Clermont 1 University, Centre Hospitalier Universitaire Gabriel Montpied, Clermont-Ferrand, France.
Arthritis Care Res (Hoboken). 2011 Apr;63(4):557-63. doi: 10.1002/acr.20364.
Rheumatoid arthritis is associated with increased cardiovascular risk. In ankylosing spondylitis (AS), there is a paucity of information concerning this risk. Our objective was to assess the incidence of myocardial infarction (MI) or strokes and the cardiovascular risk profile in AS patients.
We performed a systematic literature review using PubMed, EMBase, and the Cochrane Library up to August 2009. Incidence of MI or stroke was calculated by metaproportion. For cardiovascular risk factors, differences between AS patients and controls were expressed by standardized mean differences using inverse of variance method.
For MI, 8 longitudinal studies were included. In controls (n=82,745), 1,318 MI cases were observed (4.6%; 95% confidence interval [95% CI] 1.2%, 10.0%). In AS patients (n=3,279), 224 MI cases were reported (incidence 7.4%; 95% CI 5.2%, 10.0%). The increase in MI cases in AS patients was not significant (risk ratio 1.88; 95% CI 0.83, 4.28). For stroke, 7 longitudinal studies reported 327 strokes in AS patients (n=31,949), which is an incidence of 2.2% (95% CI 1.3%, 3.4%). In controls (n=7,372), one study reported 170 strokes (2.3%; 95% CI 2.0%, 2.7%). For cardiovascular risk factors, 15 case-control studies and 9 abstracts were included (n=1,214 for patients and n=1,000 for controls). AS patients were characterized by a higher weighted mean intima-media thickness and higher risk of metabolic syndrome. In AS patients, there was a significant decrease in triglycerides, total cholesterol, and high-density lipoprotein (HDL) cholesterol.
AS patients appear to be at higher risk of MI, which could be due to low HDL cholesterol levels or to systemic inflammation. Management of cardiovascular risk factors and control of systemic inflammation should be taken into account in AS.
类风湿关节炎与心血管风险增加相关。在强直性脊柱炎（AS）中，关于这种风险的信息很少。我们的目的是评估 AS 患者心肌梗死（MI）或中风的发生率和心血管风险状况。
我们使用 PubMed、EMBase 和 Cochrane 图书馆进行了系统文献回顾，检索截至 2009 年 8 月的文献。通过荟萃比例法计算 MI 或中风的发生率。对于心血管危险因素，使用倒数方差法表示 AS 患者与对照组之间的差异。
对于 MI，纳入了 8 项纵向研究。在对照组（n=82745）中，观察到 1318 例 MI 病例（4.6%；95%置信区间[95%CI]为 1.2%，10.0%）。在 AS 患者（n=3279）中，报告了 224 例 MI 病例（发生率为 7.4%；95%CI 为 5.2%，10.0%）。AS 患者 MI 病例的增加并不显著（风险比 1.88；95%CI 为 0.83，4.28）。对于中风，7 项纵向研究报告了 31949 例 AS 患者中的 327 例中风（发生率为 2.2%；95%CI 为 1.3%，3.4%）。在对照组（n=7372）中，一项研究报告了 170 例中风（2.3%；95%CI 为 2.0%，2.7%）。对于心血管危险因素，纳入了 15 项病例对照研究和 9 篇摘要（患者 n=1214，对照组 n=1000）。AS 患者的特征是内膜中层厚度更高和代谢综合征风险更高。在 AS 患者中，甘油三酯、总胆固醇和高密度脂蛋白（HDL）胆固醇显著降低。
AS 患者似乎有更高的 MI 风险，这可能是由于 HDL 胆固醇水平低或全身炎症所致。在 AS 中，应考虑心血管危险因素的管理和全身炎症的控制。
