Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Dudley, UK.
Curr Opin Cardiol. 2011 Jul;26(4):327-33. doi: 10.1097/HCO.0b013e32834703b5.
This review examines current evidence to address the question whether rheumatoid arthritis (RA) is a coronary heart disease equivalent, similar to type 2 diabetes mellitus (DM2).
Cross-sectional and longitudinal epidemiological studies show a two-fold higher risk of cardiovascular disease (CVD) in patients with RA, and the magnitude of this increased risk is comparable to the risk associated with DM2. However, the mechanisms responsible for this appear to be different in the two conditions, with RA-related CVD being attributed to 'high-grade' systemic inflammation as well as classical CVD risk factors. Several classical risk factors are affected by RA or its medications, and there are some paradoxical associations between obesity or lipid abnormalities and CVD death in RA.
Management of RA-related CVD is likely to require both aggressive control of inflammation and systematic screening and management of classical CVD risk factors. It remains unknown whether primary prevention strategies applied successfully in DM2 would be equally easy to implement and demonstrate similar benefits in people with RA.
本篇综述检查了目前的证据，以解决类风湿关节炎 (RA) 是否等同于冠心病这一问题，就像 2 型糖尿病 (DM2) 一样。
横断面和纵向的流行病学研究表明，RA 患者发生心血管疾病 (CVD) 的风险增加了两倍，这种风险增加的幅度与 DM2 相关的风险相当。然而，导致这两种情况的机制似乎不同，RA 相关的 CVD 归因于“高级”系统性炎症以及经典的 CVD 危险因素。一些经典的危险因素受 RA 或其药物的影响，而在 RA 中，肥胖或脂质异常与 CVD 死亡之间存在一些矛盾的关联。
RA 相关 CVD 的管理可能需要积极控制炎症，以及系统性筛查和管理经典 CVD 危险因素。目前还不清楚在 DM2 中成功实施的一级预防策略在 RA 患者中是否同样易于实施并带来类似的益处。
