:638-43. [PMID: 26297947 DOI: 10.1016/j.bbrc.2015.08.077] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Accepted: 08/17/2015] [Indexed: 11/26/2022]
Abstract
A close correlation between atherosclerosis, inflammation, and osteoporosis has been recognized, although the precise mechanism remains unclear. The growth factor progranulin (PGRN) is expressed in various cells such as macrophages, leukocytes, and chondrocytes. PGRN plays critical roles in a variety of diseases, such as atherosclerosis and arthritis by inhibiting Tumor Necrosis Factor-α (TNF-α) signaling. The purpose of this study was to investigate the effect of PGRN on bone metabolism. Forty-eight-week old female homozygous PGRN knockout mice (PGRN-KO) (n = 8) demonstrated severe low bone mass in the distal femur compared to age- and sex-matched wild type C57BL/6J mice (WT) (n = 8) [BV/TV (%): 5.8 vs. 16.6; p < 0.001, trabecular number (1/mm): 1.6 vs. 3.8; p < 0.001]. In vitro, PGRN inhibited TNF-α-induced osteoclastogenesis from spleen cells of PGRN-KO mice. Moreover, PGRN significantly promoted ALP activity, osteoblast-related mRNA (ALP, osteocalcin) expression in a dose-dependent manner and up-regulated osteoblastic differentiation by down-regulating phosphorylation of ERK1/2 in mouse calvarial cells. In conclusion, PGRN may be a promising treatment target for both atherosclerosis and inflammation-related osteoporosis.
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Affiliation(s)
- Takaaki Noguchi
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kosuke Ebina
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
| | - Makoto Hirao
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Ryota Kawase
- Department of Cardiovascular Medicine, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tohru Ohama
- Department of Cardiovascular Medicine, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Dental Anesthesiology, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shizuya Yamashita
- Department of Cardiovascular Medicine, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan; Department of Community Medicine, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Tokimitsu Morimoto
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kota Koizumi
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Kazuma Kitaguchi
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Hozo Matsuoka
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
| | - Shoichi Kaneshiro
- Department of Orthopaedic Surgery, Japan Community Health Care Organization, Osaka Hospital, 4-2-78 Fukushima Ward, Osaka 586-8521, Japan
| | - Hideki Yoshikawa
- Department of Orthopaedic Surgery, Osaka University, Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan
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Abstract
Patients with rheumatoid arthritis (RA) and other inflammatory joint diseases (IJDs) have an increased risk of premature death compared with the general population, mainly because of the risk of cardiovascular disease, which is similar in patients with RA and in those with diabetes mellitus. Pathogenic mechanisms and clinical expression of cardiovascular comorbidities vary greatly between different rheumatic diseases, but atherosclerosis seems to be associated with all IJDs. Traditional risk factors such as age, gender, dyslipidaemia, hypertension, smoking, obesity and diabetes mellitus, together with inflammation, are the main contributors to the increased cardiovascular risk in patients with IJDs. Although cardiovascular risk assessment should be part of routine care in such patients, no disease-specific models are currently available for this purpose. The main pillars of cardiovascular risk reduction are pharmacological and nonpharmacological management of cardiovascular risk factors, as well as tight control of disease activity.
