Geneva University Hospitals and University of Geneva School of Medicine, 26 Avenue Beau-Sejour, Geneva, Switzerland.
Arthritis Care Res (Hoboken). 2012 Jun;64(6):817-25. doi: 10.1002/acr.21631. Epub 2012 Feb 2.
To determine whether adding C-reactive protein, anti-cyclic citrullinated peptide antibodies, rheumatoid factor, N-terminal pro-brain natriuretic peptide (NT-proBNP), oxidized low-density lipoprotein (ox-LDL), or anti-apolipoprotein A-I (anti-Apo A-I) IgG to the Framingham 10-year cardiovascular (CV) risk score (FRS) could improve its CV prognostic accuracy in rheumatoid arthritis (RA).
We performed an ancillary study derived from a prospective single-center cohort consisting of 118 RA patients without CV disease at baseline. The FRS and the various biomarkers were assessed at enrollment and their prognostic accuracy was determined using receiver operating characteristic (ROC) curve analysis. The incremental predictive ability of biomarkers was assessed using the integrated discrimination improvement (IDI) statistics.
During a median followup period of 9 years, the incidence of CV events was 16%. Both the FRS and 3 of the biomarkers (NT-proBNP, ox-LDL, and anti-Apo A-I) were significant predictors of subsequent CV events (area under the ROC curve [AUC] between 0.68 and 0.73). Anti-Apo A-I was the only biomarker to significantly improve the prognostic ability of the FRS, with AUCs increasing from 0.72 to 0.81 and the IDI improving by 175% (P < 0.001).
Among the biomarkers tested, only anti-Apo A-I significantly improved the FRS predictive ability.
确定在弗拉明翰 10 年心血管（CV）风险评分（FRS）中加入 C 反应蛋白、抗环瓜氨酸肽抗体、类风湿因子、N 端脑钠肽前体（NT-proBNP）、氧化型低密度脂蛋白（ox-LDL）或抗载脂蛋白 A-I（anti-Apo A-I）IgG 是否可以提高类风湿关节炎（RA）患者的 CV 预后准确性。
我们进行了一项辅助研究，该研究来自一个前瞻性的单中心队列，该队列由 118 名基线时无 CV 疾病的 RA 患者组成。在入组时评估了 FRS 和各种生物标志物，并使用接收者操作特征（ROC）曲线分析确定了它们的预后准确性。使用综合判别改善（IDI）统计数据评估了生物标志物的增量预测能力。
在中位随访 9 年期间，CV 事件的发生率为 16%。FRS 和 3 种生物标志物（NT-proBNP、ox-LDL 和 anti-Apo A-I）均为随后 CV 事件的显著预测因素（ROC 曲线下面积[AUC]在 0.68 至 0.73 之间）。anti-Apo A-I 是唯一显著改善 FRS 预后能力的生物标志物，AUC 从 0.72 增加到 0.81，IDI 提高了 175%（P < 0.001）。
在测试的生物标志物中，只有 anti-Apo A-I 显著提高了 FRS 的预测能力。
