Low Serum IGF1 Is Associated with Higher Cardiovascular Morbidity in the Middle-Aged Women with Rheumatoid Arthritis

Malin C Erlandsson^1,2, Lovisa Lyngfelt³, Caroline Wasén³, Sofia Töyrä Silfverswärd³, Mitra Nadali^1,3, Rille Pullerits^1,3,4 and Maria I Bokarewa¹, ¹Rheumatology Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden, ²Department of rheumatology and inflammation research, University of Gothenburg, Gothenburg, Sweden, ³Department of Rheumatology, Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden, ⁴Department of Clinical immunology and transfusion medicine, Sahlgrenska University Hospital, Gothenburg, Sweden

Meeting: ACR/ARHP Annual Meeting 2018

Keywords: Cardiovascular disease, Comorbidity and rheumatoid arthritis (RA)

Session Information

Date: Sunday, October 21, 2018

Title: Rheumatoid Arthritis – Diagnosis, Manifestations, and Outcomes Poster I: Comorbidities

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose:

Since low serum IGF1 is generally attributed to inflammation and RA severity, we analyze if serum levels of IGF1 is associated with cardiovascular (CV) risk in women with rheumatoid arthritis (RA).

Methods:

The risk of developing of CV disease within 10 years was calculated in a cohort of 184 female RA patients (median age 53 years, range 21-71) with no history of CV events, using the Framingham strategy. A 5-year follow-up of new CV events was completed by a structured interview in all the patients. The reported CV events were confirmed through the Swedish National Patient Register. The CV risk and CV event-free survival curves were compared with respect to serum IGF1 levels, where IGF1 levels below the median of the total cohort were considered low.

Results:

The RA women with low IGF1 (n=96, median 110 pg/ml) had significantly higher CVR compared to those with normal IGF1 (n=88, median 181 pg/ml) with the predicted risk of 7.2 % and 3.3 %, respectively (p<0.001). In age-adjusted groups, CVR was significantly higher in females ≤50 years with low IGF1 (p<0.001). At 5-year follow up, 12 (6.5%) patients experienced CV event. A Kaplan-Meier analysis showed that the CV events occurred with higher frequency in the patients with low IGF1 at baseline (p=0.029). After 5 years the risk of having experienced a cardiovascular event was 5 times higher in patients with low IGF1 at baseline (RR 4.583; CI95% 1.033-20.34; p=0.027). At baseline the IGF1low group had high prevalence of hypertension (24% vs. 8.5%, p=0.004) and higher BMI (p=0.008). The atherogenic index (total cholesterol/HDL) (2.8 vs 3.0) and smoking (15% vs. 14%) was similar between the groups. With exception for disease duration, the groups were similar in RA-related CVR factors as seropositivity (91% vs 92%), disease activity measured by DAS28 (median 3.20 vs 2.90), or systemic inflammation measured by serum IL6 and IL1b. The prevalence of treatment with MTX monotherapy was higher in the IGF1low group (56% vs. 39%, p=0.024), while the use of TNFi and other biologics was similar within the groups.

Conclusion:

Female patients with RA, IGF1 levels in the normal low range are associated with higher CVR and experienced higher frequency of CV events. This increase in CV disease seems to be independent of the RA-related characteristics.

Disclosure: M. C. Erlandsson, None; L. Lyngfelt, None; C. Wasén, None; S. Töyrä Silfverswärd, None; M. Nadali, None; R. Pullerits, None; M. I. Bokarewa, None.

To cite this abstract in AMA style:

Erlandsson MC, Lyngfelt L, Wasén C, Töyrä Silfverswärd S, Nadali M, Pullerits R, Bokarewa MI. Low Serum IGF1 Is Associated with Higher Cardiovascular Morbidity in the Middle-Aged Women with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 9). https://acrabstracts.org/abstract/low-serum-igf1-is-associated-with-higher-cardiovascular-morbidity-in-the-middle-aged-women-with-rheumatoid-arthritis/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/low-serum-igf1-is-associated-with-higher-cardiovascular-morbidity-in-the-middle-aged-women-with-rheumatoid-arthritis/