Department of Rheumatology, Dudley Group of Hospitals NHS Foundation Trust, Russells Hall Hospital, Dudley DY1 2HQ, United Kingdom.
Eur J Intern Med. 2012 Oct;23(7):575-9. doi: 10.1016/j.ejim.2012.06.016. Epub 2012 Jul 28.
Cardiovascular disease (CVD) comorbidity is a significant issue for the inflammatory arthritides (IA). There is a wealth of mortality studies showing increased cardiovascular mortality in rheumatoid arthritis (RA) and the evidence suggests that the same is likely to be true of psoriatic arthritis (PsA) and ankylosing spondylitis (AS). CVD co-morbidity is due to ischaemic pathologies driven by accelerated atherosclerosis and relates to the increased prevalence and clustering of classical risk factors, which may also be affected by treatments for IA, and their interplay with novel risk factors, namely systemic inflammation. Currently we are unable to quantify the contribution that classical and novel risk factors make to an individuals' CVD risk and specific algorithms need to be developed and validated in RA, PsA and AS to facilitate clinical management. Furthermore, large clinical trials are required to assess the effect of lifestyle modifications, primary prevention strategies and effective immunosuppression on hard CVD endpoints. However, in the meantime, a pragmatic approach should be adopted towards CVD risk management. Consensus opinion has generated guidelines for the management of CVD risk in IA and we discuss the importance of assessing each individual for CVD risk and establishing a system for routine risk factor identification alongside a commitment to treat identified risk factors to specific targets.
心血管疾病（CVD）合并症是炎症性关节炎（IA）的一个重要问题。有大量的死亡率研究表明，类风湿关节炎（RA）的心血管死亡率增加，并且有证据表明，银屑病关节炎（PsA）和强直性脊柱炎（AS）也可能如此。CVD 合并症是由加速动脉粥样硬化引起的缺血性病理引起的，与常见风险因素的患病率增加和聚集有关，这些风险因素也可能受到 IA 治疗的影响，以及它们与新型风险因素（即全身炎症）的相互作用。目前，我们无法量化经典和新型风险因素对个体 CVD 风险的贡献，需要在 RA、PsA 和 AS 中开发和验证特定的算法，以促进临床管理。此外，需要进行大型临床试验来评估生活方式改变、初级预防策略和有效免疫抑制对硬性 CVD 终点的影响。然而，在此期间，应该对 CVD 风险管理采取务实的方法。共识意见已经为 IA 中的 CVD 风险管理制定了指南，我们讨论了评估每个个体 CVD 风险的重要性，并建立了一个常规风险因素识别系统，同时承诺针对特定目标治疗已确定的风险因素。
