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Garcia Camarero T, De La Torre Hernandez JM, Remuzgo-Martinez S, Lera-Gomez L, Pulito-Cueto V, Genre F, Lopez-Mejias R, Perez-Fernandez R, Gonzalez-Gay MA, Veiga-Fernandez G, Sainz Laso F, Lee Hwuang DH. The fast progressor patient as an emerging clinical entity in patients with coronary atherosclerosis; exploratory study on possible molecular substrates. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Once coronary atherosclerosis is clinically evident, it presents a very different rate of progression in each particular patient, being this progression one of the most important factors influencing on prognosis. Angiographic progression of lesions has been approached in some studies and certain driving factors have been identified. Nonetheless, clinical progression is more relevant but predictive factors remain less known.
Purpose
We aim to characterize a group of patients with accelerated clinical atherosclerosis (“fast progressors”, FP) and compare them to a stable group (“long standing stable”, LSS) both at baseline conditions, in order to explore potential markers or modulators that might have an impact on the prognosis.
Methods
We designed a case and control (1:2) study comparing the FP group (at least 3 different coronary revascularizations over the novo or previously non-significant lesions in a 10-year period of time), to a group of patients with LSS ischemic heart disease (those who have remained clinically stable during at least 10 years after a first coronary revascularization). We have analysed clinical, angiographic, social and environmental factors, as well as molecular substrates, the latter in baseline conditions.
Results
We identified 58 cases and compared them to 122 sex and age paired controls. Demographic characteristics and risk factors profile were similar in both groups. Clinical presentation at first event and coronary disease extent was also comparable in between groups. Figure 1 shows serum levels of patients during a stable phase of their disease. Creatinine was higher in the fast progressor group (FP) (p=0.03).Regarding the lipid profile LDLc and Apo B100 levels tended to be lower in the FP group most likely related to a more enhanced statin treatment in these group. Conversely, HDL and Apo A1 level were clearly lower in the FP group which could be explained due to an underlying higher risk condition. As to inflammatory determinants, CRP was found to be similar in both groups but IL-6 was significantly higher in the FP group. This could suggest that IL-6 levels might be a key marker of severity in the FP even at baseline condition. Of note, 10 patients showed IL-6 levels much higher than the mean. Moreover, we also assessed IL-6 genic expression, finding significant higher levels in the long standing stable group (LSS) (Figure 2). These findings suggest that the increase of IL-6 expression observed in the LSS group is not linked to a higher IL-6 production, therefore, the inflammatory state in those patients might be more controlled.
Conclusion
The main differential features at baseline of a clinically fast progressor patient compared to a long standing stable might reside in low HDL/Apo A1, along with a higher level of inflammation as estimated by IL-6 levels, but not CRP.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): AMGEN Serum levels of both groupsIL-6 levels
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Affiliation(s)
| | | | - S Remuzgo-Martinez
- Instituto de Investigacion Sanitaria Valdecilla (IDIVAL), Genetic epidemiology and atherosclerosis in systemic diseases and in metabolic bone diseases of the, Santander, Spain
| | - L Lera-Gomez
- Instituto de Investigacion Sanitaria Valdecilla (IDIVAL), Genetic epidemiology and atherosclerosis in systemic diseases and in metabolic bone diseases of the, Santander, Spain
| | - V Pulito-Cueto
- Instituto de Investigacion Sanitaria Valdecilla (IDIVAL), Genetic epidemiology and atherosclerosis in systemic diseases and in metabolic bone diseases of the, Santander, Spain
| | - F Genre
- Instituto de Investigacion Sanitaria Valdecilla (IDIVAL), Genetic epidemiology and atherosclerosis in systemic diseases and in metabolic bone diseases of the, Santander, Spain
| | - R Lopez-Mejias
