Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA Department of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Ann Rheum Dis. 2014 Jul;73(7):1301-8. doi: 10.1136/annrheumdis-2013-204715. Epub 2014 May 5.
To examine the association of serum inflammatory markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) and serum lipid measures (low-density lipoprotein (LDL)- and high-density lipoprotein (HDL)-cholesterol) with risk of myocardial infarction (MI) and ischaemic stroke (IS) among rheumatoid arthritis (RA) patients.
We conducted a retrospective cohort study using 2005-2010 data from a US commercial health plan. Eligible patients had two or more physician diagnoses of RA during a baseline period of at least 180 days with continuous medical and pharmacy coverage. We computed age-adjusted incidence rates of MI and IS, and used spline regression to assess non-linear associations and Cox-regression to quantify the independent association between the laboratory values and the outcomes.
We identified 44 418 eligible RA patients (mean age 49 years; 76% women). CRP>10 mg/L compared with <1 mg/L was associated with increased MI risk (HR 2.12; 95% CI 1.02 to 4.38). ESR>42 mm/h compared with <14 mm/h was associated with increased risk of MI (HR 2.53; 95% CI 1.48 to 4.31) and IS (HR 2.51; 95% CI 1.33 to 4.75) risk. HDL-cholesterol ≥60 mg/dL (1.6 mmol/L) compared with <40 mg/dL (1.0 mmol/L) was associated with reduced MI risk (HR 0.37; 0.21 to 0.66). The association between LDL and MI was not linear; the lowest risk was observed among patients with LDL between 70 mg/L (1.8 mmol/L) and 100 mg/L (2.6 mmol/L). We did not observe a significant association between LDL and IS.
This study provides evidence supporting the hypothesis that RA-related systemic inflammation plays a role in determining cardiovascular risk and a complex relationship between LDL and cardiovascular risk.
研究血清炎症标志物（红细胞沉降率（ESR）和 C 反应蛋白（CRP））和血清脂质指标（低密度脂蛋白（LDL）和高密度脂蛋白（HDL）-胆固醇）与类风湿关节炎（RA）患者心肌梗死（MI）和缺血性卒中（IS）风险的关系。
我们进行了一项回顾性队列研究，使用了美国商业健康计划在 2005-2010 年的数据。合格患者在基线期至少有 180 天的两次或两次以上的 RA 医生诊断，并有持续的医疗和药物治疗。我们计算了 MI 和 IS 的年龄调整发病率，并使用样条回归来评估非线性关系，并用 Cox 回归来量化实验室值与结果之间的独立关系。
我们确定了 44418 名合格的 RA 患者（平均年龄 49 岁；76%为女性）。与 <1mg/L 相比，CRP>10mg/L 与 MI 风险增加相关（HR 2.12；95%CI 1.02-4.38）。与 <14mm/h 相比，ESR>42mm/h 与 MI（HR 2.53；95%CI 1.48-4.31）和 IS（HR 2.51；95%CI 1.33-4.75）风险增加相关。与 <40mg/dL（1.0mmol/L）相比，HDL-胆固醇≥60mg/dL（1.6mmol/L）与 MI 风险降低相关（HR 0.37；0.21-0.66）。LDL 与 MI 之间的关系不是线性的；在 LDL 介于 70mg/L（1.8mmol/L）和 100mg/L（2.6mmol/L）之间的患者中，风险最低。我们没有观察到 LDL 与 IS 之间有显著的相关性。
本研究提供了证据支持 RA 相关的系统性炎症在决定心血管风险方面起作用的假设，以及 LDL 与心血管风险之间的复杂关系。
