Roman Mary J, Moeller Elfi, Davis Adrienne, Paget Stephen A, Crow Mary K, Lockshin Michael D, Sammaritano Lisa, Devereux Richard B, Schwartz Joseph E, Levine Daniel M, Salmon Jane E
Division of Cardiology, Weill Medical College of Cornell University, Hospital for Special Surgery, and The Rogosin Institute, New York, New York 10021, USA.
Ann Intern Med. 2006 Feb 21;144(4):249-56. doi: 10.7326/0003-4819-144-4-200602210-00006.
Rheumatoid arthritis is associated with increased morbidity and mortality because of cardiovascular disease, independent of traditional risk factors.
To determine the prevalence of preclinical atherosclerosis in patients with rheumatoid arthritis and to identify clinical and biological markers for atherosclerotic disease in this patient population.
Matched, cross-sectional study.
Hospital for Special Surgery in New York City.
98 consecutive outpatients with rheumatoid arthritis who were followed by rheumatologists and 98 controls matched on age, sex, and ethnicity.
Cardiovascular risk factor ascertainment and carotid ultrasonography in all participants; disease severity, disease treatment, and inflammatory markers in patients with rheumatoid arthritis.
Despite a more favorable risk factor profile, patients with rheumatoid arthritis had a 3-fold increase in carotid atherosclerotic plaque (44% vs. 15%; P < 0.001). The relationship between rheumatoid arthritis and carotid atherosclerotic plaque remained after accounting for age, serum cholesterol levels, smoking history, and hypertensive status; adjusted predicted prevalence was 7.4% (95% CI, 3.4% to 15.2%) for the control group and 38.5% (CI, 25.4% to 53.5%) for patients with rheumatoid arthritis. Age (P < 0.001) and current cigarette use (P < 0.014) were also significantly associated with carotid atherosclerotic plaque. Among patients with rheumatoid arthritis, atherosclerosis was related to age, hypertension status, and use of tumor necrosis factor-alpha inhibitors (a possible marker of disease severity).
The study had a cross-sectional design, and inflammatory markers were determined only once.
Patients with rheumatoid arthritis have a high prevalence of preclinical atherosclerosis independent of traditional risk factors, suggesting that chronic inflammation and, possibly, disease severity are atherogenic in this population.
类风湿关节炎因心血管疾病导致发病率和死亡率增加，且与传统风险因素无关。
确定类风湿关节炎患者临床前期动脉粥样硬化的患病率，并识别该患者群体中动脉粥样硬化疾病的临床和生物学标志物。
匹配的横断面研究。
纽约市特种外科医院。
98例连续的类风湿关节炎门诊患者，由风湿病学家随访，以及98名年龄、性别和种族匹配的对照者。
所有参与者的心血管危险因素确定和颈动脉超声检查；类风湿关节炎患者的疾病严重程度、疾病治疗和炎症标志物。
尽管类风湿关节炎患者的危险因素状况更有利，但颈动脉粥样硬化斑块增加了3倍（44%对15%；P<0.001）。在考虑年龄、血清胆固醇水平、吸烟史和高血压状态后，类风湿关节炎与颈动脉粥样硬化斑块之间的关系仍然存在；对照组的调整预测患病率为7.4%（95%CI，3.4%至15.2%），类风湿关节炎患者为38.5%（CI，25.4%至53.5%）。年龄（P<0.001）和当前吸烟（P<0.014）也与颈动脉粥样硬化斑块显著相关。在类风湿关节炎患者中，动脉粥样硬化与年龄、高血压状态和肿瘤坏死因子-α抑制剂的使用（疾病严重程度的一个可能标志物）有关。
该研究采用横断面设计，炎症标志物仅测定一次。
类风湿关节炎患者临床前期动脉粥样硬化的患病率高，且与传统风险因素无关，提示慢性炎症以及可能的疾病严重程度在该人群中具有致动脉粥样硬化作用。
