Breaking News
October 20, 2018 - Antidepressant treatment may lead to improvements in sleep quality of patients with depression
October 20, 2018 - Study reports increased risk of death in children with inflammatory bowel disease
October 20, 2018 - Number of Autism Genes Now Tops 100
October 20, 2018 - Total diet replacement programmes are effective for treating obesity
October 20, 2018 - CLARIOstar used for fluorescence measurements on CSIRO’s purpose-built research vessel
October 20, 2018 - People with more copies of AMY1 gene digest starchy carbohydrates faster
October 20, 2018 - Case Comprehensive Cancer Center wins NIH grant to study health disparities
October 20, 2018 - Newly discovered compound shows potential for treating Parkinson’s disease
October 20, 2018 - High rate of non-adherence to hormonal therapy found among premenopausal early breast cancer patients
October 20, 2018 - Immunotherapy medicine found to be effective in treating uveitis
October 20, 2018 - The Pistoia Alliance Calls for Greater Collaboration to Realise Benefits of Innovation and Announces Winners of the 2018 President’s Startup Challenge
October 20, 2018 - Female internists consistently earn less than men
October 20, 2018 - Stanford team looks at dangers of teens’ vaping habits
October 20, 2018 - New approach to understanding cancers will accelerate development of better treatments
October 20, 2018 - LJI and UC San Diego awarded $ 4.5 million as part of NCI’s Cancer Moonshot initiative
October 20, 2018 - School-based HPV vaccination did not increase risky sexual behaviors among adolescent girls
October 20, 2018 - Eye discovery to pave way for more successful corneal transplants
October 20, 2018 - New analysis examines the importance of location in the opioid crisis
October 20, 2018 - Green filters increase reading speed for children with dyslexia
October 19, 2018 - Bariatric Sx Cuts Macrovascular Complications in Obesity, T2DM
October 19, 2018 - Better assessments for early age-related macular degeneration
October 19, 2018 - Visible and valued: Stanford Medicine’s first-ever LGBTQ+ Forum | News Center
October 19, 2018 - Understanding of metal-free enzymes used by bacteria could lead to new effective antibiotics
October 19, 2018 - Beckman Coulter Life Sciences announces new research-focused website
October 19, 2018 - Study finds link between refined soluble fibers, gut microbiota and liver cancer
October 19, 2018 - Social media reduces risk of depression among seniors with pain
October 19, 2018 - Newly developed synthetic DNA molecule may one day be used as ‘vaccine’ for prostate cancer
October 19, 2018 - Preoperative weight loss may not provide health benefits after surgery
October 19, 2018 - U.S. Birth Rates Continue to Drop as Age of New Moms Rises
October 19, 2018 - New technology can keep an eye on babies’ movements in the womb
October 19, 2018 - Juul e-cigarettes pose addiction risk for young users | News Center
October 19, 2018 - Gene sequencing reveals crucial molecular aspects of Trypanosoma brucei
October 19, 2018 - New DNA vaccine strategy protects mice against lethal challenge by multiple H3N2 viruses
October 19, 2018 - Study shows close link between cytokine interleukin-1ß and obesity-promoted colon cancer
October 19, 2018 - Muscle mass plays a critical role in health, shows research
October 19, 2018 - Study finds undiagnosed prediabetes in many infertile men
October 19, 2018 - The Current issue of “The view from here” is concerned with Nanotherapeutic strategies
October 19, 2018 - Delay in replacing the Pap smear with HPV screening is costing lives
October 19, 2018 - Physicians battle pediatric diseases of ear, nose, throat in Zimbabwe | News Center
October 19, 2018 - Researchers investigate why some cancers affect only young women
