Department of Clinical Immunology and Rheumatology, Academic Medical Center, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands.
Nat Rev Rheumatol. 2010 Mar;6(3):157-64. doi: 10.1038/nrrheum.2009.277. Epub 2010 Feb 9.
Rheumatoid arthritis (RA) is a prototypical immune-mediated inflammatory disease that is characterized by increased cardiovascular morbidity and mortality, independent of the traditional risk factors for cardiovascular disease. The chronic inflammatory state--a hallmark of RA--is considered to be a driving force for accelerated atherogenesis. Consequently, aggressive control of RA disease activity is thought to be instrumental for cardiovascular risk reduction. Currently, statin-mediated reduction of LDL-cholesterol levels is considered to be the cornerstone of cardiovascular disease prevention. In addition to their lipid-lowering capabilities, statins exert immunomodulatory effects, which could be of dual benefit in the treatment of RA. Guidelines on the reduction of cardiovascular risk in patients with RA are lacking, however, largely owing to the absence of data from randomized controlled trials. This Review focuses on the pathophysiology of cardiovascular events in RA, as well as the need to adjust cardiovascular risk engines to better-accommodate the impact of chronic inflammatory disease over and above the established risk factors to predict cardiovascular risk in patients with RA.
类风湿关节炎（RA）是一种典型的免疫介导的炎症性疾病，其特征是心血管发病率和死亡率增加，且独立于心血管疾病的传统危险因素。慢性炎症状态——RA 的标志——被认为是动脉粥样硬化加速发生的驱动力。因此，积极控制 RA 疾病活动被认为是降低心血管风险的关键。目前，他汀类药物降低 LDL-胆固醇水平被认为是预防心血管疾病的基石。除了降低血脂的能力外，他汀类药物还具有免疫调节作用，这在 RA 的治疗中可能具有双重益处。然而，针对 RA 患者降低心血管风险的指南尚缺乏，这主要是由于缺乏来自随机对照试验的数据。本综述重点介绍了 RA 中心血管事件的病理生理学，以及调整心血管风险引擎的必要性，以更好地适应慢性炎症性疾病对预测 RA 患者心血管风险的影响，而不仅仅是考虑已确立的危险因素。
