类风湿关节炎、抗环瓜氨酸肽抗体阳性与妇女健康倡议中的心血管疾病风险。
Rheumatoid Arthritis, Anti-Cyclic Citrullinated Peptide Positivity, and Cardiovascular Disease Risk in the Women's Health Initiative.
机构信息
University of Pittsburgh, Pittsburgh, Pennsylvania.
University of Colorado, Denver.
出版信息
Arthritis Rheumatol. 2015 Sep;67(9):2311-22. doi: 10.1002/art.39198.
OBJECTIVE
To evaluate the incidence of cardiovascular disease (CVD) morbidity and mortality over the course of 10 years among the more than 160,000 postmenopausal women in the Women's Health Initiative (WHI) in relation to self-reported rheumatoid arthritis (RA), taking disease-modifying antirheumatic drugs (DMARDs), anti-cyclic citrullinated peptide (anti-CCP) positivity, rheumatoid factor (RF) positivity, CVD risk factors, joint pain, and inflammation (white blood cell count and interleukin-6 levels).
METHODS
Anti-CCP and RF were measured in a sample of WHI participants with self-reported RA (n = 9,988). RA was classified as self-reported RA plus anti-CCP positivity and/or taking DMARDs. Anti-CCP-negative women with self-reported RA and not taking DMARDs were classified as having "unverified RA."
RESULTS
Age-adjusted rates of coronary heart disease (CHD), stroke, CVD, fatal CVD, and total mortality were higher in women with RA than in women with no reported RA, with multivariable-adjusted hazard ratios of 1.46 (95% confidence interval [95% CI] 1.17-1.83) for CHD and 2.55 (95% CI 1.86-3.51) for fatal CVD. Among women with RA, anti-CCP positivity and RF positivity were not significantly associated with higher risk of any outcomes, despite slightly higher risk of death for those who were anti-CCP positive than for those who were anti-CCP negative. Joint pain severity and CVD risk factors were strongly associated with CVD risk, even in women with no reported RA. CVD incidence was increased in women with RA versus women with no reported RA at almost all risk factor levels, except for low levels of joint pain or inflammation. Among women with RA, inflammation was more strongly associated with fatal CVD and total mortality than with CHD or CVD.
CONCLUSION
Among postmenopausal women, RA was associated with 1.5-2.5-fold higher CVD risk. CVD risk was strongly associated with CVD risk factors, joint pain severity, and inflammation, but not with anti-CCP positivity or RF positivity.
目的
评估超过 160,000 名参加妇女健康倡议（WHI）的绝经后妇女在 10 年内心血管疾病（CVD）发病率和死亡率与自我报告的类风湿关节炎（RA）、使用疾病修饰抗风湿药物（DMARDs）、抗环瓜氨酸肽（抗-CCP）阳性、类风湿因子（RF）阳性、CVD 风险因素、关节疼痛和炎症（白细胞计数和白细胞介素-6 水平）的关系。
方法
在 WHI 参与者中，对自我报告的 RA 患者（n=9988）进行了抗 CCP 和 RF 检测。RA 被归类为自我报告的 RA 加上抗 CCP 阳性和/或使用 DMARDs。未使用 DMARDs 且自我报告的 RA 为抗 CCP 阴性的女性被归类为“未确诊 RA”。
结果
年龄调整后的冠心病（CHD）、中风、CVD、致命 CVD 和总死亡率在有 RA 的女性中高于无 RA 的女性，多变量调整后的危险比分别为 1.46（95%置信区间[95%CI] 1.17-1.83）和 2.55（95%CI 1.86-3.51）。在有 RA 的女性中，尽管抗 CCP 阳性的女性比抗 CCP 阴性的女性死亡风险略高，但抗 CCP 阳性和 RF 阳性与任何结局的风险增加均无显著相关性。关节疼痛严重程度和 CVD 风险因素与 CVD 风险密切相关，即使在无 RA 报告的女性中也是如此。与无 RA 报告的女性相比，在几乎所有的风险因素水平下，RA 女性的 CVD 发病率均增加，除了关节疼痛或炎症水平较低的情况。在有 RA 的女性中，炎症与致命 CVD 和总死亡率的相关性强于 CHD 或 CVD。
结论
在绝经后妇女中，RA 与 CVD 风险增加 1.5-2.5 倍相关。CVD 风险与 CVD 风险因素、关节疼痛严重程度和炎症密切相关，但与抗 CCP 阳性或 RF 阳性无关。
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