Terrier Benjamin, Chironi Gilles, Pagnoux Christian, Cohen Pascal, Puéchal Xavier, Simon Alain, Mouthon Luc, Guillevin Loïc
From the Department of Internal Medicine, Referral Center for Systemic and Autoimmune Diseases, Hôpital Cochin, AP-HP, Université Paris-Descartes; Centre de Médecine Préventive Cardiovasculaire, Hôpital Européen Georges-Pompidou, Inserm U970, Université Paris-Descartes, Paris, France; and Mount Sinai Hospital, University of Toronto, Division of Rheumatology, Department of Medicine, Toronto, Ontario, Canada.
J Rheumatol. 2014 Apr;41(4):723-9. doi: 10.3899/jrheum.130882. Epub 2014 Mar 1.
Systemic necrotizing vasculitides (SNV) are associated with more frequent subclinical atherosclerosis, suggesting that SNV might be associated with a higher risk of major cardiovascular events (MCVE). We aimed to identify factors predictive of MCVE in patients with SNV.
Patients in remission from SNV were assessed for CV risk factors and subclinical atherosclerosis. MCVE was defined as myocardial infarction, stroke, arterial revascularization, hospitalization for unstable angina, and/or death from CV causes. MCVE-free survival curves were compared using the log-rank test.
Forty-two patients were followed for 7.1±2.6 years. Eight patients (18.9%) had MCVE. The respective 5- and 10-year MCVE rates were 9.5% and 26.8%. National Cholesterol Education Program/Adult Treatment Panel III (NCEP/ATP III)-defined high-risk status [hazard ratio (HR) 5.02 (95% CI: 1.17-27.4), p=0.03], BMI>30 kg/m2 [HR 4.84 (95% CI: 1.46-116), p=0.02], and plaque detection in the abdominal aorta (p=0.01) were significantly associated with MCVE. SNV characteristics, corticosteroid maintenance therapy, and C-reactive protein>5 mg/l were not associated with MCVE. Plaque in the aorta was significantly associated with high-risk status (p<0.001), while BMI and high-risk status were independent variables. Thus, a BMI>30 kg/m2 and/or a high-risk status were strongly associated with MCVE (p=0.004). Carotid intima-media thickness (IMT) identified patients with early MCVE and was correlated with the time to MCVE (r2=0.68, p=0.01).
These results suggest that factors associated with a higher MCVE risk in patients with SNV are NCEP/ATP III-defined high-risk status and BMI>30 kg/m2. Carotid IMT could help identify patients with SNV at risk of early MCVE.
系统性坏死性血管炎（SNV）与更频繁的亚临床动脉粥样硬化相关，这表明SNV可能与主要心血管事件（MCVE）的较高风险相关。我们旨在确定SNV患者中MCVE的预测因素。
对处于缓解期的SNV患者进行心血管危险因素和亚临床动脉粥样硬化评估。MCVE定义为心肌梗死、中风、动脉血运重建、因不稳定型心绞痛住院和/或心血管原因导致的死亡。使用对数秩检验比较无MCVE生存曲线。
42例患者随访7.1±2.6年。8例患者（18.9%）发生MCVE。5年和10年MCVE发生率分别为9.5%和26.8%。美国国家胆固醇教育计划/成人治疗小组第三次报告（NCEP/ATP III）定义的高危状态[风险比（HR）5.02（95%可信区间：1.17 - 27.4），p = 0.03]、体重指数（BMI）>30 kg/m²[HR 4.84（95%可信区间：1.46 - 116），p = 0.02]以及腹主动脉斑块检测（p = 0.01）与MCVE显著相关。SNV特征、糖皮质激素维持治疗和C反应蛋白>5 mg/L与MCVE无关。主动脉斑块与高危状态显著相关（p<0.001），而BMI和高危状态是独立变量。因此，BMI>30 kg/m²和/或高危状态与MCVE密切相关（p = 0.004）。颈动脉内膜中层厚度（IMT）可识别早期MCVE患者，并与发生MCVE的时间相关（r² = 0.68，p = 0.01）。
这些结果表明，SNV患者中与较高MCVE风险相关的因素是NCEP/ATP III定义的高危状态和BMI>30 kg/m²。颈动脉IMT有助于识别有早期MCVE风险的SNV患者。
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