RESEARCH - Effect of RF on mortality and coronary heart disease

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Ann Rheum Dis doi:10.1136/ard.2009.110536

Basic and translational research

Extended report

Effect of rheumatoid factor on mortality and coronary heart disease

Gunnar Tomasson1, Thor Aspelund2,3, Thorbjorn Jonsson4, Helgi

Valdimarsson4, T Felson1, Vilmundur Gudnason2,3

+ Author Affiliations

1Section of Rheumatology and the Clinical Epidemiology Research and

Training Unit, Boston University School of Medicine, Boston,

Massachusetts, USA

2Icelandic Heart Association, Kopavogur, Iceland

3University of Iceland, Reykjavik, Iceland

4Landspitali University Hospital, Reykjavik, Iceland

Abstract

Objective

An association between rheumatoid factor (RF) and increased mortality

has been described in individuals with rheumatoid arthritis. The

objective of this study 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 attended for a study visit during the years

1974–84. RF was measured and information obtained on cardiovascular

risk factors, joint symptoms and erythrocyte sedimentation rate (ESR).

The subjects were followed with respect to mortality and incident CHD

through 2005. Adjusted comparison of overall survival and CHD

event-free survival in RF-positive versus RF-negative subjects was

performed using 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 to 1.80) and cardiovascular mortality (HR 1.57,

95% CI 1.15 to 2.14) after adjusting for age and sex. Further

adjustment for cardiovascular risk factors and ESR only modestly

attenuated this effect. An increase in CHD among the RF-positive

subjects did not reach statistical significance (HR 1.32, 95% CI 0.96

to 1.81, adjusted for age and sex). Subjects with RF but without joint

symptoms also had increased overall mortality and cardiovascular

mortality (HR for overall mortality 1.33, 95% CI 1.01 to 1.74, after

adjustment).

Conclusion

In a general population cohort, RF was associated with increased

all-cause mortality and cardiovascular mortality after adjustment for

cardiovascular risk factors, even in subjects without joint symptoms.

http://ard.bmj.com/content/early/2010/06/28/ard.2009.110536.abstract?papetoc

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