Charles-Schoeman Christina, Gonzalez-Gay Miguel A, Kaplan Irina, Boy Mary, Geier Jamie, Luo Zhen, Zuckerman Andrea, Riese Richard
University of California, Los Angeles, CA.
Hospital Universitario Marqués de Valdecilla, IDIVAL, Santander, Spain.
Semin Arthritis Rheum. 2016 Aug;46(1):71-80. doi: 10.1016/j.semarthrit.2016.03.004. Epub 2016 Mar 9.
Cardiovascular (CV) morbidity and mortality are increased in patients with active, untreated rheumatoid arthritis (RA), despite lower levels of total and low-density lipoprotein cholesterol reported in individuals with active RA compared with those without RA. Alterations in non-traditional lipid assessments, such as high-density lipoprotein (HDL) function and HDL-associated proteins, have been described in patients with active RA, including elevated HDL-associated serum amyloid A and decreased paraoxonase-1 activity. We review changes in both traditional lipoprotein concentrations and non-traditional lipoprotein assessments in multiple studies of treatment with disease-modifying antirheumatic drugs (DMARDs), including non-biologic and biologic DMARDs and tofacitinib. In addition, data from a recently published clinical trial with tofacitinib that describe a potential mechanism for suppression of cholesterol levels in active RA patients are reviewed. Finally, CV event data from various studies of DMARDs are presented, and the current management of RA patients with regard to the CV risk is reviewed.
心血管（CV）发病率和死亡率在患有活动性、未治疗的类风湿性关节炎（RA）患者中有所增加，尽管与无RA的个体相比，活动性RA患者的总胆固醇和低密度脂蛋白胆固醇水平较低。在活动性RA患者中已发现非传统脂质评估指标存在改变，如高密度脂蛋白（HDL）功能和HDL相关蛋白，包括HDL相关血清淀粉样蛋白A升高和对氧磷酶-1活性降低。我们回顾了多项使用改善病情抗风湿药物（DMARDs）治疗的研究中传统脂蛋白浓度和非传统脂蛋白评估的变化，包括非生物DMARDs、生物DMARDs和托法替布。此外，还回顾了最近发表的一项托法替布临床试验的数据，该数据描述了活动性RA患者胆固醇水平受抑制的潜在机制。最后，展示了DMARDs各项研究中的CV事件数据，并回顾了当前RA患者CV风险的管理情况。
