COMP a novel predictor of CVD and CAD in RA

A study published in BMC Rheumatology concluded that circulating Cartilage oligomeric matrix protein (COMP) could serve as a potential predictor of cardiovascular disease (CVD) and coronary artery disease (CAD) in Rheumatoid arthritis. Individuals with active disease for at least two years following RA diagnosis, as well as those with cumulative disease activity, are at a higher risk for CVD and CAD, regardless of traditional CVD risk factors.

This study aimed to determine if baseline serum COMP, patient characteristics, traditional CVD risk factors, and disease activity over time can predict CVD in early RA patients. The study included 233 patients with early RA, recruited between 1995 and 2005. Cox regression was used to assess potential predictors of CVD and CAD.

Key findings from the study are:

• A first-ever diagnosis of CVD and CAD occurred in 70 and 52 patients, respectively.
• Age, sex, hypertension and diabetes predicted CVD and CAD.
• There was an association between COMP and increased risk of CVD and CAD with crude hazard ratios per SD 1.45 and 1.51respectively.
• When adjusted for age, sex, hypertension, diabetes and ESR, results were similar but did not reach significance with HRs 1.32 and 1.35, respectively.
• Baseline disease activity did not independently predict CVD.
• High DAS28 (> 5.1) at two years was associated with an increased risk of subsequent CVD [adjusted HR 2.58] and CAD.
• ESR and CRP at two years and cumulative disease activity over two years independently predicted CVD and CAD.

The study's main limitation was the small sample size that affected the multivariate analyses' statistical power.

High levels of systemic inflammation and disease activity score in 28 joints (DAS28) after diagnosis, as well as cumulative disease activity, were associated with increased risk of CVD and CAD, independent of traditional CVD risk factors, they added. 

Awareness of the particularly increased risk of heart disease among difficult-to-treat patients is important to improve cardiovascular-related outcomes in Rheumatoid arthritis patients.

Reference:

Rydell et al. Cardiovascular disease risk in early rheumatoid arthritis: the impact of cartilage oligomeric matrix protein (COMP) and disease activity. BMC Rheumatol 7, 43 (2023). https://doi.org/10.1186/s41927-023-00367-2