October 19, 2018 - Drugmakers funnel millions to lawmakers; a few dozen get $100,000-plus
October 19, 2018 - Unselfish people tend to have more children and receive higher salaries
October 19, 2018 - New findings reveal potential cellular players in tumor microenvironment
October 19, 2018 - Some countries take more time for reimbursement decisions on new cancer drugs
October 19, 2018 - Human brain cell transplant offers insights into neurological conditions
October 19, 2018 - Parental education associated with increased family health care spending
October 19, 2018 - New statistical method estimates long- and short-term risk of recurrence of breast cancer in US women
October 19, 2018 - Father’s exposure to nicotine may cause cognitive deficits in descendants
October 19, 2018 - Could we prevent Alzheimer’s disease by treating herpes?
October 19, 2018 - Nurse-led care can be more successful in managing gout
October 19, 2018 - Trump administration, pharma exchange verbal volleys on drug-price transparency
October 19, 2018 - Duke researchers find way to detect blood doping in athletes
October 19, 2018 - Many primary care doctors are still prescribing sedative drugs for older adults
October 19, 2018 - Finger length can predict sexuality in women say researchers
October 19, 2018 - Study finds differences in side-effects experienced by male and female OG cancer patients
October 19, 2018 - Dysfunction of single gene leads to miscarriages
October 19, 2018 - Few Seniors Who Self-Harm Referred for Mental Health Care
October 19, 2018 - Don’t sweat the sweet stuff
October 19, 2018 - URMC researchers discover new approach to deliver therapeutics to the brain
October 19, 2018 - Speech Pathology Australia raises awareness about Developmental Language Disorder
October 19, 2018 - Middlemen suppliers can increase drug prices and hospital bills, say Johns Hopkins researchers
October 19, 2018 - Survey finds high prevalence of HTLV-1 infection among teens and adults in Gabon
October 19, 2018 - Bliss funds research to find whether parental touch can help alleviate pain in premature infants
October 19, 2018 - Human neurons employ highly compartmentalized signaling, study shows
October 19, 2018 - Ultromics expands multiple clinical trials for coronary heart disease to the U.S.
October 19, 2018 - $11 million NIH grant for Clemson University helps launch new center for musculoskeletal research
October 19, 2018 - A new approach identified to control Zika virus, dengue fever
October 19, 2018 - Head Blows Without Concussion May Not Damage Brain, Study Claims
October 19, 2018 - US opioid use not declined, despite focus on abuse and awareness of risk
October 19, 2018 - Next-generation RNA sequencing technology sheds new light on human mitochondrial diseases
October 19, 2018 - UT Southwestern biochemist receives 2019 Breakthrough Prize in Life Sciences for innate immunity discovery
October 19, 2018 - The immune system also plays a key role in day-to-day function of healthy organs
October 19, 2018 - New tool may reveal how the brain structure impacts brain activity, human behavior
October 19, 2018 - Trump Administration announces ‘Winning on Reducing Food Waste’ initiative
October 19, 2018 - For-profit nursing home residents more likely to experience health issues caused by substandard care
October 19, 2018 - Incidence of stroke has risen steadily among marijuana users, show studies
October 19, 2018 - Conceptual framework proposed to examine role of exercise in multiple sclerosis
October 19, 2018 - Near infrared spectroscopy technique for accurate evaluation of chondral injuries
October 19, 2018 - Scientists receive $5.1 million grant to develop stem cell-based therapy for blinding retinal conditions
October 19, 2018 - Shorter physician encounters associated with antibiotic prescribing
Novel CV Risk Marker in RA Identified

