Carotid Atherosclerosis, Disease Measures, Oxidized Low-density Lipoproteins, and Atheroprotective Natural Antibodies for Cardiovascular Disease in Early Rheumatoid Arthritis - An Inception Cohort Study
Carotid Atherosclerosis, Disease Measures, Oxidized Low-density Lipoproteins, and Atheroprotective Natural Antibodies for Cardiovascular Disease in Early Rheumatoid Arthritis - An Inception Cohort Study
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DOI：
10.3899/jrheum.111334
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发表时间：
2012-06-01
影响因子：
3.9
通讯作者：
Hafstroem, Ingiaeld
中科院分区：
文献类型：
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作者：
Ajeganova, Sofia;de Faire, Ulf;Hafstroem, Ingiaeld
Objective.虽然类风湿性关节炎（RA）患者心血管疾病（CVD）的风险增加已得到证实，但其背后的机制仍不清楚。我们研究了颈动脉粥样硬化、RA疾病指标或潜在的心血管生物标志物是否影响RA发病队列中CVD的发病率。在疾病发作后0、3、12、24和60个月评估RA疾病指标和CVD生物标志物，并在5年后进行颈动脉超声检查。研究结局为心血管事件-急性心肌梗死、心绞痛、充血性心力衰竭或缺血性脑血管事件。采用生存分析、考克斯回归和纵向回归进行统计学分析。共有105例患者在RA发作前未发生CVD事件，发生了17起CVD事件，发生率为1.35起事件/100人-年（95% CI 0.71-2.0）。颈动脉内膜中层厚度的测量结果显示，CVD事件的发生率没有差异，但双侧颈动脉斑块患者的CVD事件发生率高于无斑块患者（p = 0.012）。第一年内28个关节的疾病活动性评分、疼痛视觉模拟评分和斯坦福大学健康评估问卷评分的改善以及甲氨蝶呤（MTX）的使用与CVD事件风险的降低相关，与年龄无关[风险比0.68（95% CI 0.5-0.97）、0.97（95% CI 0.95-0.99）、0.35（95% CI 0.15-0.82）和0.34（95% CI 0.12-0.91）。在纵向分析中，观察到在随后发生CVD事件的患者中氧化低密度脂蛋白（oxLDL）增加和抗磷酸胆碱抗体（抗PC）降低的可能性。双侧颈动脉斑块与无心血管疾病生存率低相关。早期减少炎症、疼痛和残疾以及MTX的使用与更好的CVD结局相关。升高的oxLDL和低IgM抗PC水平可能将RA的慢性炎症与CVD事件的风险增加联系起来。（2012年5月15日首次发布; J Rheumol 2012;39：1146-54; doi：10.3899/jrheum.111334）
Objective. Although an enhanced risk of cardiovascular disease (CVD) in persons with rheumatoid arthritis (RA) is well established, the mechanisms behind it remain unclear. We studied whether carotid atherosclerosis, RA disease measures, or potential cardiovascular biomarkers influenced the incidence of CVD in an RA inception cohort.Methods. RA disease measures and CVD biomarkers were assessed at 0, 3, 12, 24, and 60 months after disease onset, and carotid ultrasonography after 5 years. The study outcome was incident CVD events - acute myocardial infarction, angina pectoris, congestive heart failure, or ischemic cerebrovascular event. Survival analysis and Cox and longitudinal regressions were used for statistical analyses.Results. A total of 105 patients, without CVD events prior to RA onset, experienced 17 CVD events, an incidence rate of 1.35 events per 100 person-years (95% CI 0.71-2.0). The rate of CVD events did not differ with regard to measures of carotid intima-media thickness, but it was higher for patients with bilateral carotid plaques than for those without (p = 0.012). Improvement in Disease Activity Score for 28 joints, visual analog scale for pain, and Stanford Health Assessment Questionnaire score over the first year, as well as usage of methotrexate (MTX), was associated, independent of age, with reduction of risk of CVD event [hazard ratios 0.68 (95% CI 0.5-0.97), 0.97 (95% CI 0.95-0.99), 0.35 (95% CI 0.15-0.82), and 0.34 (95% CI 0.12-0.91), respectively. In longitudinal analyses, increasing oxidized low-density lipoprotein (oxLDL) and probability for low antiphosphorylcholine antibodies (anti-PC) were observed in those who experienced a subsequent CVD event.Conclusion. Bilateral carotid plaques were associated with poor CVD-free survival. Early reductions of inflammation, pain, and disability as well as MTX usage were associated with better CVD outcome. Elevated oxLDL and low IgM anti-PC levels may link chronic inflammation in RA to enhanced risk of CVD events. (First Release May 15 2012; J Rheumatol 2012;39:1146-54; doi:10.3899/jrheum.111334)