Arthritis & Rheumatism, Volume 60,
October 2009 Abstract Supplement
The 2009 ACR/ARHP Annual Scientific Meeting
Philadelphia October 16-21, 2009.
Antiphospholipid Antibodies Predict Future Arterial Events
Neville1, Carolyn, Rauch1, Joyce, Kassis2, Jeannine, Solymoss1, Susan, Joseph3, Lawrence, Belisle3, P., Fortin4, P. R.
To determine the role of antiphospholipid antibodies (aPL) in predicting new arterial (VE-A) and venous (VE-V) vascular events in an ongoing prospective cohort of individuals.
Demographic and clinical data were obtained at baseline and semiannually. All events were confirmed by consensus with medical record review by a panel of physicians. Blood samples were collected at baseline and annually for four years, and stored frozen at -70°C. Assays performed included: IgG/IgM anticardiolipin antibodies (aCL), lupus anticoagulant (LA), and IgG/IgM anti-b2-glycoprotein I antibodies (ab2GPI). Kaplan-Meier and proportional hazard survival analyses were used to compare the time to new VE-A or VE-V in aPL-positive (defined as aCL IgG/IgM >40, LA, and/or ab2GPI positive) versus aPL-negative individuals. Multivariate regression analyses were performed using new VE-A or VE-V as outcome variable and aPL positivity as predictor variable. Covariates for outcome VE-A were age, gender, family history of CVD (FMH), smoking, systemic lupus erythematosus (SLE), hypertension (HTN), diabetes mellitus (DM), smoking, previous VE-A, activated protein C resistance (APCR), and hyperhomocysteinemia. Covariates for outcome VE-V were age, gender, SLE, previous VE-V, anticoagulation therapy (ACT), APCR, antithrombin III, factor V Leiden mutation and MTHFR mutations.
414 persons enrolled in 1997 with mean (SD) age 46.4 (14.1) years, 83.1% female; 53.3% had FMH, 20.5% had SLE, 27.8% were smokers, 15.9% had HTN, 5.6% had DM, and 16.4% had had previous vascular events (VE). Fifty-nine (14%) individuals were aPL-positive at baseline, and 38 more became aPL-positive during follow-up for a total of 97 (23.4%). During 11 years of follow-up (median 9.5 [IQR=4.0, 10.6] years), 52 (12.6%) individuals sustained 78 new events (36 had VE-A; 17 had VE-V; 2 had both). The proportion of VE-free survivors at 10 years was 88% (95%CI=84%, 92%) for aPL-negative and 67% (95%CI=54%, 81%) for aPL-positive individuals. The proportion of VE-A-free survivors at 10 years was 91% (CI = 88%, 95%) for aPL-negative and 76% (CI = 65%, 89%) for aPL-positive individuals. For VE-V-free survivors, the proportions were 97% (CI = 95%, 99%) for aPL-negative and 83% (CI = 73%, 95%) for aPL-positive individuals. Multivariate regression analyses revealed that VE-A were predicted by aPL positivity [HR= 2.52 (CI=1.17, 5.47)], age [HR=1.05 (CI=1.02, 1.07)], DM [HR=3.93 (CI=1.66, 9.32)], smoking [HR=2.31 (CI=1.15, 4.64)], and previous VE-A [HR=4.77 (CI=2.32, 9.82)]. While the effect of aPL positivity on VE-V cannot be accurately estimated from our data [HR=1.86 (CI=0.67, 5.20)], VE-V were predicted by previous VE-V [HR=4.00 (CI=1.35, 11.87)], ACT [HR=4.60 (CI=1.50, 14.08)], and APCR deficiency [HR=5.21 (CI=1.95, 13.90)].
aPL positivity independently predicts VE-A, whereas the effect of aPL on VE-V is less clear.
To cite this abstract, please use the following information:
Neville, Carolyn, Rauch, Joyce, Kassis, Jeannine, Solymoss, Susan, Joseph, Lawrence, Belisle, P., et al; Antiphospholipid Antibodies Predict Future Arterial Events [abstract]. Arthritis Rheum 2009;60 Suppl 10 :1214