Naranjo Antonio, Sokka Tuulikki, Descalzo Miguel A, Calvo-Alén Jaime, Hørslev-Petersen Kim, Luukkainen Reijo K, Combe Bernard, Burmester Gerd R, Devlin Joe, Ferraccioli Gianfranco, Morelli Alessia, Hoekstra Monique, Majdan Maria, Sadkiewicz Stefan, Belmonte Miguel, Holmqvist Ann-Carin, Choy Ernest, Tunc Recep, Dimic Aleksander, Bergman Martin, Toloza Sergio, Pincus Theodore
Hospital de Gran Canaria Dr, Negrin, University of Las Palmas de Gran Canaria, Barranco de la Ballena s/n 35011, Spain.
Arthritis Res Ther. 2008;10(2):R30. doi: 10.1186/ar2383. Epub 2008 Mar 6.
We analyzed the prevalence of cardiovascular (CV) disease in patients with rheumatoid arthritis (RA) and its association with traditional CV risk factors, clinical features of RA, and the use of disease-modifying antirheumatic drugs (DMARDs) in a multinational cross-sectional cohort of nonselected consecutive outpatients with RA (The Questionnaires in Standard Monitoring of Patients with Rheumatoid Arthritis Program, or QUEST-RA) who were receiving regular clinical care.
The study involved a clinical assessment by a rheumatologist and a self-report questionnaire by patients. The clinical assessment included a review of clinical features of RA and exposure to DMARDs over the course of RA. Comorbidities were recorded; CV morbidity included myocardial infarction, angina, coronary disease, coronary bypass surgery, and stroke. Traditional risk factors recorded were hypertension, hyperlipidemia, diabetes mellitus, smoking, physical inactivity, and body mass index. Unadjusted and adjusted hazard ratios (HRs) (95% confidence interval [CI]) for CV morbidity were calculated using Cox proportional hazard regression models.
Between January 2005 and October 2006, the QUEST-RA project included 4,363 patients from 48 sites in 15 countries; 78% were female, more than 90% were Caucasian, and the mean age was 57 years. The prevalence for lifetime CV events in the entire sample was 3.2% for myocardial infarction, 1.9% for stroke, and 9.3% for any CV event. The prevalence for CV risk factors was 32% for hypertension, 14% for hyperlipidemia, 8% for diabetes, 43% for ever-smoking, 73% for physical inactivity, and 18% for obesity. Traditional risk factors except obesity and physical inactivity were significantly associated with CV morbidity. There was an association between any CV event and age and male gender and between extra-articular disease and myocardial infarction. Prolonged exposure to methotrexate (HR 0.85; 95% CI 0.81 to 0.89), leflunomide (HR 0.59; 95% CI 0.43 to 0.79), sulfasalazine (HR 0.92; 95% CI 0.87 to 0.98), glucocorticoids (HR 0.95; 95% CI 0.92 to 0.98), and biologic agents (HR 0.42; 95% CI 0.21 to 0.81; P < 0.05) was associated with a reduction of the risk of CV morbidity; analyses were adjusted for traditional risk factors and countries.
In conclusion, prolonged use of treatments such as methotrexate, sulfasalazine, leflunomide, glucocorticoids, and tumor necrosis factor-alpha blockers appears to be associated with a reduced risk of CV disease. In addition to traditional risk factors, extra-articular disease was associated with the occurrence of myocardial infarction in patients with RA.
我们在一个跨国横断面队列中，对未经过挑选的连续类风湿关节炎（RA）门诊患者（类风湿关节炎患者标准监测问卷项目，即QUEST-RA）进行了分析，这些患者正在接受常规临床护理，分析了RA患者心血管（CV）疾病的患病率及其与传统CV危险因素、RA临床特征以及使用改善病情抗风湿药物（DMARDs）之间的关联。
该研究包括由风湿病学家进行的临床评估以及患者的自我报告问卷。临床评估包括回顾RA的临床特征以及RA病程中DMARDs的使用情况。记录合并症；CV疾病包括心肌梗死、心绞痛、冠状动脉疾病、冠状动脉搭桥手术和中风。记录的传统危险因素有高血压、高脂血症、糖尿病、吸烟、缺乏身体活动和体重指数。使用Cox比例风险回归模型计算CV疾病的未调整和调整风险比（HRs）（95%置信区间[CI]）。
在2005年1月至2006年10月期间，QUEST-RA项目纳入了来自15个国家48个地点的4363例患者；78%为女性，超过90%为白种人，平均年龄为57岁。整个样本中终身CV事件的患病率为：心肌梗死3.2%，中风1.9%，任何CV事件9.3%。CV危险因素的患病率为：高血压32%，高脂血症14%，糖尿病8%，曾经吸烟43%，缺乏身体活动73%，肥胖18%。除肥胖和缺乏身体活动外，传统危险因素与CV疾病显著相关。任何CV事件与年龄和男性性别相关，关节外疾病与心肌梗死相关。长期使用甲氨蝶呤（HR 0.85；95% CI 0.81至0.89）、来氟米特（HR 0.59；95% CI 0.43至0.79）、柳氮磺胺吡啶（HR 0.92；95% CI 0.87至0.98）、糖皮质激素（HR 0.95；95% CI 0.92至0.98）和生物制剂（HR 0.42；95% CI 0.21至0.81；P < 0.05）与CV疾病风险降低相关；分析针对传统危险因素和国家进行了调整。
总之，长期使用甲氨蝶呤、柳氮磺胺吡啶、来氟米特、糖皮质激素和肿瘤坏死因子-α阻滞剂等治疗似乎与CV疾病风险降低相关。除传统危险因素外，关节外疾病与RA患者心肌梗死的发生相关。
