Anti-Cyclic Citrullinated Peptide Antibodies are Not Elevated in a Heart Failure Population without Rheumatoid Arthritis

Background: Anti-cyclic citrullinated peptide autoantibodies (anti-CCP) have been associated with erosive arthritis in patients with rheumatoid arthritis (RA), a population with overall increased cardiovascular risk. Our group has recently identified protein carbamylation and citrulline levels (that may cross-react with anti-CCP) linking to increased major adverse cardiac events (MACE 5 death, myocardial infarction, stroke) in cardiac patients with depressed systolic function. The prognostic value of anti-CCP in non-RA heart failure cohort remains unknown. Methods: We measured anti-CCP in 720 subjects with an ejection fraction less than 50% undergoing elective coronary angiography, without an acute coronary event. Adjudicated MACE outcomes were ascertained over the ensuing 3 years for all subjects following enrollment. Results: In our study population (mean age 63611 years, 65% male), the median and mean anti-CCP levels were 0.2 U/mL and 0.0 U/mL 6 0.1 U/mL, respectively. Overall, anti-CCP did not predict future MACE, either alone (Hazard ratio [HR] 1.3 [95%CI 0.81-2.1], p5NS) or after adjusting for traditional risk factors and renal function (HR: 1.21 [95%CI 0.74-2.01], p5NS) nor was it present at significant levels in the nonselective population undergoing cardiac catheterization. Only 1% patients had elevated anti-CCP levels ($0.6 U/mL). Conclusion: In stable heart failure population without RA, anti-CCP antibodies are not detectable at significant levels and do not predict future MACE