类风湿关节炎患者动脉僵硬度和亚临床颈动脉粥样硬化对心血管疾病的预测价值
Predictive Value of Arterial Stiffness and Subclinical Carotid Atherosclerosis for Cardiovascular Disease in Patients with Rheumatoid Arthritis.
作者信息
Ikdahl Eirik, Rollefstad Silvia, Wibetoe Grunde, Olsen Inge C, Berg Inger-Jorid, Hisdal Jonny, Uhlig Till, Haugeberg Glenn, Kvien Tore K, Provan Sella A, Semb Anne Grete
机构信息
From the Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; Section of Vascular Investigations, Oslo University Hospital Aker; National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo; Martina Hansens Hospital, Bærum; Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.E. Ikdahl, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; S. Rollefstad, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; G. Wibetoe, MD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital; I.C. Olsen, PhD, Department of Rheumatology, Diakonhjemmet Hospital; I.J. Berg, MD, Department of Rheumatology, Diakonhjemmet Hospital; J. Hisdal, DrPhilos, Section of Vascular Investigations, Oslo University Hospital Aker; T. Uhlig, MD, Professor, National Resource Centre for Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital; G. Haugeberg, MD, Professor, Martina Hansens Hospital, and Division of Rheumatology, Department of Neuroscience, Norwegian University of Science and Technology; T.K. Kvien, MD, Professor, Department of Rheumatology, Diakonhjemmet Hospital; S.A. Provan, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; A.G. Semb, MD, PhD, Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital.
出版信息
J Rheumatol. 2016 Sep;43(9):1622-30. doi: 10.3899/jrheum.160053. Epub 2016 Jun 15.
OBJECTIVE
We evaluated the predictive value of these vascular biomarkers for cardiovascular disease (CVD) events in patients with rheumatoid arthritis (RA): aortic pulse wave velocity (aPWV), augmentation index (AIx), carotid intima-media thickness (cIMT), and carotid plaques (CP). They are often used as risk markers for CVD.
METHODS
In 2007, 138 patients with RA underwent clinical examination, laboratory tests, blood pressure testing, and vascular biomarker measurements. Occurrence of CVD events was recorded in 2013. Predictive values were assessed in Kaplan-Meier plots, log-rank, and crude and adjusted Cox proportional hazard (PH) regression analyses.
RESULTS
Baseline median age and disease duration was 59.0 years and 17.0 years, respectively, and 76.1% were women. CVD events occurred in 10 patients (7.2%) during a mean followup of 5.4 years. Compared with patients with low aPWV, AIx, cIMT, and without CP, patients with high aPWV (p < 0.001), high AIx (p = 0.04), high cIMT (p = 0.01), and CP (p < 0.005) at baseline experienced more CVD events. In crude Cox PH regression analyses, aPWV (p < 0.001), cIMT (p < 0.001), age (p = 0.01), statin (p = 0.01), and corticosteroid use (p = 0.01) were predictive of CVD events, while AIx was nonsignificant (p = 0.19). The Cox PH regression estimates for vascular biomarkers were not significantly altered when adjusting individually for demographic variables, traditional CVD risk factors, RA disease-related variables, or medication. All patients who developed CVD had CP at baseline.
CONCLUSION
CP, aPWV, and cIMT were predictive of CVD events in this cohort of patients with RA. Future studies are warranted to examine the additive value of arterial stiffness and carotid atherosclerosis markers in CVD risk algorithms. Regional Ethical Committee approval numbers 2009/1582 and 2009/1583.
目的
我们评估了这些血管生物标志物对类风湿关节炎（RA）患者心血管疾病（CVD）事件的预测价值，这些生物标志物包括主动脉脉搏波速度（aPWV）、增强指数（AIx）、颈动脉内膜中层厚度（cIMT）和颈动脉斑块（CP）。它们常被用作CVD的风险标志物。
方法
2007年，138例RA患者接受了临床检查、实验室检测、血压检测和血管生物标志物测量。2013年记录CVD事件的发生情况。在Kaplan-Meier曲线、对数秩检验以及粗和调整后的Cox比例风险（PH）回归分析中评估预测价值。
结果
基线时的中位年龄和病程分别为59.0岁和17.0年，76.1%为女性。在平均5.4年的随访期间，10例患者（7.2%）发生了CVD事件。与aPWV、AIx、cIMT较低且无CP的患者相比，基线时aPWV较高（p<0.001）、AIx较高（p=0.04）、cIMT较高（p=0.01）以及有CP（p<0.005）的患者发生更多CVD事件。在粗Cox PH回归分析中，aPWV（p<0.001）、cIMT（p<0.001）、年龄（p=0.01）、他汀类药物（p=0.01）和使用皮质类固醇（p=0.01）可预测CVD事件，而AIx无统计学意义（p=0.19）。在分别对人口统计学变量、传统CVD风险因素、RA疾病相关变量或药物进行调整后，血管生物标志物的Cox PH回归估计值未发生显著改变。所有发生CVD的患者在基线时均有CP。
结论
在该队列RA患者中，CP、aPWV和cIMT可预测CVD事件。未来有必要开展研究，以检验动脉僵硬度和颈动脉粥样硬化标志物在CVD风险算法中的附加价值。地区伦理委员会批准号2009/1582和2009/1583。
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