OP0087 Increased risk of ischaemic heart disease and mortality among fmf patients – perspective from a big database
Authors: S Tiosano, R. Shapira, O. Gendelman, D. Comaneshter, E. Pras, A.D. Cohen, H. Amital
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Familial Mediterranean fever (FMF) is a systemic autoinflammatory monogenic disease. It has been previously reported that FMF patients are prone to develop ischaemic heart disease (IHD),<sup>1 2</sup> mostly due to increased inflammatory activity and endothelial dysfunction.<sup>3 4</sup> However, large-scale information regarding the extent and prognosis of IHD among FMF patients is lacking. <h3>Objectives</h3> To check whether an association exists between FMF and IHD, and to assess the long-term prognostic significance of IHD among FMF patients using a big data registry with a 15 year follow-up period. <h3>Methods</h3> Utilising the medical records of Clalit Health Services, the largest HMO in Israel, we extracted a cohort of FMF patients along with their age-and-sex matched controls. Dates of registration in the medical records of FMF, IHD and death, as well as anthropometric information and medical comorbidities were extracted from the database. To compare the distribution of variables across the cohort strata, univariate analysis was performed using Chi-square and student t-test. Multivariate analysis using a logistic regression model was used to find variables associated with IHD. Survival analysis using Cox proportional hazards method and a log-rank test was performed to find variables associated with increased risk of all-cause mortality. <h3>Results</h3> The cohort included 7,670 FMF patients and 7670 age-and-sex matched controls. The mean age of both groups was 39.1, and both consisted 50.1% females. IHD was observed among 491 FMF patients (6.4%) vs 375 controls (4.89%), p&lt;0.001. In multivariate logistic regression, FMF was found to be independently associated with a diagnosis of IHD (OR 1.44, 95% CI: 1.21 to 1.72). After over 15 years of follow-up, 345 (4.5%) of FMF patients had died, compared to 271 (3.53%) of the controls (p&lt;0.001). In multivariate survival analysis, both FMF and IHD were found to be significantly associated with increased risk to all-cause mortality (HR 1.29, 95% CI: 1.10 to 1.53 and HR 1.57, 95% CI: 1.29 to 1.9, respectively). <h3>Conclusions</h3> IHD is associated with worse prognosis among FMF patients compared to controls. Proper screening methods are recommended to assess whether early identification and treatment may improve life expectancy. <h3>References</h3> [1] Langevitz P, Livneh A, Neumann L, et al. Prevalence of ischemic heart disease in patients with familial Mediterranean fever. <i>Isr Med Assoc J IMAJ</i>2001;3:9–12. [2] Twig G, Livneh A, Vivante A, et al. Cardiovascular and metabolic risk factors in inherited autoinflammation. J Clin Endocrinol Metab2014;99:E2123–E2128. doi:10.1210/jc.2014-2096 [3] Akdogan A, Calguneri M, Yavuz B, et al. Are Familial Mediterranean Fever (FMF) patients at increased risk for atherosclerosis? Impaired endothelial function and increased intima media thickness are found in FMF. J Am Coll Cardiol2006;48:2351–2353. doi:10.1016/j.jacc.2006.09.013 [4] Sari I, Karaoglu O, Can G, et al. Early ultrasonographic markers of atherosclerosis in patients with familial Mediterranean fever. Clin Rheumatol2007;26:1467–1473. doi:10.1007/s10067-006-0529-2 <h3>Disclosure of Interest</h3> None declared