RESEARCH - The effect of rheumatoid factor on mortality and coronary heart disease

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Ann Rheum Dis. Published Online First: 23 July 2009.

doi:10.1136/ard.2009.110536

BMJ Publishing Group Ltd & European League Against Rheumatism.

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Extended Report

The effect of rheumatoid factor on mortality and coronary heart disease

Gunnar Tomasson 1*, Thor Aspelund 2, Thorbjorn Jonsson 3, Helgi

Valdimarsson 3, T Felson 1 and Vilmundur Gudnason 2

1 Boston University, United States

2 Icelandic Heart Association, Iceland

3 Landspitali University Hospital, Iceland

Abstract

Objective: In persons with rheumatoid arthritis, studies have

described an association of rheumatoid factor (RF) with increased

mortality. Our objective was to determine the effect of RF on

mortality and coronary heart disease (CHD) in the general population.

Methods: Subjects were participants in a population-based study

focused on cardiovascular disease who came for study visit during the

years 1974-1984. RF was measured and information obtained on

cardiovascular risk factors, joint symptoms and erythrocyte

sedimentation rate (ESR). Subjects were followed with respect to

mortality and incident CHD through 2005. Adjusted comparison of

overall survival and CHD-event free survival among the RF-positive vs.

RF-negative subjects was performed with proportional hazards

regression models.

Results: Of 11,872 subjects, 140 had positive RF. At baseline, RF was

associated with diabetes mellitus and smoking and inversely associated

with serum cholesterol. RF-positive subjects had increased all-cause

mortality (HR=1.47, 95% CI: 1.19-1.80) and cardiovascular mortality

(HR=1.57, 95% CI: 1.15-2.14) after adjusting for age and sex. Further

adjustment for cardiovascular risk factors and ESR only modestly

attenuated this effect. Increase in CHD among the RF-positive subjects

did not reach statistical significance. (HR=1.32, 95% CI: 0.96-1.81)

adjusted for age and sex. Subjects with RF but without joint symptoms

also had increased overall mortality and cardiovascular mortality

(after adjustment, HR for overall mortality =1.33, 95% CI 1.01-1.74).

Conclusion: In a general population cohort, RF was associated with

increased all-cause mortality and cardiovascular mortality after

adjustment for cardiovascular risk factors, even among subjects

without joint symptoms.

http://ard.bmj.com/cgi/content/abstract/ard.2009.110536v1?papetoc

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