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Red cell distribution width is associated with endothelial progenitor cell depletion and vascular-related mediators in rheumatoid arthritis. Atherosclerosis 2015; 240:131-6. [DOI: 10.1016/j.atherosclerosis.2015.03.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 03/03/2015] [Accepted: 03/03/2015] [Indexed: 12/31/2022]
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Chen DY, Chen YM, Hsieh TY, Hsieh CW, Lin CC, Lan JL. Significant effects of biologic therapy on lipid profiles and insulin resistance in patients with rheumatoid arthritis. Arthritis Res Ther 2015; 17:52. [PMID: 25889426 PMCID: PMC4384305 DOI: 10.1186/s13075-015-0559-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2014] [Accepted: 02/16/2015] [Indexed: 12/24/2022] Open
Abstract
Introduction The goal of this study was to investigate (1) the associations of rheumatoid arthritis (RA)-related inflammation or rheumatoid factor/anti-cyclic citrullinated peptide (anti-CCP) positivity with lipid profiles and insulin resistance (IR), (2) the effects of biologic therapy on lipid profiles and IR, and (3) potential predictors for the presence of subclinical atherosclerosis. Methods Serum levels of lipid profiles were determined by enzymatic methods in 32 adalimumab-treated patients, 16 etanercept-treated patients, 24 tocilizumab-treated patients, and 20 biologic-naïve patients. Atherogenic index, which corresponds to the ratio of total cholesterol to high-density lipoprotein cholesterol (HDL-C), was calculated. IR was measured by homeostasis model assessment. Pro-inflammatory cytokine levels were examined by enzyme-linked immunosorbent assay. Common carotid artery intima-media thickness was determined by using sonography. Results There was an inverse correlation between disease activity (disease activity score for 28 joints, or DAS28) and low-density lipoprotein cholesterol (LDL-C) levels (r = −0.226, P <0.05) and a positive correlation between DAS28 and IR (r = 0.361, P <0.005). Anti-CCP-positive patients had significantly higher DAS28 and IR compared with anti-CCP-negative patients. There was also a positive correlation between IR and levels of interleukin-6 or tumor necrosis factor-alpha (TNF-α). HDL-C levels significantly increased in patients receiving 6-month anti-TNF-α therapy, and levels of total cholesterol, LDL-C, and triglyceride increased in tocilizumab-treated patients. IR significantly decreased in patients under biologic therapy but was unchanged in biologic-naïve patients. Age, IR, and DAS28 were significant predictors of severe subclinical atherosclerosis (odds ratios of 1.08, 2.77, and 2.52, respectively). Conclusions Significant associations of RA-related inflammation with lipid profiles and IR indicate the involvement of RA in atherosclerosis pathogenesis. Biologic therapies were associated with IR reduction without change in atherogenic index, but their beneficial effects on atherosclerosis reduction need to be verified in the future.
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Affiliation(s)
- Der-Yuan Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital and Faculty of Medicine, National Yang Ming University, Taiwan Boulevard, Taichung, 40705, Taiwan. .,Institute of Biomedical Science, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung, 40227, Taiwan. .,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung, 40227, Taiwan. .,Institute of Microbiology and Immunology, Chung Shan Medical University, No.110, Sec.1, Jianguo N.Rd., Taichung, 40201, Taiwan.
| | - Yi-Ming Chen
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital and Faculty of Medicine, National Yang Ming University, Taiwan Boulevard, Taichung, 40705, Taiwan. .,Institute of Biomedical Science, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung, 40227, Taiwan. .,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung, 40227, Taiwan.
| | - Tsu-Yi Hsieh
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital and Faculty of Medicine, National Yang Ming University, Taiwan Boulevard, Taichung, 40705, Taiwan.
| | - Chia-Wei Hsieh
- Division of Allergy, Immunology and Rheumatology, Taichung Veterans General Hospital and Faculty of Medicine, National Yang Ming University, Taiwan Boulevard, Taichung, 40705, Taiwan. .,Institute of Biomedical Science, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung, 40227, Taiwan. .,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung, 40227, Taiwan.
| | - Chi-Chen Lin
- Institute of Biomedical Science, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung, 40227, Taiwan. .,Rong Hsing Research Center for Translational Medicine, National Chung Hsing University, No.250, Guoguang Rd., South Dist., Taichung, 40227, Taiwan.
| | - Joung-Liang Lan
- Division of Immunology and Rheumatology, China Medical University Hospital, No. 2, Yude Rd., North Dist., Taichung, 40404, Taiwan. .,College of Medicine, China Medical University, No. 2, Yude Rd., North Dist., Taichung, 40404, Taiwan.
