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Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative.
Arthritis Rheumatol. 2015 Sep; 67(9):2311-22.AR

Abstract

OBJECTIVE

To evaluate the incidence of cardiovascular disease (CVD) morbidity and mortality over the course of 10 years among the more than 160,000 postmenopausal women in the Women's Health Initiative (WHI) in relation to self-reported rheumatoid arthritis (RA), taking disease-modifying antirheumatic drugs (DMARDs), anti-cyclic citrullinated peptide (anti-CCP) positivity, rheumatoid factor (RF) positivity, CVD risk factors, joint pain, and inflammation (white blood cell count and interleukin-6 levels).

METHODS

Anti-CCP and RF were measured in a sample of WHI participants with self-reported RA (n = 9,988). RA was classified as self-reported RA plus anti-CCP positivity and/or taking DMARDs. Anti-CCP-negative women with self-reported RA and not taking DMARDs were classified as having "unverified RA."

RESULTS

Age-adjusted rates of coronary heart disease (CHD), stroke, CVD, fatal CVD, and total mortality were higher in women with RA than in women with no reported RA, with multivariable-adjusted hazard ratios of 1.46 (95% confidence interval [95% CI] 1.17-1.83) for CHD and 2.55 (95% CI 1.86-3.51) for fatal CVD. Among women with RA, anti-CCP positivity and RF positivity were not significantly associated with higher risk of any outcomes, despite slightly higher risk of death for those who were anti-CCP positive than for those who were anti-CCP negative. Joint pain severity and CVD risk factors were strongly associated with CVD risk, even in women with no reported RA. CVD incidence was increased in women with RA versus women with no reported RA at almost all risk factor levels, except for low levels of joint pain or inflammation. Among women with RA, inflammation was more strongly associated with fatal CVD and total mortality than with CHD or CVD.

CONCLUSION

Among postmenopausal women, RA was associated with 1.5-2.5-fold higher CVD risk. CVD risk was strongly associated with CVD risk factors, joint pain severity, and inflammation, but not with anti-CCP positivity or RF positivity.

Authors+Show Affiliations

University of Pittsburgh, Pittsburgh, Pennsylvania.University of Pittsburgh, Pittsburgh, Pennsylvania.University of Colorado, Denver.Washington Hospital Center, Washington, DC.University of Pittsburgh, Pittsburgh, Pennsylvania.University of Colorado, Denver.Stanford University, Stanford, California, and VA Palo Alto Health Care System, Palo Alto, California.University of Vermont, Burlington.Stanford University, Stanford, California.Brown University, Providence, Rhode Island.Brown University, Providence, Rhode Island.Vanderbilt University and Nashville VA Medical Center, Nashville, Tennessee.University of Pittsburgh, Pittsburgh, Pennsylvania.University of Pittsburgh, Pittsburgh, Pennsylvania.University of Pittsburgh, Pittsburgh, Pennsylvania.

Pub Type(s)

Journal Article
Observational Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

25988241

Citation

Mackey, Rachel H., et al. "Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative." Arthritis & Rheumatology (Hoboken, N.J.), vol. 67, no. 9, 2015, pp. 2311-22.
Mackey RH, Kuller LH, Deane KD, et al. Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative. Arthritis Rheumatol. 2015;67(9):2311-22.
Mackey, R. H., Kuller, L. H., Deane, K. D., Walitt, B. T., Chang, Y. F., Holers, V. M., Robinson, W. H., Tracy, R. P., Hlatky, M. A., Eaton, C. B., Liu, S., Freiberg, M. S., Talabi, M. B., Schelbert, E. B., & Moreland, L. W. (2015). Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative. Arthritis & Rheumatology (Hoboken, N.J.), 67(9), 2311-22. https://doi.org/10.1002/art.39198
Mackey RH, et al. Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative. Arthritis Rheumatol. 2015;67(9):2311-22. PubMed PMID: 25988241.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative. AU - Mackey,Rachel H, AU - Kuller,Lewis H, AU - Deane,Kevin D, AU - Walitt,Brian T, AU - Chang,Yue-Fang, AU - Holers,V Michael, AU - Robinson,William H, AU - Tracy,Russell P, AU - Hlatky,Mark A, AU - Eaton,Charles B, AU - Liu,Simin, AU - Freiberg,Matthew S, AU - Talabi,Mehret Birru, AU - Schelbert,Erik B, AU - Moreland,Larry W, PY - 2014/09/11/received PY - 2015/05/05/accepted PY - 2015/5/20/entrez PY - 2015/5/20/pubmed PY - 2015/11/17/medline SP - 2311 EP - 22 JF - Arthritis & rheumatology (Hoboken, N.J.) JO - Arthritis Rheumatol VL - 67 IS - 9 N2 - OBJECTIVE: To evaluate the incidence of cardiovascular disease (CVD) morbidity and mortality over the course of 10 years among the more than 160,000 postmenopausal women in the Women's Health Initiative (WHI) in relation to self-reported rheumatoid arthritis (RA), taking disease-modifying antirheumatic drugs (DMARDs), anti-cyclic citrullinated peptide (anti-CCP) positivity, rheumatoid factor (RF) positivity, CVD risk factors, joint pain, and inflammation (white blood cell count and interleukin-6 levels). METHODS: Anti-CCP and RF were measured in a sample of WHI participants with self-reported RA (n = 9,988). RA was classified as self-reported RA plus anti-CCP positivity and/or taking DMARDs. Anti-CCP-negative women with self-reported RA and not taking DMARDs were classified as having "unverified RA." RESULTS: Age-adjusted rates of coronary heart disease (CHD), stroke, CVD, fatal CVD, and total mortality were higher in women with RA than in women with no reported RA, with multivariable-adjusted hazard ratios of 1.46 (95% confidence interval [95% CI] 1.17-1.83) for CHD and 2.55 (95% CI 1.86-3.51) for fatal CVD. Among women with RA, anti-CCP positivity and RF positivity were not significantly associated with higher risk of any outcomes, despite slightly higher risk of death for those who were anti-CCP positive than for those who were anti-CCP negative. Joint pain severity and CVD risk factors were strongly associated with CVD risk, even in women with no reported RA. CVD incidence was increased in women with RA versus women with no reported RA at almost all risk factor levels, except for low levels of joint pain or inflammation. Among women with RA, inflammation was more strongly associated with fatal CVD and total mortality than with CHD or CVD. CONCLUSION: Among postmenopausal women, RA was associated with 1.5-2.5-fold higher CVD risk. CVD risk was strongly associated with CVD risk factors, joint pain severity, and inflammation, but not with anti-CCP positivity or RF positivity. SN - 2326-5205 UR - https://www.unboundmedicine.com/medline/citation/25988241/Rheumatoid_Arthritis_Anti_Cyclic_Citrullinated_Peptide_Positivity_and_Cardiovascular_Disease_Risk_in_the_Women's_Health_Initiative_ L2 - https://doi.org/10.1002/art.39198 DB - PRIME DP - Unbound Medicine ER -