Anti-apolipoprotein A-1 IgG, incident cardiovascular events, and lipid paradox in rheumatoid arthritis.

To validate the prognostic accuracy of anti-apolipoprotein A-1 (AAA1) IgG for incident major adverse cardiovascular (CV) events (MACE) in rheumatoid arthritis (RA) and study their associations with the lipid paradox at a multicentric scale. Baseline AAA1 IgG, lipid profile, atherogenic indexes, and cardiac biomarkers were measured on the serum of 1,472 patients with RA included in the prospective Swiss Clinical Quality Management registry with a median follow-up duration of 4.4 years. MACE was the primary endpoint defined as CV death, incident fatal or non-fatal stroke, or myocardial infarction (MI), while elective coronary revascularization (ECR) was the secondary endpoint. Discriminant accuracy and incidence rate ratios (IRR) were respectively assessed using C-statistics and Poisson regression models. During follow-up, 2.4% (35/1,472) of patients had a MACE, consisting of 6 CV deaths, 11 MIs, and 18 strokes; ECR occurred in 2.1% (31/1,472) of patients. C-statistics indicated that AAA1 had a significant discriminant accuracy for incident MACE [C-statistics: 0.60, 95% confidence interval (95% CI): 0.57-0.98, AAA1 independently predicts CV deaths, and marginally MACE in RA. Further investigations are requested to ascertain whether AAA1 could enhance CV risk stratification by identifying patients with RA at low CV risk.

Informations de copyright

© 2024 Mongin, Pagano, Lamacchia, Juillard, Antinori-Malaspina, Dan, Ciurea, Möller, Gabay, Finckh and Vuilleumier.

Déclaration de conflit d'intérêts

AF and DD have received consultancies from AbbVie, AstraZeneca, BMS, Lilly, Pfizer, and UCB; and research support to their institution from AbbVie, BMS, Galapagos, Lilly, and Pfizer. NV declared to be president of the FAMH (Association of Medical Laboratories of Switzerland) and past president of the Swiss Society of Clinical Chemistry. No other relationships or activities appear to have influenced the submitted work. NV and SP are named as co-inventors of the patent related to cterA1, peptide (“Mimetic peptides for prognosis, diagnosis or treatment of a cardiovascular disease”, No. P1347EP00). The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The authors declared that they were an editorial board member of Frontiers at the time of submission. This had no impact on the peer review process and the final decision.