- Instituto de Investigacion Sanitaria Valdecilla (IDIVAL), Genetic epidemiology and atherosclerosis in systemic diseases and in metabolic bone diseases of the, Santander, Spain
| | - R Perez-Fernandez
- Instituto de Investigacion Sanitaria Valdecilla (IDIVAL), Genetic epidemiology and atherosclerosis in systemic diseases and in metabolic bone diseases of the, Santander, Spain
| | - M A Gonzalez-Gay
- Instituto de Investigacion Sanitaria Valdecilla (IDIVAL), Genetic epidemiology and atherosclerosis in systemic diseases and in metabolic bone diseases of the, Santander, Spain
| | | | - F Sainz Laso
- University Hospital Marques de Valdecilla, Santander, Spain
| | - D H Lee Hwuang
- University Hospital Marques de Valdecilla, Santander, Spain
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Dessein P, Corrales A, Lopez-Mejias R, Solomon A, Woodiwiss A, Llorca J, Norton G, Genre F, Blanco R, Pina T, Gonzalez-Juanatey C, Tsang L, Gonzalez-Gay M. FRI0093 The Framingham Score is a Useful Surrogate Marker of High Risk Subclinical Atherosclerosis in Patients with Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dessein P, Lopez-Mejias R, Ubilla B, Genre F, Corrales A, Hernandez J, Ferraz-Amaro I, Tsang L, Pina T, Llorca J, Blanco R, Gonzalez-Juanatey C, Gonzalez-Gay M. THU0163 TNF-related Apoptosis-inducing Ligand and Cardiovascular Disease in Rheumatoid Arthritis. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pina Murcia T, Genre F, Lopez-Mejias R, Armesto S, Ubilla B, Mijares V, Dierssen-Sotos T, Corrales A, Gonzalez-Lopez M, Gonzalez-Vela M, Blanco R, Llorca J, Gonzalez-Gay M. AB0077 Leptin is Related with Inflammation and Metabolic Syndrome Features and Resistin with Disease Severity in Patients with Psoriasis Undergoing Treatment with Adalimumab. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.4100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Pina T, Genre F, Lopez-Mejias R, Armesto S, Ubilla B, Mijares V, Dierssen-Sotos T, Gonzalez-Lopez MA, Gonzalez-Vela MC, Blanco R, Hernández JL, Llorca J, Gonzalez-Gay MA. Relationship of leptin with adiposity and inflammation and resistin with disease severity in psoriatic patients undergoing anti-TNF-alpha therapy. J Eur Acad Dermatol Venereol 2015; 29:1995-2001. [PMID: 25823684 DOI: 10.1111/jdv.13131] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 03/09/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND Altered secretion patterns of proinflammatory adipokines may influence the increased risk of cardiovascular mortality observed in patients with chronic inflammatory diseases. OBJECTIVE To determine whether two adipokines, leptin and resistin, correlate with metabolic syndrome features and disease severity in psoriatic patients who underwent anti-TNF-α therapy. METHODS Prospective study of consecutive non-diabetic patients with moderate-to-severe psoriasis who completed 6 months of therapy with anti-TNF-α- adalimumab. Patients with kidney disease, hypertension or body mass index ≥35 Kg/m(2) were excluded. Metabolic and clinical evaluation was performed at the onset of anti-TNF-α treatment and at month 6. RESULTS Twenty-nine patients were assessed. A correlation between adiposity and leptin was observed (waist circumference and leptin levels after 6 months of therapy: r = 0.43; P = 0.030). Leptin concentration also correlated with blood pressure before adalimumab onset (systolic: r = 0.48; P = 0.013 and diastolic blood pressure: r = 0.50; P = 0.010 ). A marginally significant negative correlation between insulin sensitivity (QUICKI) and leptin levels was also observed. CRP levels correlated with leptin prior to the onset of adalimumab (r = 0.45; P = 0.020) and with resistin both before (r = 0.45; P = 0.020) and after 6 months of therapy (r = 0.55; P = 0.004). A positive association between parameters of disease activity such as BSA (r = 0.60; P = 0.001) and PASI (r = 0.63; P = 0.001) prior to the onset of adalimumab therapy and resistin concentrations was also disclosed. No significant changes in leptin and resistin concentrations following the 6-month treatment with adalimumab were seen. CONCLUSION In patients with moderate-to-severe psoriasis leptin correlates with metabolic syndrome features and inflammation whereas resistin correlate with inflammation and disease severity.
