Santos Maria José, Vinagre Filipe, Silva José José, Gil Victor, Fonseca João Eurico
Rheumatology Research Unit, Instituto de Medicina Molecular da Faculdade de Medicina da Universidade de Lisboa, Edifício Egas Moniz, Lisbon, Portugal.
Acta Reumatol Port. 2010 Jul-Sep;35(3):325-32.
Premature atherosclerosis is well-documented both in Systemic Lupus Erythematosus (SLE) and in Rheumatoid Arthritis (RA) patients, but cardiovascular (CV) risk is particularly high in lupus women. Although conventional CV risk factors do not fully explain the excessive risk in inflammatory diseases, they remain major contributors to atherosclerosis. The aim of the present study was to investigate whether CV risk factors are differentially associated with SLE and RA.
One hundred women with SLE, 98 with RA and 102 controls matched on age and without overt CV or renal disease were assessed for the presence of Framingham (hypertension, hypercholesterolemia, low HDL, diabetes, smoking) and other CV risks (atherogenic index of plasma (AIP), insulin resistance, obesity, central obesity, metabolic syndrome, uric acid, sedentarism, hypothyroidism and family history of premature CV disease).
Modifiable CV risk factors are highly prevalent and occur more frequently in SLE and RA than in age-matched controls. Some differences in Framingham risk factors were found between SLE and RA, with hypertension being more common in young lupus women, hypercholesterolemia more frequent in RA and low HDL-C more frequent in SLE. However, the estimated 10-year Framingham CHD risk or the Reynolds Risk Score was comparable in both diseases. Although hypercholesterolemia was more frequent in RA, lupus women display a more atherogenic lipid profile, with significantly lower HDL-C levels (56.5±16 mg/dl versus 63.7±18; p=0.005), and more cases above the high risk cutpoints for cholesterol/HDL-C (14% versus 4.1%; p=0.01) and for AIP (15% versus 6.1%; p=0.03). Also, uric acid levels are higher in SLE women (4.8±1.5 mg/dl) than in RA (4.1±1.1 mg/dl), p=0.001. On the other hand, insulin resistance is significantly higher in women with RA as compared with SLE (median HOMA-IR 3.5 [6.4]) versus 0.72 [2.5]; p<0.0001) and the difference remained significant after adjustment for BMI and corticosteroids.
Cardiovascular risk profile is distinct in SLE and RA women and the contribution of traditional CV risk factors to atherogenesis may be different in these two diseases. Prospective studies are necessary to understand how the control of modifiable risks can improve CV outcome in different inflammatory settings.
早发动脉粥样硬化在系统性红斑狼疮（SLE）和类风湿关节炎（RA）患者中均有充分记录，但狼疮女性的心血管（CV）风险尤其高。尽管传统的CV风险因素不能完全解释炎症性疾病中的过度风险，但它们仍是动脉粥样硬化的主要促成因素。本研究的目的是调查CV风险因素与SLE和RA是否存在差异关联。
对100名SLE女性、98名RA女性以及102名年龄匹配且无明显CV或肾脏疾病的对照者进行评估，以确定是否存在弗明汉（高血压、高胆固醇血症、低高密度脂蛋白、糖尿病、吸烟）及其他CV风险（血浆致动脉粥样硬化指数（AIP）、胰岛素抵抗、肥胖、中心性肥胖、代谢综合征、尿酸、久坐不动、甲状腺功能减退以及早发CV疾病家族史）。
可改变的CV风险因素非常普遍，且在SLE和RA中比在年龄匹配的对照者中更频繁出现。在SLE和RA之间发现了一些弗明汉风险因素的差异，高血压在年轻狼疮女性中更常见，高胆固醇血症在RA中更频繁，而低高密度脂蛋白胆固醇在SLE中更频繁。然而，两种疾病中估计的10年弗明汉冠心病风险或雷诺兹风险评分相当。尽管高胆固醇血症在RA中更频繁，但狼疮女性的脂质谱更具致动脉粥样硬化性，高密度脂蛋白胆固醇水平显著更低（56.5±16mg/dl对63.7±18；p=0.005），胆固醇/高密度脂蛋白胆固醇（14%对4.1%；p=0.01）和AIP（15%对6.1%；p=0.03）高于高风险切点的病例更多。此外，SLE女性的尿酸水平（4.8±1.5mg/dl）高于RA女性（4.1±1.1mg/dl），p=0.001。另一方面，与SLE相比，RA女性的胰岛素抵抗显著更高（HOMA-IR中位数3.5[6.4]对0.72[2.5]；p<0.0001），在调整体重指数和皮质类固醇后差异仍然显著。
SLE和RA女性的心血管风险特征不同，传统CV风险因素在这两种疾病中对动脉粥样硬化形成的作用可能不同。有必要进行前瞻性研究以了解控制可改变风险如何改善不同炎症背景下的CV结局。
