Republished: The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis.
Republished: The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis.
复制标题
重新发表：类风湿性关节炎患者炎症标志物、血脂与心血管事件风险之间的关联。
DOI：
10.1136/postgradmedj-2013-204715rep
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发表时间：
2014
影响因子：
5.1
通讯作者：
Curtis,JeffreyR
中科院分区：
文献类型：
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作者：
Zhang,Jie;Chen,Lang;Delzell,Elizabeth;Muntner,Paul;Hillegass,WilliamB;Safford,MonikaM;Millan,IrisYolandaNavarro;Crowson,CynthiaS;Curtis,JeffreyR
目的探讨血清炎症标志物与慢性乙型肝炎的关系（红细胞沉降率（ESR）和C反应蛋白（CRP））和血脂指标在类风湿关节炎（RA）患者中，低密度脂蛋白（LDL）-和高密度脂蛋白（HDL）-胆固醇与心肌梗死（MI）和缺血性卒中（IS）的风险。2010年数据来自美国商业健康计划。符合条件的患者在至少180天的基线期内有两次或两次以上的RA医生诊断，并有连续的医疗和药房保险。 我们计算了年龄调整后的MI和IS的发病率，并使用样条回归评估非线性协会和Cox回归量化的实验室值和outcomes.ResultsWe之间的独立关联确定了44 418名合格的RA患者（平均年龄49岁，76%的妇女）。 与<1 mg/L相比，CRP>10 mg/L与MI风险增加相关（HR 2.12; 95% CI 1.02 - 4.38）。 与<14 mm/h相比，ESR>42 mm/h与MI（HR 2.53; 95% CI 1.48 - 4.31）和IS（HR 2.51; 95% CI 1.33 - 4.75）风险增加相关。 与<40 mg/dL（1.0 mmol/L）相比，HDL-胆固醇≥60 mg/dL（1.6 mmol/L）与MI风险降低相关（HR 0.37; 0.21 - 0.66）。 LDL和MI之间的相关性不是线性的; LDL在70 mg/L（1.8 mmol/L）和100 mg/L（2.6 mmol/L）之间的患者中观察到的风险最低。 我们没有观察到一个显着的LDL和IS之间的关联。ConclusionsThis研究提供的证据支持的假设，RA相关的全身炎症起着决定心血管风险和LDL和心血管风险之间的复杂关系的作用。
ObjectiveTo examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients.MethodsWe conducted a retrospective cohort study using 2005–2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess non-linear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes.ResultsWe identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol ≥60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS.ConclusionsThis study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.