Association between anti-cyclic citrullinated peptide antibodies and ischemic heart disease in patients with rheumatoid arthritis.
OBJECTIVE
Patients with rheumatoid arthritis (RA) have an increased risk of cardiovascular disease that may not always be related to the presence of traditional cardiovascular risk factors. The aim of this study was to determine if anti-cyclic citrullinated peptide (anti-CCP) antibodies are associated with cardiovascular disease in patients with RA.


METHODS
Anti-CCP antibodies were determined by enzyme-linked immunosorbent assay in the earliest serum sample available from 937 patients with a diagnosis of RA. We studied the relationship between anti-CCP antibodies with traditional cardiovascular risk factors and cardiovascular events.


RESULTS
We found positive anti-CCP antibodies (>25 units/ml) in 672 patients (71.7%). There was no association between the anti-CCP antibodies and cardiovascular risk factors such as smoking, hypertension, dyslipidemia, being overweight, or diabetes mellitus. However, patients who had positive anti-CCP antibodies experienced more frequent ischemic heart disease (6.5% versus 2.6%; odds ratio [OR] 2.58, 95% confidence interval [95% CI] 1.17-5.65) and had higher mortality rates (11.2% versus 6.8%; OR 1.72, 95% CI 1.01-2.91). Similar results were obtained when we considered anti-CCP titers 20-fold higher (>500 units/ml). Multivariable analysis showed that ischemic heart disease is independently associated with positive anti-CCP antibodies (OR 2.8, 95% CI 1.19-6.56; P = 0.009).


CONCLUSIONS
Anti-CCP antibodies in patients with RA are independently associated with the development of ischemic heart disease.
López-Longo
Francisco Javier
FJ
Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Oliver-Miñarro
Desamparados
D
de la Torre
Inmaculada
I
González-Díaz de Rábago
Eugenia
E
Sánchez-Ramón
Silvia
S
Rodríguez-Mahou
Margarita
M
Paravisini
Alexandra
A
Monteagudo
Indalecio
I
González
Carlos-Manuel
CM
García-Castro
Marta
M
Casas
María Dolores
MD
Carreño
Luis
L