Novel CV Risk Marker in RA Identified

image_pdfDownload PDFimage_print

Action Points

  • Anti-citrullinated fibrinogen (anti-cit-fibrinogen) may serve as a potential biomarker for assessing cardiovascular (CV) risk in patients with rheumatoid arthritis (RA).
  • Note that the study suggests that anti-cit-fibrinogens can improve CV risk stratification in RA patients.

Anti-citrullinated fibrinogen (anti-cit-fibrinogen) may serve as a potential biomarker for assessing cardiovascular (CV) risk in patients with rheumatoid arthritis (RA).

In examining 10 types of anti-cit-fibrinogens in patients with RA, anti-cit-fibrinogens as a group were associated with coronary artery disease (CAD) outcomes, with the association driven by a subset of autoantibodies in a subgroup that contained seven of the 10 anti-cit-fibrinogens, found researchers from Boston and Bordeaux, France.

Boris P. Hejblum, PhD, of Harvard School of Public Health in Boston, and the University of Bordeaux in France, and colleagues wrote that their study supports preclinical data and suggests that anti-cit-fibrinogens can improve CV risk stratification in RA patients.

“While our study adjusted for traditional CV risk factors, future Phase 4 biomarker development studies investigating the predictive value of these biomarkers in an independent cohort are needed,” they wrote in Arthritis Care & Research.

CV disease is the leading cause of death for patients with RA. Traditional risk factors tend to underestimate CV risk in patients with RA. A specific class of anti-citrullinated proteins antibodies (ACPAs), anti-cit-fibrinogen, have been studied as a potential marker for CV disease in RA, with research to suggest “a mechanistic pathway whereby inflammation promoted cit-fibrinogen in atherosclerotic plaques, and thus the development of anti-cit-fibrinogen may be a useful marker of inflammation, atherosclerotic burden and CV risk in RA,” Hejblum and colleagues wrote. A subsequent study that used a different platform to measure anti-cit-fibrinogen, however, failed to detect an association between carotid intima media thickness and anti-cit-fibrinogen titers.

These previous studies examined surrogate CV outcomes, prompting the authors to examine the association between ACPAs and CAD outcomes in a cohort of 1,006 patients with RA from two large tertiary care hospitals. Plasma samples from patients were measured for anti-cit-fibrinogen. Antibodies directed against 10 epitopes of cit-fibrinogen were measured.

The mean age of the patients was 61.0 years; 79.0% were female, and 72.2% were positive for anti-cyclic citrullinated peptide (CCP).

A principal components analysis (PCA) was performed to assess whether the anti-cit-fibrinogens clustered into groups, and each group was tested for its association with CAD.

From the PCA analysis, three main groups emerged: PC1, PC2, and PC3. PC1 accounted for more than 80% of the anti-cit-fibrinogen antibody variability among all anti-cit-fibrinogen antibodies. PC2 explained an additional 7.7% of variability; and PC3, an additional 3.5% of variability.

As a group, the anti-cit-fibrinogens were associated with a higher risk of CAD, adjusted for age, gender, race, diabetes, hypertension, hyperlipidemia, smoking, and use of non-biologic disease-modifying antirheumatic drugs (DMARDs), biologic DMARDs, and prednisone (P=0.00011). By subgroup, the strongest association was observed in group PC2, which included seven of the 10 anti-cit-fibrinogens examined (P=0.015).

A sensitivity analysis using ICD9 codes showed a similar association between anti-cit-fibrinogen as a group with ischemic heart disease (P=0.00029), as well as between-group PC2 and ischemic heart disease (P=0.004). Using the same covariates for adjustment, no association between anti-CCP positivity and CAD was observed (OR 1.3, 95% CI 0.7-2.3).

A total of 897 RA patients had high-sensitivity C-reactive protein (hsCRP) data recorded. The association between anti-cit fibrinogens and CAD remained significant, adjusting for CV risk factors and hsCRP (P=0.00022 among overall cohort, P=0.0071 for group PC2). This association remained significant after adjusting the model to include hsCRP and anti-CCP status. The concentrations of anti-cit fibrinogen therefore provided information additional to anti-CCP in identifying which RA patients had CAD, Hejblum and colleagues said.

They added that the study may explain why some previous reports did not find associations between anti-cit-fibrinogen and surrogate measures of CV risk: “While we detected a significant association between all anti-cit-fibrinogens with CAD, the signal appeared to be driven by a group of targets within the large fibrinogen molecule. Thus, if a particular ACPA assay does not measure antibodies targeting specific regions of fibrinogen, an association with CAD, may not be detected.”

A limitation to the study, the team noted, was the collection of samples in patients with prevalent CAD, thus not permitting an estimation of the value of anti-cit-fibrinogen in predicting future CAD risk.

Funding was provided by the Rheumatology Research Foundation.

  • Reviewed by
    Robert Jasmer, MD Associate Clinical Professor of Medicine, University of California, San Francisco and Dorothy Caputo, MA, BSN, RN, Nurse Planner

1969-12-31T19:00:00-0500

last updated

Tagged with:

About author

Related Articles