Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents
Atherosclerosis in Rheumatoid Arthritis: Promoters and Opponents
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DOI：
10.1007/s12016-018-8714-z
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发表时间：
2020-02-01
影响因子：
9.1
通讯作者：
Cutolo, Maurizio
中科院分区：
文献类型：
--
作者：
Carbone, Federico;Bonaventura, Aldo;Cutolo, Maurizio
大量流行病学数据确定心血管（CV）疾病是类风湿性关节炎（RA）患者死亡的主要原因。鉴于此，RA患者可能受益于额外的CV风险筛查和更强化的预防策略。然而，目前的CV风险分层算法仍然是针对一般人群的，并且严重低估了RA患者的CV风险。RA患者的急性CV事件在很大程度上与动脉粥样硬化加速相关。由于动脉粥样硬化的病理生理学特征与炎症RA滑膜中发生的病理生理学特征重叠，因此了解这些共同途径是RA患者预防CV的迫切需要和主要挑战。遗传背景、代谢状态、肠道微生物组和全身炎症也被认为是其他关键的促动脉粥样硬化因素。本综述的目的是更新目前关于RA患者动脉粥样硬化形成的病理生理学和改善疾病的抗风湿药物的潜在抗动脉粥样硬化作用的知识。
Substantial epidemiological data identified cardiovascular (CV) diseases as a main cause of mortality in patients with rheumatoid arthritis (RA). In light of this, RA patients may benefit from additional CV risk screening and more intensive prevention strategies. Nevertheless, current algorithms for CV risk stratification still remain tailored on general population and are burdened by a significant underestimation of CV risk in RA patients. Acute CV events in patients with RA are largely related to an accelerated atherosclerosis. As pathophysiological features of atherosclerosis overlap those occurring in the inflamed RA synovium, the understanding of those common pathways represents an urgent need and a leading challenge for CV prevention in patients with RA. Genetic background, metabolic status, gut microbiome, and systemic inflammation have been also suggested as additional key pro-atherosclerotic factors. The aim of this narrative review is to update the current knowledge about pathophysiology of atherogenesis in RA patients and potential anti-atherosclerotic effects of disease-modifying anti-rheumatic drugs.