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Affiliation(s)
- T Pina
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - F Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - R Lopez-Mejias
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - S Armesto
- Dermatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - B Ubilla
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - V Mijares
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - T Dierssen-Sotos
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, Santander, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain
| | - M A Gonzalez-Lopez
- Dermatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - M C Gonzalez-Vela
- Pathology Division, Hospital Universitario Marqués de Valdecilla, University of Cantabria, Santander, Spain
| | - R Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - J L Hernández
- Department of Internal Medicine, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
| | - J Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, Santander, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain
| | - M A Gonzalez-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain
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Pina T, Genre F, Lopez-Mejias R, Armesto S, Ubilla B, Mijares V, Dierssen-Sotos T, Corrales A, Gonzalez-Lopez MA, Gonzalez-Vela MC, Blanco R, Llorca J, Gonzalez-Gay MA. Anti-TNF-α therapy reduces retinol-binding protein 4 serum levels in non-diabetic patients with psoriasis: a 6-month prospective study. J Eur Acad Dermatol Venereol 2015; 30:92-5. [PMID: 25650695 DOI: 10.1111/jdv.13005] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2014] [Accepted: 01/07/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Retinol-binding protein-4 (RBP4), an adipokine considered as an emerging cardiometabolic risk factor, is increased in patients with moderate-to-severe psoriasis. OBJECTIVE In this study, we aimed to establish the effect of anti-TNF-α therapy on RBP4 levels in patients with moderate-to-severe psoriasis. We also assessed if RBP4 levels correlate with metabolic syndrome features and disease severity in these patients. METHODS Prospective study on a series of consecutive non-diabetic patients with moderate-to-severe psoriasis who completed 6 months of therapy with adalimumab. Patients with kidney disease, hypertension or body mass index ≥ 35 kg/m(2) were excluded. Metabolic and clinical evaluation was performed at the onset of treatment (time 0) and at month 6. RESULTS Twenty-nine patients were assessed. Statistically significant reduction (P = 0.0001) of RBP4 levels was observed after 6 months of therapy (RBP4 at time 0: 55.7 ± 21.4 μg/mL, vs. 35.6 ± 29.9 μg/mL at month 6). No significant correlation between basal RBP4 levels and metabolic syndrome features or disease severity was found. Nevertheless, although RBP4 levels did not correlate with insulin resistance, a negative and significant correlation between RBP4 levels obtained after 6 months of adalimumab therapy and other metabolic syndrome features such as abdominal perimeter and body mass index were observed. At that time, a negative and significant correlation between RBP4 levels and disease activity scores and ultrasensitive CRP levels was also disclosed. CONCLUSION Our results support an influence of the anti-TNF-α blockade on RBP4 serum levels. This finding is of potential relevance due to increased risk of cardiovascular disease in patients with psoriasis.
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Affiliation(s)
- T Pina
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - F Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - R Lopez-Mejias
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - S Armesto
- Dermatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - B Ubilla
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - V Mijares
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - T Dierssen-Sotos
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain
| | - A Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - M A Gonzalez-Lopez
- Dermatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - M C Gonzalez-Vela
- Pathology Division, Hospital Universitario Marques de Valdecilla, University of Cantabria, Santander, Spain
| | - R Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
| | - J Llorca
- Department of Epidemiology and Computational Biology, School of Medicine, University of Cantabria, and CIBER Epidemiología y Salud Pública (CIBERESP), IDIVAL, Santander, Spain
| | - M A Gonzalez-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases, Rheumatology Division, Hospital Universitario Marques de Valdecilla, IDIVAL, Santander, Spain
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7
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Pina T, Armesto S, Lopez-Mejias R, Genre F, Ubilla B, Gonzalez-Lopez M, Gonzalez-Vela M, Corrales A, Blanco R, Garcia-Unzueta M, Hernandez J, Llorca J, Gonzalez-Gay M. Anti-TNF-α therapy improves insulin sensitivity in non-diabetic patients with psoriasis: a 6-month prospective study. J Eur Acad Dermatol Venereol 2014; 29:1325-30. [DOI: 10.1111/jdv.12814] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 09/29/2014] [Indexed: 01/08/2023]
Affiliation(s)
- T. Pina
