Objective: In persons with rheumatoid arthritis, studies have described an association of rheumatoid factor (RF) with increased mortality. Our objective was to determine the effect of RF on mortality and coronary heart disease (CHD) in the general population.
Methods: Subjects were participants in a population-based study focused on cardiovascular disease who came for study visit during the years 1974-1984. RF was measured and information obtained on cardiovascular risk factors, joint symptoms and erythrocyte sedimentation rate (ESR). Subjects were followed with respect to mortality and incident CHD through 2005. Adjusted comparison of overall survival and CHD-event free survival among the RF-positive vs. RF-negative subjects was performed with Cox proportional hazards regression models.
Results: Of 11,872 subjects, 140 had positive RF. At baseline, RF was associated with diabetes mellitus and smoking and inversely associated with serum cholesterol. RF-positive subjects had increased all-cause mortality (HR=1.47, 95% CI: 1.19-1.80) and cardiovascular mortality (HR=1.57, 95% CI: 1.15-2.14) after adjusting for age and sex. Further adjustment for cardiovascular risk factors and ESR only modestly attenuated this effect. Increase in CHD among the RF-positive subjects did not reach statistical significance. (HR=1.32, 95% CI: 0.96-1.81) adjusted for age and sex. Subjects with RF but without joint symptoms also had increased overall mortality and cardiovascular mortality (after adjustment, HR for overall mortality =1.33, 95% CI 1.01-1.74).
Conclusion: In a general population cohort, RF was associated with increased all-cause mortality and cardiovascular mortality after adjustment for cardiovascular risk factors, even among subjects without joint symptoms.