Aubry Marie-Christine, Maradit-Kremers Hilal, Reinalda Megan S, Crowson Cynthia S, Edwards William D, Gabriel Sherine E
Divisions of Anatomic Pathology, Health Science Research, Biostatistics, and Rheumatology, Mayo Clinic, Rochester, Minnesota 55905, USA.
J Rheumatol. 2007 May;34(5):937-42. Epub 2007 Mar 15.
Patients with rheumatoid arthritis (RA) are at increased risk for cardiovascular diseases (CVD). We compared the histologic features of coronary artery disease in patients with RA and non-RA controls.
Forty-one RA patients who died and underwent autopsy between 1985 and 2003 were matched to 82 non-RA controls of the same age and sex with similar history of CVD and autopsy date. Coronary arteries were submitted for histologic evaluation. The grade of stenosis was evaluated in each artery. The numbers of vulnerable plaques and acute coronary lesions were counted. The composition of a representative stable and vulnerable plaque from each vessel was evaluated. Chi-square tests were used to compare differences between groups.
Patients and controls had similar age at death (mean 79 yrs) and 61% were female in both groups. Overall, there was no significant difference in grade of stenosis or number of acute coronary lesions. Among subjects with CVD, 54% of controls had grade 3-4 lesions in left main artery versus only 7% of patients (p = 0.023). Vulnerable plaques in left anterior descending (LAD) artery were significantly more common in patients than controls (p = 0.018). Inflammation was observed more frequently in patients, in both the media of left circumflex (p = 0.005) and adventitia of LAD artery (p = 0.024). Similar trends were seen for subjects with heart failure.
There was less histologic evidence of atherosclerosis but greater evidence of inflammation and instability in RA patients compared to controls. These differences suggest that the mechanisms responsible for cardiovascular morbidity and mortality may be different in patients with RA.
类风湿关节炎(RA)患者患心血管疾病(CVD)的风险增加。我们比较了RA患者和非RA对照者冠状动脉疾病的组织学特征。
选取1985年至2003年间死亡并接受尸检的41例RA患者,与82例年龄、性别相同,具有相似CVD病史和尸检日期的非RA对照者进行匹配。将冠状动脉送检进行组织学评估。评估每条动脉的狭窄程度。计算易损斑块和急性冠状动脉病变的数量。评估来自每条血管的代表性稳定斑块和易损斑块的组成。采用卡方检验比较组间差异。
患者和对照者的死亡年龄相似(平均79岁),两组中61%为女性。总体而言,狭窄程度分级或急性冠状动脉病变数量无显著差异。在患有CVD的受试者中,54%的对照者左主干动脉有3 - 4级病变,而患者仅为7%(p = 0.023)。患者左前降支(LAD)动脉的易损斑块明显比对照者更常见(p = 0.018)。在患者中,左回旋支中膜(p = 0.005)和LAD动脉外膜(p = 0.024)的炎症更常见。心力衰竭患者也有类似趋势。
与对照者相比,RA患者动脉粥样硬化的组织学证据较少,但炎症和不稳定性的证据更多。这些差异表明,RA患者心血管发病和死亡的机制可能不同。