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Serum levels of anticyclic citrullinated peptide antibodies, interleukin-6, tumor necrosis factor-α, and C-reactive protein are associated with increased carotid intima-media thickness: a cross-sectional analysis of a cohort of rheumatoid arthritis patients without cardiovascular risk factors. BIOMED RESEARCH INTERNATIONAL 2015; 2015:342649. [PMID: 25821796 PMCID: PMC4363501 DOI: 10.1155/2015/342649] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 08/18/2014] [Accepted: 08/19/2014] [Indexed: 01/22/2023]
Abstract
The main cause of death in rheumatoid arthritis (RA) is cardiovascular events. We evaluated the relationship of anticyclic citrullinated peptide (anti-CCP) antibody levels with increased carotid intima-media thickness (cIMT) in RA patients. Methods. Forty-five anti-CCP positive and 37 anti-CCP negative RA patients, and 62 healthy controls (HC) were studied. All groups were assessed for atherogenic index of plasma (AIP) and cIMT. Anti-CCP, C-reactive protein (CRP), and levels of tumor necrosis factor alpha (TNFα) and interleukin-6 (IL-6) were measured by enzyme-linked immunosorbent assay (ELISA). Results. The anti-CCP positive RA patients showed increased cIMT compared to HC and anti-CCP negative (P < 0.001). Anti-CCP positive versus anti-CCP negative RA patients, had increased AIP, TNFα and IL-6 (P < 0.01), and lower levels of high density lipoprotein cholesterol (HDL-c) (P = 0.02). The cIMT correlated with levels of anti-CCP (r = 0.513, P = 0.001), CRP (r = 0.799, P < 0.001), TNFα (r = 0.642, P = 0.001), and IL-6 (r = 0.751, P < 0.001). In multiple regression analysis, cIMT was associated with CRP (P < 0.001) and anti-CCP levels (P = 0.03). Conclusions. Levels of anti-CCP and CRP are associated with increased cIMT and cardiovascular risk supporting a clinical role of the measurement of cIMT in RA in predicting and preventing cardiovascular events.
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Parra-Salcedo F, Contreras-Yáñez I, Elías-López D, Aguilar-Salinas CA, Pascual-Ramos V. Prevalence, incidence and characteristics of the metabolic syndrome (MetS) in a cohort of Mexican Mestizo early rheumatoid arthritis patients treated with conventional disease modifying anti-rheumatic drugs: the complex relationship between MetS and disease activity. Arthritis Res Ther 2015; 17:34. [PMID: 25889060 PMCID: PMC4362822 DOI: 10.1186/s13075-015-0549-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 02/03/2015] [Indexed: 12/13/2022] Open
Abstract
Introduction A higher prevalence of metabolic syndrome (MetS) has been described in rheumatoid arthritis (RA), along with an association with disease activity. Objectives were to describe prevalence of MetS at RA diagnosis in a cohort of Mexican Mestizo early RA patients, and to define a causal association between MetS and disease activity. Methods The study population was a prospective cohort. At baseline and at fixed 6-months-intervals, patients had medical evaluations, fasting serum glucose, triglycerides, high-density lipoprotein cholesterol and acute reactant-phase determinations. MetS was defined according to international criteria and body mass index (BMI) ≥30 kg/m2 was used as a surrogate of the waist circumference. The study was approved by the internal review board. Appropriated statistics and Cox regression analysis were used. All statistical tests were two-sided and evaluated at the 0.05 significance level. Results Up to March 2014, data from 160 patients were analyzed. At baseline, they were more frequently middle-aged females and had moderate to high disease activity. Prevalence of MetS varied from 11.3% to 17.5% in patients and was lower to that from matched controls (versus 26.3% to 30%, P ≤0.01). Up to last follow-up, 39 patients (34.5%) developed incidental MetS. In the Cox regression analysis, cumulative disease activity score (DAS) 28 (odds ratio (OR): 1.81, 95% confidence interval (CI): 1.346 to 2.433, P = 0.000) and baseline BMI (OR: 1.13, 96% CI: 1.035 to 1.236, P = 0.007) were the only predictors for incidental MetS. RA patients with incidental MetS accumulated more disease activity and had less frequent remission than their counterparts. Logistic regression analysis showed that incidental MetS (OR: 0.2, 95% CI: 0.01 to 0.99, P = 0.052) and baseline DAS28 (OR: 0.4, 95% CI: 0.2 to 0.9, P = 0.02) were the only predictors for achieving or maintaining sustained (≥6 months) remission. Conclusions MetS prevalence in a cohort of early RA patients was lower than that from matched controls. Cumulative disease activity and higher BMI were risk factors for incidental Mets; higher baseline disease activity and incidental MetS prevented sustained remission. In addition to disease activity, MetS needs to be controlled to impact disease outcomes.
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Affiliation(s)
- Federico Parra-Salcedo
- Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
| | - Irazú Contreras-Yáñez
- Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
| | - Daniel Elías-López
- Department of Metabolism and Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
| | - Carlos A Aguilar-Salinas
- Department of Metabolism and Endocrinology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
| | - Virginia Pascual-Ramos
- Department of Rheumatology and Immunology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia sección XVI, Tlalpan 14000, México, DF, México.
