Division of Rheumatology, Catholic University of the Sacred Heart, Rome, Italy.
Autoimmun Rev. 2011 Aug;10(10):582-9. doi: 10.1016/j.autrev.2011.04.018. Epub 2011 Apr 22.
Rheumatoid arthritis (RA) patients have an incidence of cardiovascular (CV) diseases at least two times higher than the general population. Atherosclerosis, the main determinant of CV morbidity and mortality, and carotid intima-media thickness, an early preclinical marker of atherosclerosis, also occur early on in RA. Traditional CV risk factors seem to have the same prevalence in RA and non-RA patients, and thus do not fully explain the increased CV burden, suggesting that RA inflammation and therapies play a role in increasing CV risk in these patients. The metabolic syndrome and fat tissue are likely to be the major players in this complex network. The metabolic syndrome (MetS) represents a cluster of cardiovascular risk factors that have in common insulin resistance and increased visceral adiposity. This entity has received great attention in the last few years due to its contribution to the burden of cardiovascular morbidity and mortality. Moreover, recently the adipose tissue has emerged as a dynamic organ that releases several inflammatory and immune mediators (adipokines). The association of MetS and atherosclerosis is thought to be partly mediated by altered secretion of adipokines by the adipose tissue and, on the other hand, there are evidence that adipokines may play some role in inflammatory arthritides. Obesity is now regarded as a systemic, low-grade inflammatory state, and inflammation as a link between obesity, metabolic syndrome, and cardiovascular diseases. To obtain a full control of the CV risk, data suggest that it is therefore mandatory a "tight control" of both RA and MetS inflammations.
类风湿关节炎（RA）患者发生心血管（CV）疾病的几率至少是普通人群的两倍。动脉粥样硬化是 CV 发病率和死亡率的主要决定因素，颈动脉内膜中层厚度是动脉粥样硬化的早期临床前标志物，在 RA 中也很早就出现了。传统的 CV 危险因素在 RA 和非 RA 患者中的患病率似乎相同，因此不能完全解释 CV 负担增加，这表明 RA 炎症和治疗在这些患者的 CV 风险增加中起作用。代谢综合征和脂肪组织可能是这个复杂网络中的主要参与者。代谢综合征（MetS）代表一组心血管危险因素，它们共同的特征是胰岛素抵抗和内脏脂肪增加。由于其对心血管发病率和死亡率负担的贡献，近年来该实体受到了极大的关注。此外，最近脂肪组织已成为一种释放多种炎症和免疫介质（脂肪因子）的活跃器官。代谢综合征与动脉粥样硬化的关联部分被认为是脂肪组织中脂肪因子分泌改变介导的，另一方面，有证据表明脂肪因子可能在炎症性关节炎中发挥一些作用。肥胖现在被认为是一种全身性的低度炎症状态，炎症是肥胖、代谢综合征和心血管疾病之间的联系。为了充分控制 CV 风险，有数据表明，因此必须严格控制 RA 和代谢综合征的炎症。
