Service de rhumatologie B, hôpital Cochin, AP-HP, université Paris-V René-Descartes, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
Joint Bone Spine. 2011 Jan;78(1):23-30. doi: 10.1016/j.jbspin.2010.02.040. Epub 2010 May 14.
To assess the association between cardiovascular (CV) risk and low-dose corticosteroids (LD-CT, defined as a daily dose <10mg/day of prednisone) in rheumatoid arthritis (RA) patients.
A systematic review of the literature up to June 2009 was performed.
(1) cardiovascular risk factors: high blood pressure, glycemia and lipid profile, carotid intima-media thickness, pulse-wave velocity, ventricular function; (2) "hard" outcomes: heart failure (HF), stroke, myocardial infarction (MI) or mortality.
descriptive, comparing CV risk between LD-CT-treated RA patients and LD-CT-non-treated RA patients.
Of the 1138 screened reports, the literature search identified 37 assessing CV risk in LD-CT treated RA. The analysis showed a protective effect on serum lipid profile, an increase of insulin resistance or glycemia, probably no effect on blood pressure, no effect on atherosclerosis, discrepancies regarding arterial stiffness and no effect on ventricular function or heart rate variability. An association of LD-CT with major CV events was found in 4/6 studies. This included MI (HR=1.7 [1.2-2.3]), stroke (OR=4.36 [1.60-11.90] for LDC between 6 and 10mg/day), mortality (HR=2.03 [1.25-3.32]) and a composite index of CV events (in the group of rheumatoid factor positive RA, HR=2.21 [1.22-4.00]). Two studies did not find any significant association between LD-CT exposure and mortality (OR=2.25 [0.29-102.5]) or a composite index of CV events (OR=1.3 [0.8-2.0]).
Although the literature review showed poor association between LDC exposure and CV risk factors, a trend of increasing major CV events was identified.
评估心血管（CV）风险与类风湿关节炎（RA）患者低剂量皮质类固醇（LD-CT，定义为每日泼尼松剂量<10mg）之间的关系。
对截至 2009 年 6 月的文献进行了系统评价。
（1）心血管危险因素：高血压、血糖和血脂谱、颈动脉内膜中层厚度、脉搏波速度、心室功能；（2）“硬”终点：心力衰竭（HF）、中风、心肌梗死（MI）或死亡率。
描述性分析，比较 LD-CT 治疗 RA 患者和 LD-CT 非治疗 RA 患者的 CV 风险。
在筛选的 1138 篇报告中，文献检索确定了 37 篇评估 LD-CT 治疗 RA 患者 CV 风险的报告。分析显示，LD-CT 治疗对血清血脂谱有保护作用，对胰岛素抵抗或血糖有升高作用，可能对血压无影响，对动脉粥样硬化无影响，对动脉僵硬度的影响存在差异，对心室功能或心率变异性无影响。有 4/6 项研究发现 LD-CT 与主要 CV 事件相关。这包括 MI（HR=1.7[1.2-2.3]）、中风（LDC 为 6-10mg/天的 OR=4.36[1.60-11.90]）、死亡率（HR=2.03[1.25-3.32]）和 CV 事件综合指数（类风湿因子阳性 RA 组 HR=2.21[1.22-4.00]）。有 2 项研究未发现 LD-CT 暴露与死亡率（OR=2.25[0.29-102.5]）或 CV 事件综合指数（OR=1.3[0.8-2.0]）之间存在任何显著关联。
尽管文献综述显示 LD-CT 暴露与 CV 危险因素之间的相关性较差，但确定了主要 CV 事件增加的趋势。
