Risk Factors for the Rapid Increase in Risk of Acute Coronary Events in Patients With New-Onset Rheumatoid Arthritis: A Nested Case-Control Study
Risk Factors for the Rapid Increase in Risk of Acute Coronary Events in Patients With New-Onset Rheumatoid Arthritis: A Nested Case-Control Study
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DOI：
10.1002/art.39267
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发表时间：
2015-11-01
影响因子：
13.3
通讯作者：
Askling, Johan
中科院分区：
文献类型：
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作者：
Mantel, Angla;Holmqvist, Marie;Askling, Johan
目的探讨新发类风湿性关节炎（RA）患者发生急性冠状动脉综合征（ACS）的危险因素。方法对纳入RA流行病学调查研究的RA患者进行巢式病例对照研究。使用瑞典国家健康登记册识别 ACS 病例，并根据基于发病密度的抽样与最多 5 名未患 ACS 的对照进行匹配。从医疗图表和基于登记的来源收集有关潜在暴露的信息（临床疾病活动、血清学特征、遗传标记、合并症、药物治疗和病假）。结果我们确定了 138 例病例和 624 例对照。吸烟、心肌梗塞病史以及 RA 发病后一年病假 > 50 天与 ACS 风险增加相关。第一年和整个随访期间的 C 反应蛋白水平、红细胞沉降率、28 个关节疾病活动评分 (DAS28) 的曲线下面积以及上三分位数的整体健康状况均与 ACS 风险增加密切相关。使用缓解疾病的抗风湿药物治疗不会改变 ACS 风险，类风湿因子 (RF) 或共享表位等位基因的存在也不会改变，而高抗瓜氨酸蛋白抗体 (ACPA) 水平与 ACS 风险显着相关。 结论 在这项关于 RA 事件中 ACS 危险因素的研究中，炎症活动的临床标志物、疾病活动以及 RA 发病后第一年的病假和伤残抚恤金总天数被确定为ACS 危险因素。我们发现与 RF 没有关联，而 RF 之前被认为与 RA 中的心血管疾病风险有关，但与高 ACPA 水平存在显着相关性。
Objective To investigate risk factors for acute coronary syndrome (ACS) in patients with new-onset rheumatoid arthritis (RA).Methods We performed a nested case-control study of patients with incident RA included in the Epidemiological Investigation of RA study. Cases with ACS were identified using Swedish national health registers and matched with up to 5 controls without ACS, based on incidence density-based sampling. Information on potential exposures (clinical disease activity, serologic features, genetic markers, comorbidities, pharmacotherapies, and sick leave) was collected from medical charts and register-based sources.Results We identified 138 cases and 624 controls. Smoking, history of myocardial infarction, and >50 days of sick leave the year following RA onset were associated with an increased risk of ACS. Area under the curve measurements of C-reactive protein level, erythrocyte sedimentation rate, Disease Activity Score in 28 joints (DAS28), and global health in the upper tertile during the first year and the complete followup period were both strongly associated with an increased risk of ACS. Treatment with disease-modifying antirheumatic drugs did not alter the ACS risk, nor did the presence of rheumatoid factor (RF) or shared epitope alleles, whereas high anti-citrullinated protein antibody (ACPA) levels were borderline significantly associated with ACS risk.Conclusion In this study of risk factors for ACS in incident RA, clinical markers of inflammatory activity, disease activity, and total number of days of sick leave and disability pension during the first year following RA onset were identified as ACS risk factors. We found no association with RF, which was previously linked to cardiovascular disease risk in RA, but there was a borderline significant association with high ACPA levels.