THE ROLE OF INFLAMMATORY BIOMARKERS IN PREDICTING CARDIOVASCULAR EVENTS IN PATIENTS WITH RHEUMATOID ARTHRITIS: A COMPREHENSIVE REVIEW AND META-ANALYSIS
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Keywords
Rheumatoid arthritis, cardiovascular events, inflammatory biomarkers, C-reactive protein, interleukin-6, tumor necrosis factor-alpha, meta-analysis, cardiovascular risk, atherosclerosis, systemic inflammation
Abstract
Background: Rheumatoid arthritis (RA) is a chronic inflammatory disorder that is a known risk factor for cardiovascular disease (CVD). As RA is a systemic disease characterized by a systemic inflammation, the atherosclerosis developed in patients with RA depends on inflammatory biomarkers of RA being predictive for early intervention and management.
Objectives: In this review and meta-analysis, we review the role of inflammatory biomarkers in predicting cardiovascular events in patients with RA. Ultimately, the aim is to determine which biomarkers are the most closely tied to cardiovascular outcomes and to evaluate the predictive value of these for the disease in multiple studies.
Methodology: Searches were subsequently conducted in multiple databases including PubMed, Scopus and Web of Science for all papers from 2001 to 2023. If a study investigated the relationship between inflammatory biomarkers and subsequent cardiovascular events among RA patients it was included. Random effects meta-analysis was used with a random effects model to account for heterogeneity and data was extracted and pooled. The Newcastle-Ottawa scale was used to assess the quality of the included studies.
Results: Meta-analysis of these 28 studies show that the presence of inflammatory markers (such as C reactive protein [CRP], interleukin-6 [IL 6], and tumor necrosis factorα [TNFa]) are associated with an increased risk of cardiovascular events in RA patients. CRP emerged as the most consistent predictor, with a pooled hazard ratio (HR) of 1.45 (95% CI: 1.25-1.68). In addition, other biomarkers such as IL-6 and TNF-α also exhibited significant relatedness, although less strongly predictive.
Conclusion: In patients with RA, cardiovascular events are predictive of inflammatory biomarkers. Specifically, CRP, IL-6, and TNF-α have utility in both risk stratification and could be used in routine clinical practice to enhance cardiovascular risk management in RA patients. More research is necessary to see if these biomarkers do indeed function together to provide better predictive value for the overall disease.
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Afsal Safeer
Medcare Hospitals, Dubai, UAE
Refaa Mujeeb Alji
RAK Medical and Health Sciences University, Ajman, UAE
Ahmed Elmutasim Ahmed Elamin
M.B.B.S National Ribat University, Khartoum, Sudan
Gitty George
Medical University of Varna, Bulgaria
Cinderella Almatrooshi
SEHA, Abu Dhabi, UAE
Rameesha Asif
Lahore Medical and Dental College, Lahore, Pakistan
Rayan Tareg Mohamed Ahmed
Sheikh Khalifa Medical City, Abu Dhabi, UAE
Ahmad Maher Husni Abdelkhalik
Tbilisi State Medical University (TSMU), Georgia
Muhammad Bin Shakaib
Rawal Institute of Health Sciences, Islamabad, Pakistan
Ali Hamza
Shanxi Medical University (山西医科大学）Taiyuan, China
Majd Aldin Oudeh
Odessa National Medical University, Ukraine
Linda Saad A, AL Ghamdi
Faculty of Medicine, Al-Baha University