Dalbeni A, Giollo A, Tagetti A, Atanasio S, Orsolini G, Cioffi G, Ognibeni F, Rossini M, Minuz P, Fava C, Viapiana O
Division of General Medicine and Hypertension, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Division of Rheumatology, Department of Medicine, University and Azienda Ospedaliera Universitaria Integrata of Verona, Verona, Italy.
Int J Cardiol. 2017 Jun 1;236:488-492. doi: 10.1016/j.ijcard.2017.01.072. Epub 2017 Jan 14.
Patients with chronic inflammatory arthritis experience an increased incidence of cardiovascular (CV) events. In addition to visualizing atherosclerotic plaques, ultrasound examinations (USs) of the carotid arteries permit the measurement of subclinical markers of atherosclerosis, such as intima-media thickness (cIMT) and carotid segmental distensibility (cDC). The aims of the study were to identify the determinants of atherosclerosis acceleration (plaques, cIMT and cDC) in a sample of patients suffering from chronic arthritis and to compare these patients with a control group of people with ≤1 traditional risk factor (TRF) for CV disease.
We recruited 137 patients with rheumatoid arthritis (RA), 43 patients with psoriatic arthritis (PsA), 28 patients with ankylosing spondylitis (AS) and 48 healthy volunteers without histories of previous CV events. These patients underwent carotid artery US examinations using dedicated hardware.
Regression and multivariate analyses demonstrated that only age (p<0.001) was consistently associated with cDC, cIMT and atherosclerotic plaques, both in the entire sample of patients with arthritis and in the subgroup of patients with RA. Among modifiable TRFs for cardiovascular disease, only hypertension, diabetes mellitus and smoking exhibited associations with some carotid phenotypes, with borderline significance. When patients with RA carrying ≤1 TRF were compared with control subjects carrying ≤1 TRF, only cDC was slightly lower in the RA group than in the control group.
Age is the major determinant of subclinical atherosclerosis in patients with different types of arthritis, as the contributions of other TRFs and disease activity and duration indices to the disease seem to be limited.
慢性炎症性关节炎患者发生心血管（CV）事件的发生率增加。除了可视化动脉粥样硬化斑块外，颈动脉超声检查（US）还可以测量动脉粥样硬化的亚临床标志物，如内膜中层厚度（cIMT）和颈动脉节段扩张性（cDC）。本研究的目的是确定慢性关节炎患者样本中动脉粥样硬化加速（斑块、cIMT和cDC）的决定因素，并将这些患者与患有≤1种心血管疾病传统危险因素（TRF）的对照组人群进行比较。
我们招募了137例类风湿关节炎（RA）患者、43例银屑病关节炎（PsA）患者、28例强直性脊柱炎（AS）患者和48名无既往CV事件病史的心健康志愿者。这些患者使用专用硬件进行了颈动脉超声检查。
回归分析和多变量分析表明，仅年龄（p<0.001）在整个关节炎患者样本以及RA患者亚组中均与cDC、cIMT和动脉粥样硬化斑块持续相关。在心血管疾病的可改变TRF中，只有高血压、糖尿病和吸烟与某些颈动脉表型存在关联，且具有临界显著性。当将携带≤1种TRF的RA患者与携带≤1种TRF的对照组受试者进行比较时，RA组的cDC仅略低于对照组。
年龄是不同类型关节炎患者亚临床动脉粥样硬化的主要决定因素，因为其他TRF以及疾病活动和病程指标对该疾病的影响似乎有限。
