Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment.
Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment.
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DOI：
10.1093/rheumatology/keu224
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发表时间：
2014-12
期刊：
影响因子：
--
通讯作者：
Nurmohamed M
中科院分区：
文献类型：
--
作者：
Choy E;Ganeshalingam K;Semb AG;Szekanecz Z;Nurmohamed M
RA患者患心血管(CV)疾病的风险增加。与RA相关的高炎症负担似乎是心血管风险增加的关键驱动因素。炎症与加速的动脉粥样硬化有关，并与未经治疗的类风湿性关节炎患者的心血管风险和血脂水平之间的关系的矛盾倒置有关，最近创造了脂悖论。此外，炎症负担还与脂蛋白的质和量变化有关，与高密度脂蛋白胆固醇相关的抗炎和动脉粥样硬化保护作用显著改变。RA疗法可以提高血脂水平，这可能是由于其消炎作用而反映了血脂的正常化。然而，炎症和RA治疗对血脂谱的这些混杂影响给评估RA患者的心血管风险和解释传统的心血管风险评分带来了挑战。在这篇综述中，我们研究了类风湿关节炎增加的炎症负担与心血管风险之间的关系，探索炎症如何影响血脂谱，类风湿关节炎治疗的影响，以及旨在改善心血管预后的类风湿关节炎患者识别和监测心血管风险的策略。
Risk of cardiovascular (CV) disease is increased among RA patients. High inflammatory burden associated with RA appears to be a key driver of the increased cardiovascular risk. Inflammation is linked with accelerated atherosclerosis and associated with a paradoxical inversion of the relationship between CV risk and lipid levels in patients with untreated RA, recently coined the lipid paradox. Furthermore, the inflammatory burden is also associated with qualitative as well as quantitative changes in lipoproteins, with the anti-inflammatory and atheroprotective roles associated with high-density lipoprotein cholesterol significantly altered. RA therapies can increase lipid levels, which may reflect the normalization of lipids due to their inflammatory-dampening effects. However, these confounding influences of inflammation and RA therapies on lipid profiles pose challenges for assessing CV risk in RA patients and interpretation of traditional CV risk scores. In this review we examine the relationship between the increased inflammatory burden in RA and CV risk, exploring how inflammation influences lipid profiles, the impact of RA therapies and strategies for identifying and monitoring CV risk in RA patients aimed at improving CV outcomes.
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