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Autoantibodies to the Atheroma Component Beta2-Glycoprotein I and Risk of Symptomatic Peripheral Artery Disease

Department of Rheumatology, Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil

Henrique L. Staub, PhD

Department of Rheumatology, Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil

João B. Petracco, MD

Department of Vascular Surgery of Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil

Gary L. Norman, PhD

INOVA Diagnostics, Inc., San Diego, CA

Andrew J. Lassen, BS

INOVA Diagnostics, Inc., San Diego, CA

Nádia Schiavo, MD

Department of Rheumatology, Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil

Rodrigo B. K. Borges, MD

Department of Rheumatology, Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil

Carlos A. von Mühlen, MD, PhD

Department of Rheumatology, Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil

Peripheral artery disease (PAD) is mostly related to atherosclerosis. Autoimmunity and, in particular, antibodies to cardiolipin (aCL) and phospholipid cofactors such as beta2-glycoprotein I (beta2-gpI) might influence the development of atheroma. Beta2-glycoprotein I (beta2-gpI) has been found in atheroma. It has previously been shown that immunoglobulin A (IgA) anti-beta2-gpI antibodies are associated with a risk of cerebral ischemia and myocardial infarction. This case control study aimed to determine whether elevated levels of aCL/anti-beta2-gpI antibodies are associated with a risk of symptomatic PAD (sPAD). Cases comprised a nonselected population of patients with sPAD (intermittent claudication or critical ischemia). Patient recruitment was based on arteriography changes. Controls were selected from patients admitted to orthopedic wards as a result of fractures or muscle-ligamentous disorders. Age, sex, race, hypertension, smoking, diabetes mellitus, and hypercholesterolemia were evaluated as risk factors in both groups. IgG/IgM/IgA aCL and anti-beta2-gpI were detected by enzyme-linked immunoabsorbant assays (ELISA). To estimate the grade of association of antibodies with sPAD, odds ratios (OR) were calculated. Logistic regression was utilized for adjustment of confounding factors. Seventy-seven cases and 93 controls were studied. The mean age was 61.5 years for cases and 47.5 years for controls (p <0.001). Among the risk factors evaluated, the presence of hypertension showed the strongest association with sPAD (OR 12.1; 95%CI 5.8—30). The presence of IgA anti-beta2-gpI was independently associated with sPAD (OR 5.4; 95%CI 1.8—15.8; p = 0.01). IgA aCL was strongly associated with the outcome (nonadjusted OR 11.5 after Agresti correction). IgA aCL and IgA anti-beta2-gpI antibodies were not associated with any known risk factors for sPAD or with arteriography changes. The occurrence of these autoantibodies might represent one of the links between autoimmunity and atherosclerosis in patients with sPAD.

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