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Arts EEA, Popa CD, Den Broeder AA, Donders R, Sandoo A, Toms T, Rollefstad S, Ikdahl E, Semb AG, Kitas GD, Van Riel PLCM, Fransen J. Prediction of cardiovascular risk in rheumatoid arthritis: performance of original and adapted SCORE algorithms. Ann Rheum Dis 2015; 75:674-80. [PMID: 25691119 DOI: 10.1136/annrheumdis-2014-206879] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 01/25/2015] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Predictive performance of cardiovascular disease (CVD) risk calculators appears suboptimal in rheumatoid arthritis (RA). A disease-specific CVD risk algorithm may improve CVD risk prediction in RA. The objectives of this study are to adapt the Systematic COronary Risk Evaluation (SCORE) algorithm with determinants of CVD risk in RA and to assess the accuracy of CVD risk prediction calculated with the adapted SCORE algorithm. METHODS Data from the Nijmegen early RA inception cohort were used. The primary outcome was first CVD events. The SCORE algorithm was recalibrated by reweighing included traditional CVD risk factors and adapted by adding other potential predictors of CVD. Predictive performance of the recalibrated and adapted SCORE algorithms was assessed and the adapted SCORE was externally validated. RESULTS Of the 1016 included patients with RA, 103 patients experienced a CVD event. Discriminatory ability was comparable across the original, recalibrated and adapted SCORE algorithms. The Hosmer-Lemeshow test results indicated that all three algorithms provided poor model fit (p<0.05) for the Nijmegen and external validation cohort. The adapted SCORE algorithm mainly improves CVD risk estimation in non-event cases and does not show a clear advantage in reclassifying patients with RA who develop CVD (event cases) into more appropriate risk groups. CONCLUSIONS This study demonstrates for the first time that adaptations of the SCORE algorithm do not provide sufficient improvement in risk prediction of future CVD in RA to serve as an appropriate alternative to the original SCORE. Risk assessment using the original SCORE algorithm may underestimate CVD risk in patients with RA.
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Affiliation(s)
- E E A Arts
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - C D Popa
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands Department of Rheumatology, Bernhoven Hospital, Uden, The Netherlands
| | - A A Den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - R Donders
- Department of Epidemiology, Biostatistics and Health Technology Assessment, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Sandoo
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
| | - T Toms
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
| | - S Rollefstad
- Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - E Ikdahl
- Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - A G Semb
- Preventive Cardio-Rheuma Clinic, Diakonhjemmet Hospital, Oslo, Norway
| | - G D Kitas
- Department of Rheumatology, Dudley Group NHS Foundation Trust, Dudley, UK
| | - P L C M Van Riel
- Department of Rheumatology, Bernhoven Hospital, Uden, The Netherlands Radboud Institute for Health Sciences, IQ healthcare, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Fransen
- Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands
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Chung CP, Solus JF, Oeser A, Li C, Raggi P, Smith JR, Stein CM. A variant in the osteoprotegerin gene is associated with coronary atherosclerosis in patients with rheumatoid arthritis: results from a candidate gene study. Int J Mol Sci 2015; 16:3885-94. [PMID: 25679449 PMCID: PMC4346932 DOI: 10.3390/ijms16023885] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 02/06/2015] [Indexed: 01/23/2023] Open
Abstract
Objective: Patients with rheumatoid arthritis (RA) have accelerated atherosclerosis, but there is limited information about the genetic contribution to atherosclerosis in this population. Therefore, we examined the association between selected genetic polymorphisms and coronary atherosclerosis in patients with RA. Methods: Genotypes for single-nucleotide polymorphisms (SNPs) in 152 candidate genes linked with autoimmune or cardiovascular risk were measured in 140 patients with RA. The association between the presence of coronary artery calcium (CAC) and SNP allele frequency was assessed by logistic regression with adjustment for age, sex, and race. To adjust for multiple comparisons, a false discovery rate (FDR) threshold was set at 20%. Results: Patients with RA were 54 ± 11 years old and predominantly Caucasian (89%) and female (69%). CAC was present in 70 patients (50%). A variant in rs2073618 that encodes an Asn3Lys missense substitution in the osteoprotegerin gene (OPG, TNFRSF11B) was significantly associated with the presence of CAC (OR = 4.09, p < 0.00026) and withstands FDR correction. Conclusion: Our results suggest that a polymorphism of the TNFRSF11B gene, which encodes osteoprotegerin, is associated with the presence of coronary atherosclerosis in patients with RA. Replication of this finding in independent validation cohorts will be of interest.
