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Cardiovascular disease risk assessment in patients with familial Mediterranean fever related renal amyloidosis

  • Romano, Micol1, 2
  • Piskin, David3
  • Berard, Roberta A.1
  • Jackson, Bradley C.1
  • Acikel, Cengizhan4
  • Carrero, Juan J.5
  • Lachmann, Helen J.6
  • Yilmaz, Mahmut I.7
  • Demirkaya, Erkan1, 8
  • 1 University of Western Ontario, 800 Commissioners Rd E. B1-146, London, ON, N6A 5W9, Canada , London (Canada)
  • 2 ASST G Pini, Milano, Italy , Milano (Italy)
  • 3 London Health Sciences Center, London, ON, Canada , London (Canada)
  • 4 CRI - Clinical Research International Ltd., Cologne, Germany , Cologne (Germany)
  • 5 Karolinska Institutet, Stockholm, Sweden , Stockholm (Sweden)
  • 6 Centre for Amyloidosis & Acute Phase Proteins, London, UK , London (United Kingdom)
  • 7 Epigenetic Health Solutions, Ankara, Turkey , Ankara (Turkey)
  • 8 University of Western Ontario, London, ON, Canada , London (Canada)
Published Article
Scientific Reports
Springer Nature
Publication Date
Oct 27, 2020
DOI: 10.1038/s41598-020-75433-7
Springer Nature


Chronic inflammation and proteinuria is a risk factor for cardiovascular disease (CVD) in patients with chronic kidney diseases and rheumatologic disorders. Our aim was to investigate the CVD events (CVDEs) and survival between the patients with FMF-related AA amyloidosis and glomerulonephropathies (GN) to define possible predictors for CVDEs. A prospective follow-up study with FMF-amyloidosis and glomerulonephropathy (GN) was performed and patients were followed for CVDEs. Flow-mediated dilatation (FMD), FGF-23, serum lipid, hsCRP levels, BMI and HOMA were assessed. A Cox regression analysis was performed to evaluate the risk factors for CVDEs. There were 107 patients in the FMF-amyloidosis group and 126 patients with GN group. Forty-seven CVDEs were observed during the 4.2-years follow up; all 28 patients in the FMF-amyloidosis group and 14/19 patients with GN developed CVDEs before the age of 40 (p = 0.002). CVD mortality was 2.8 times higher (95% CI 1.02–7.76) in patients with FMF-amyloidosis. Across both groups, FMD and FGF23 (p < 0.001) levels were independently associated with the risk of CVDEs. Patients with FMF-amyloidosis are at increased risk of early CVDEs with premature mortality age. FGF 23, FMD and hsCRP can stratify the risk of early CVD in patients with FMF-related AA amyloidosis.

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