Abstract
Coronary artery disease (CAD) is one of the most common causes of death worldwide. CAD is characterized by atherosclerosis and inflammation of the intima layer in blood vessels. Autoimmune diseases have a well-established association with CAD, which is accredited to the role immune modulators play in atherogenesis and autoimmune disease. Antinuclear-antibody (ANA) is an immunoglobulin that attacks nuclear and cytoplasmic components within cells, serving as a biomarker for many autoimmune conditions. This study evaluates whether ANA titers serve as an independent risk factor for CAD and its clinical manifestations. A scoping review was conducted using the following databases: CINAHL (Cumulative Index to Nursing and Allied Health Literature), Embase, ProQuest, OVID Medline, and PubMed. The search terms "Coronary artery disease" OR "Coronary disease" OR "Coronary aneurysm" AND "Antibodies, Antinuclear" were used to search for articles from 2000 to 2024. The initial search identified 442 articles and a total of 13 articles were included in the final results for data extraction. After analysis, 329 patients with CAD were found to have positive ANA titers, where a titer greater than 1:40 was considered positive. Among these patients, the most prevalent titer was 1:160 (0.31, n=103). Confounding rheumatological factors were evaluated: anti-cardiolipin IgG and IgM were the second most common antibodies (0.39, n=130) (0.37. n=123). Furthermore, a strong positive association between ANA titers and the number of stenotic coronary vessels was seen in the coronary artery ectasia (CAE) population. Hypertension was the most frequently observed comorbidity. Although smoking and being a male individual is a common risk factor for CAD, it was found that ANA titers were most prevalent in female nonsmokers. Results indicate that positive ANA titers could be an independent risk factor for CAD in patients without established autoimmune disease. This is evidence, particularly among patients with CAE, that the severity of ectasia in the coronary vessels is correlated with the strength of ANA titers. This investigation suggests that patients with positive ANA titers should undergo preliminary cardiovascular screening. Further research is needed to isolate ANA from traditional risk factors of CAD and to explore the potential use of ANA titers as a screening tool for CAD.