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Affiliation(s)
- Cecilia P Chung
- Departments of Medicine and Biostatistics, Vanderbilt University, Nashville, TN 37232, USA.
| | - Joseph F Solus
- Departments of Medicine and Biostatistics, Vanderbilt University, Nashville, TN 37232, USA.
| | - Annette Oeser
- Departments of Medicine and Biostatistics, Vanderbilt University, Nashville, TN 37232, USA.
| | - Chun Li
- Biostatistics, Vanderbilt University, Nashville, TN 37232, USA.
| | - Paolo Raggi
- Mazankowski Alberta Heart Institute, Department of Medicine, University of Alberta, Edmonton, AB T6G 2B7, Canada.
| | - Jeffrey R Smith
- Departments of Medicine and Biostatistics, Vanderbilt University, Nashville, TN 37232, USA.
| | - C Michael Stein
- Departments of Medicine and Biostatistics, Vanderbilt University, Nashville, TN 37232, USA.
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Ursum J, Nielen MMJ, Twisk JWR, Peters MJL, Schellevis FG, Nurmohamed MT, Korevaar JC. Cardiovascular disease-related hospital admissions of patients with inflammatory arthritis. J Rheumatol 2014; 42:188-92. [PMID: 25512486 DOI: 10.3899/jrheum.140476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Patients with inflammatory arthritis (IA) have an increased risk of cardiovascular diseases (CVD), suggesting a high rate of CVD-related hospitalizations, but data on this topic are limited. Our study addressed hospital admissions for CVD in a primary care-based population of patients with IA and controls. METHODS All newly diagnosed patients with IA between 2001 and 2010 were selected from electronic medical records of the Netherlands Institute for Health Services Research Primary Care database, representing a national network of general practices. Two control patients matched for age, sex, and practice were selected for each patient with IA. Hospital admission data for all patients was retrieved from the Dutch Hospital Data. RESULTS There were 2615 patients with IA and 5555 controls included in our study. CVD-related hospital admissions were observed more frequently among patients with IA as compared with control patients: 48% versus 36% (p < 0.001) in a followup period of 4 years. Patients with IA were more often hospitalized because of ischemic heart disease (OR 1.7, 95% CI 1.2-2.2) and for day-care admission because of cerebrovascular disease (OR 2.2, 95% CI 1.0-4.9). CONCLUSION Increased hospital admission rates confirm the higher CVD burden among patients with IA compared with controls, and underscore the need for proper CVD risk management in patients with IA.
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Affiliation(s)
- Jennie Ursum
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre.
| | - Mark M J Nielen
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - Jos W R Twisk
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - Mike J L Peters
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - François G Schellevis
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - Michael T Nurmohamed
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
| | - Joke C Korevaar
- From the Netherlands Institute for Health Services Research (NIVEL), Utrecht; the EMGO+ Institute for Health and Care Research, VU University; Department of Epidemiology and Biostatistics, Department of Internal Medicine, Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, and the Department of Rheumatology, VU University Medical Centre, Amsterdam, the Netherlands.J. Ursum, PhD; M.M.J. Nielen, PhD; J.C. Korevaar, PhD, NIVEL; J.W.R. Twisk, PhD, EMGO+ Institute for Health and Care Research, VU University, and the Department of Epidemiology and Biostatistics, VU University Medical Centre; M.J.L. Peters, PhD, Department of Internal Medicine, VU University Medical Centre; F.G. Schellevis, Professor, NIVEL, and the Department of General Practice and Elderly Care Medicine/EMGO Institute for Health and Care Research, VU University Medical Centre; M.T. Nurmohamed, PhD, Department of Internal Medicine, and the Department of Rheumatology, VU University Medical Centre
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Altered profile of circulating microparticles in rheumatoid arthritis patients. Clin Sci (Lond) 2014; 128:437-48. [DOI: 10.1042/cs20140675] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cell-derived microparticles in rheumatoid arthritis are associated with disease-specific features and traditional CVR factors and impair endothelial functionality by promoting endothelial activation in vitro.
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