Serum antinuclear autoantibodies are associated with measures of oxidative stress and lifestyle factors: analysis of LIPIDOGRAM2015 and LIPIDOGEN2015 studies

Should antinuclear antibodies (ANA) be used to screen for connective tissue disease in neurological patients?

BACKGROUND

Patients with connective tissue diseases (CTD) can have a wide range of neurological manifestations. Neurological complaints may be the presenting symptom of CTD. Therefore, screening for CTD using anti-nuclear antibodies (ANA) is a common practice. However, due to the abundance of positive ANA in a healthy population, interpretation of the results may be complex.

METHODS

we retrospectively evaluated files of patients hospitalized for evaluation of neurological symptoms in Sheba Medical Center during the years 2007-2022. Data was collected regarding epidemiology, ANA status, and rheumatological diagnosis.

RESULTS

4723 patients' files were reviewed. Of them, 46.6 % were positive for ANA. 6.9 % of them were diagnosed with CTD. This population had significantly higher rates of positive ANA status (71.2 % vs 28.8 %, p < 0.001), was significantly older (59.4 vs 53.4 years, p < 0.001) and had a significantly higher ANA titer (1:484.8, 1:268 p < 0.001) compared to patients without CTD. Factors which were found predictive for CTD diagnosis included female gender, older age, ANA titer above 1:160, and the diagnosis of a non-vascular etiology for the neurological disease.

CONCLUSION

Females, older patients, patients with high ANA titer and with diagnosis of a non-vascular cause to their neurological complains may be more likely to harbor a CTD and should probably be further evaluated.

Prevalence of Antinuclear Antibodies in Patients With Coronary Artery Disease: A Scoping Review

Coronary artery disease (CAD) is one of the most common causes of death worldwide. CAD is characterized by atherosclerosis and inflammation of the intima layer in blood vessels. Autoimmune diseases have a well-established association with CAD, which is accredited to the role immune modulators play in atherogenesis and autoimmune disease. Antinuclear-antibody (ANA) is an immunoglobulin that attacks nuclear and cytoplasmic components within cells, serving as a biomarker for many autoimmune conditions. This study evaluates whether ANA titers serve as an independent risk factor for CAD and its clinical manifestations. A scoping review was conducted using the following databases: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, ProQuest, OVID Medline, and PubMed. The search terms "Coronary artery disease" OR "Coronary disease" OR "Coronary aneurysm" AND "Antibodies, Antinuclear" were used to search for articles from 2000 to 2024. The initial search identified 442 articles and a total of 13 articles were included in the final results for data extraction. After analysis, 329 patients with CAD were found to have positive ANA titers, where a titer greater than 1:40 was considered positive. Among these patients, the most prevalent titer was 1:160 (0.31, n=103). Confounding rheumatological factors were evaluated: anti-cardiolipin IgG and IgM were the second most common antibodies (0.39, n=130) (0.37. n=123). Furthermore, a strong positive association between ANA titers and the number of stenotic coronary vessels was seen in the coronary artery ectasia (CAE) population. Hypertension was the most frequently observed comorbidity. Although smoking and being a male individual is a common risk factor for CAD, it was found that ANA titers were most prevalent in female nonsmokers. Results indicate that positive ANA titers could be an independent risk factor for CAD in patients without established autoimmune disease. This is evidence, particularly among patients with CAE, that the severity of ectasia in the coronary vessels is correlated with the strength of ANA titers. This investigation suggests that patients with positive ANA titers should undergo preliminary cardiovascular screening. Further research is needed to isolate ANA from traditional risk factors of CAD and to explore the potential use of ANA titers as a screening tool for CAD.

Impact of surrogates for insulin resistance on mortality and life expectancy in primary care: a nationwide cross-sectional study with registry linkage (LIPIDOGRAM2015)

Background

Insulin resistance (IR) is an important risk factor for multiple chronic diseases, increasing mortality and reducing life expectancy. The associations between emerging surrogates for IR, triglyceride-glucose index (TyG) and TyG-related indicators, with all-cause mortality and life expectancy in middle-aged and older patients in primary care are unclear.

Methods

This study originated from the Polish primary care cohort LIPIDOGRAM2015, including patients aged ≥45 years. Baseline fasting triglycerides and fasting glucose were used to derive TyG. Other TyG-related indicators included TyG-adjusted body mass index (TyG-BMI), TyG-adjusted waist circumference (TyG-WC), TyG-adjusted waist-to-hip, and TyG-adjusted waist-to-height. In this longitudinal analysis, we assessed associations between TyG-related indicators with total all-cause mortality, premature (age at death ≤75 years) all-cause mortality and years of life lost (YLL).

Findings

We included 10,688 patients (mean age 61.8 ± 9.3 years; 63.5% female). Cumulative total and premature all-cause mortality were 7.2% and 4.6%, respectively, during 5.7 years (IQR 5.6-5.7) of follow-up. Lowest (Q1) and highest quartile (Q4) of TyG-BMI and TyG-WC were associated with total all-cause mortality (second quartile [Q2]: reference; TyG-BMI: Q1: aHR 1.33, 95% CI 1.07-1.65, Q4: aHR 1.28, 95% CI 1.03-1.58; TyG-WC: Q1: aHR 1.44, 95% CI 1.14-1.82, Q4: aHR 1.29, 95% CI 1.04-1.59), similar results for premature all-cause mortality. Within age 45-80 years, compared with Q2 and third quartile, YLL were 4.49 and 5.46 years for TyG-BMI Q1 and Q4, respectively, 3.24 and 5.31 years for TyG-WC Q1 and Q4, respectively.

Interpretation

TyG-BMI and TyG-WC demonstrated a U-shaped association with total and premature all-cause mortality. Low and high levels of TyG-BMI and TyG-WC were associated with reduced life expectancy. Despite the relatively short follow-up period, significant associations were still observed, but longer follow-up studies are required to further explore these relationships.

Funding

Polish Lipid Association, College of Family Physician in Poland, Valeant in Poland.

Prevalence of a large panel of systemic autoantibodies in the Bavarian adult population

Objective

Autoimmune diseases commonly feature the presence of specific humoral autoantibodies. However, the prevalence of a large panel of systemic autoantibodies has never been assessed in the general population. We, therefore, described the prevalence of about 50 humoral systemic autoantibodies in a sample of the general Bavarian adult population.

Methods

Non-fasting venous serum samples from 331 participants were analyzed for 7 autoantibody screening tests (nuclear, cytoplasmic, and mitotic ANA, ANCA, cANCA and pANCA, anti-ENA autoantibodies) and 44 different monospecific humoral non-organ specific/systemic autoantibodies using indirect immunofluorescence tests, ELISAs, and line blots. In order to assess associations between sex, age, BMI, education level, smoking status and the presence of systemic autoantibodies, logistic regression analyses were conducted.

Results

At least one screening test was positive in 29.9% of the participants, and 42.3% of the participants were seropositive for at least one monospecific autoantibody. The most frequently found monospecific autoantibodies were rheumatoid factor (35.6%), ß2-glycoprotein 1 IgM (4.8%), and cardiolipin IgG (1.8%). Only few associations between sex, age, BMI, education, smoking status and autoantibody frequencies were observed.

Conclusion

Systemic autoantibodies are common in the general Bavarian population, and largely independent of sex, age, BMI, education, or smoking status. The study results may give orientation to clinicians about the occurrence of autoantibodies in the population, not (yet) associated with clinical symptoms.