Giles Jon T, Szklo Moyses, Post Wendy, Petri Michelle, Blumenthal Roger S, Lam Gordon, Gelber Allan C, Detrano Robert, Scott William W, Kronmal Richard A, Bathon Joan M
Department of Medicine, The Johns Hopkins University, The Johns Hopkins Hospital, Baltimore, MD 21287, USA.
Arthritis Res Ther. 2009;11(2):R36. doi: 10.1186/ar2641. Epub 2009 Mar 10.
Although cardiovascular morbidity and mortality are increased in rheumatoid arthritis, little is known about the burden of subclinical coronary atherosclerosis in these patients.
Using computed tomography, coronary artery calcification was measured in 195 men and women with rheumatoid arthritis aged 45 to 84 years without clinical cardiovascular disease and compared with 1,073 controls without rheumatoid arthritis enrolled in the Baltimore cohort of the Multi-Ethnic Study of Atherosclerosis.
The prevalence of coronary calcification (Agatston score > 0) was significantly higher in men, but not women, with rheumatoid arthritis after adjusting for sociodemographic and cardiovascular risk factors (prevalence ratio = 1.19; P = 0.012). Among participants with prevalent calcification, those with rheumatoid arthritis had adjusted mean Agatston scores 53 units higher than controls (P = 0.002); a difference greater for men than women (P for interaction = 0.017). In all analyses, serum IL-6 attenuated the association between rheumatoid arthritis and coronary calcification, suggesting its role as a potential mediator of enhanced atherosclerosis. Notably, increasing severity of rheumatoid arthritis was associated with a higher prevalence and extent of coronary calcification among both men and women with rheumatoid arthritis, and for all age categories. The largest percentage difference in coronary arterial calcification between rheumatoid arthritis patients and their nonrheumatoid arthritis counterparts was observed in the youngest age category.
Increasing rheumatoid arthritis disease severity was associated with a higher prevalence and greater extent of coronary artery calcification, potentially mediated through an atherogenic effect of chronic systemic inflammation. Gender and age differences in association with coronary calcification suggest that preventive measures should be emphasized in men with rheumatoid arthritis, and considered even in younger rheumatoid arthritis patients with low levels of traditional cardiovascular risk factors.
尽管类风湿关节炎患者心血管疾病的发病率和死亡率有所增加，但对于这些患者亚临床冠状动脉粥样硬化的负担却知之甚少。
采用计算机断层扫描技术，对195名年龄在45至84岁之间、无临床心血管疾病的类风湿关节炎男性和女性患者进行冠状动脉钙化测量，并与参加动脉粥样硬化多族裔研究巴尔的摩队列的1073名无类风湿关节炎的对照者进行比较。
在调整社会人口统计学和心血管危险因素后，类风湿关节炎男性患者冠状动脉钙化（阿加斯顿评分>0）的患病率显著高于对照组，但女性患者则不然（患病率比值=1.19；P=0.012）。在存在钙化的参与者中，类风湿关节炎患者的调整后平均阿加斯顿评分比对照组高53分（P=0.002）；男性差异大于女性（交互作用P=0.017）。在所有分析中，血清白细胞介素-6减弱了类风湿关节炎与冠状动脉钙化之间的关联，表明其作为动脉粥样硬化增强潜在介质的作用。值得注意的是，类风湿关节炎病情严重程度增加与类风湿关节炎男性和女性患者以及所有年龄组冠状动脉钙化的患病率和程度升高有关。在最年轻的年龄组中，类风湿关节炎患者与其非类风湿关节炎对照者之间冠状动脉钙化的百分比差异最大。
类风湿关节炎疾病严重程度增加与冠状动脉钙化的患病率升高和程度加重有关，可能是通过慢性全身炎症的致动脉粥样硬化作用介导的。与冠状动脉钙化相关的性别和年龄差异表明，应强调对类风湿关节炎男性患者采取预防措施，甚至对于传统心血管危险因素水平较低的年轻类风湿关节炎患者也应考虑采取预防措施。