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases; Rheumatology Division; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
| | - S. Armesto
- Dermatology Division; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
| | - R. Lopez-Mejias
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases; Rheumatology Division; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
| | - F. Genre
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases; Rheumatology Division; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
| | - B. Ubilla
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases; Rheumatology Division; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
| | - M.A. Gonzalez-Lopez
- Dermatology Division; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
| | - M.C. Gonzalez-Vela
- Pathology Division; Hospital Universitario Marques de Valdecilla; University of Cantabria; Santander Spain
| | - A. Corrales
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases; Rheumatology Division; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
| | - R. Blanco
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases; Rheumatology Division; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
| | - M.T. Garcia-Unzueta
- Endocrinology Research Unit; Medical Laboratory Department; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
| | - J.L. Hernandez
- Department of Internal Medicine; Hospital Universitario Marques de Valdecilla; University of Cantabria; Santander Spain
| | - J. Llorca
- Department of Epidemiology and Computational Biology; School of Medicine; University of Cantabria; Santander Spain
- CIBER Epidemiología y Salud Pública (CIBERESP); IDIVAL; Santander Spain
| | - M.A. Gonzalez-Gay
- Epidemiology, Genetics and Atherosclerosis Research Group on Systemic Inflammatory Diseases; Rheumatology Division; Hospital Universitario Marques de Valdecilla; IDIVAL; Santander Spain
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Lopez-Mejias R, Ubilla B, Corrales A, Hernandez J, Genre F, Ferraz-Amaro I, Tsang L, Llorca J, Blanco R, Gonzalez-Juanatey C, Gonzalez-Gay M, Dessein P. AB0352 Osteoprotegerin, Disease Severity and Established Cardiovascular Disease in Rheumatoid Arthritis: A CASE Control Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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9
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Gonzalez-Gay MA, Lopez-Mejias R, Garcia-Porrua C. HLA-DRB1* association with sarcoidosis. Clin Exp Rheumatol 2014; 32:298. [PMID: 24295517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2013] [Accepted: 10/22/2013] [Indexed: 06/02/2023]
Affiliation(s)
- M A Gonzalez-Gay
- Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, IFIMAV, Santander, Spain.
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Garcia-Bermudez M, González-Juanatey C, Lopez-Mejias R, Rodriguez-Rodriguez L, Pérez-Esteban S, Castañeda S, Urcelay E, Miranda-Filloy JA, Gómez-Vaquero C, Fernández-Gutierrez B, Balsa A, González-Alvaro I, Blanco R, Llorca J, Martín J, Gonzalez-Gay MA. Influence of MHCIITA rs3087456 and rs4774 polymorphisms in the susceptibility to cardiovascular disease of patients with rheumatoid arthritis. Clin Exp Rheumatol 2012; 30:51-57. [PMID: 22272574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 09/06/2011] [Indexed: 05/31/2023]
Abstract
OBJECTIVES MHCIITA is a major regulator of MHC expression that has been reported to be involved in the susceptibility to rheumatoid arthritis (RA) and myocardial infarction. In this study we investigated the potential association of two MHCIITA gene polymorphisms with cardiovascular (CV) risk in patients with RA. METHODS 1302 patients fulfilling the 1987 ACR classification criteria for RA were genotyped for the MHCIITA rs3087456 and rs4774 gene polymorphisms to determine the influence of MHCIITA variants in the development of CV events. The potential influence of these polymorphisms in the development of subclinical atherosclerosis was also analysed in a subgroup of patients with no history of CV events by the assessment of two surrogate markers of atherosclerosis; brachial and carotid ultrasonography to determine endothelial function and carotid artery intima-media thickness, respectively. RESULTS No statistically significant differences in the allele or genotype frequencies for each individual MHCIITA gene polymorphism between RA patients who experienced CV events, or not, were found. This was also the case when each polymorphism was assessed according to results obtained from surrogate markers of atherosclerosis. Also, in assessing the combined influence of both MHCIITA gene polymorphisms in the risk of CV disease after adjustment for gender, age at time of disease diagnosis, follow-up time, traditional CV risk factors, and shared epitope status, patients with CV events only showed a marginally decreased frequency of the MHCIITA rs3087456-rs4774 G-G allele combination (p=0.08; odds ratio: 0.63 [95% confidence interval: 0.37-1.05]). CONCLUSIONS Our data do not support an influence of MHCIITA rs3087456 and rs4774 polymorphisms in the increased risk of CV events of patients with RA.
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Affiliation(s)
- M Garcia-Bermudez
- Instituto de Parasitología y Biomedicina López-Neyra, C.S.I.C., Granada, Spain
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