van Halm V P, Peters M J L, Voskuyl A E, Boers M, Lems W F, Visser M, Stehouwer C D A, Spijkerman A M W, Dekker J M, Nijpels G, Heine R J, Bouter L M, Smulders Y M, Dijkmans B A C, Nurmohamed M T
Department of Rheumatology, VU University Medical Center, Amsterdam 1007 MB, The Netherlands.
Ann Rheum Dis. 2009 Sep;68(9):1395-400. doi: 10.1136/ard.2008.094151. Epub 2008 Aug 12.
Patients with rheumatoid arthritis (RA) have an increased cardiovascular risk, but the magnitude of this risk is not known precisely. A study was undertaken to investigate the associations between RA and type 2 diabetes (DM2), a well-established cardiovascular risk factor, on the one hand, and cardiovascular disease (CVD) on the other.
The prevalence of CVD (coronary, cerebral and peripheral arterial disease) was determined in 353 randomly selected outpatients with RA (diagnosed between 1989 and 2001, aged 50-75 years; the CARRE study) and in participants of a population-based cohort study on diabetes and CVD (the Hoorn study). Patients with RA with normal fasting glucose levels from the CARRE study (RA, n = 294) were compared with individuals from the Hoorn study with normal glucose metabolism (non-diabetic, n = 258) and individuals with DM2 (DM2, n = 194).
The prevalence of CVD was 5.0% (95% CI 2.3% to 7.7%) in the non-diabetic group, 12.4% (95% CI 7.5% to 17.3%) in the DM2 group and 12.9% (95% CI 8.8% to 17.0%) in those with RA. With non-diabetic individuals as the reference category, the age- and gender-adjusted prevalence odds ratio (OR) for CVD was 2.3 (95% CI 1.1 to 4.7) for individuals with DM2 and 3.1 (95% CI 1.6 to 6.1) for those with RA. There was an attenuation of the prevalences after adjustment for conventional cardiovascular risk factors (OR 2.0 (95% CI 0.9 to 4.5) and 2.7 (95% CI 1.2 to 5.9), respectively).
The prevalence of CVD in RA is increased to an extent that is at least comparable to that of DM2. This should have implications for primary cardiovascular prevention strategies in RA.
类风湿关节炎（RA）患者心血管疾病风险增加，但该风险的具体程度尚不清楚。本研究旨在探讨RA与2型糖尿病（DM2，一种已明确的心血管疾病风险因素）之间的关联，以及RA与心血管疾病（CVD）之间的关联。
在353例随机选取的RA门诊患者（于1989年至2001年确诊，年龄50 - 75岁；CARRE研究）以及一项基于人群的糖尿病与CVD队列研究（Hoorn研究）的参与者中，确定CVD（冠状动脉、脑动脉和外周动脉疾病）的患病率。将CARRE研究中空腹血糖水平正常的RA患者（RA组，n = 294）与Hoorn研究中糖代谢正常的个体（非糖尿病组，n = 258）以及DM2患者（DM2组，n = 194）进行比较。
非糖尿病组CVD患病率为5.0%（95%可信区间2.3%至7.7%），DM2组为12.4%（95%可信区间7.5%至17.3%），RA患者组为12.9%（95%可信区间8.8%至17.0%）。以非糖尿病个体为参照类别，DM2患者CVD的年龄和性别调整患病率比值比（OR）为2.3（95%可信区间1.1至4.7），RA患者为3.1（95%可信区间1.6至6.1）。在对传统心血管疾病风险因素进行调整后，患病率有所降低（分别为OR 2.0（95%可信区间0.9至4.5）和2.7（95%可信区间1.2至5.9））。
RA患者中CVD的患病率增加到了至少与DM2相当的程度。这应对RA的一级心血管疾病预防策略产生影响。
