Kokkonen Heidi, Stenlund Hans, Rantapää-Dahlqvist Solbritt
Department of Public Health and Clinical Medicine, Rheumatology, Umeå University, Building 6M, 901 87, Umeå, Sweden.
Department of Public Health and Clinical Medicine, Epidemiology and Global Health, Umeå University, Umeå, Sweden.
Arthritis Res Ther. 2017 Jun 30;19(1):148. doi: 10.1186/s13075-017-1351-8.
Patients with rheumatoid arthritis (RA) are at increased risk of developing cardiovascular disease (CVD). Our aim was to evaluate the impact of factors related to CVD, such as smoking, lipid levels, hypertension, body mass index (BMI) and diabetes, in individuals prior to the onset of symptoms of RA.
A nested case-control study was performed including data from 547 pre-symptomatic individuals (i.e. individuals who had participated in population surveys in northern Sweden prior to onset of symptoms of RA, median time to symptom onset 5.0 (interquartile range 2.0-9.0) years) and 1641 matched controls. Within the survey, health examinations prior to symptom onset were performed, blood samples were analysed for plasma glucose and lipids, and data on lifestyle factors had been collected with a questionnaire. CVD risk factors were extracted and further analysed with conditional logistic regression models for association with subsequent RA development, including hypertension, apolipoprotein (Apo)B/ApoA1 ratio, BMI, diabetes and smoking habits.
Smoking and BMI ≥ 25 (odds ratio (OR) (95% confidence interval (CI)) =1.86 (1.48-2.35) and OR = 1.28 (1.01-1.62), respectively) were associated with increased risk for future RA development. In women, elevated ApoB/ApoA1 ratio (OR = 1.36 (1.03-1.80)) and smoking (OR = 1.82 (1.37-2.41)) were significantly associated with being pre-symptomatic for RA, whilst in men smoking (OR = 1.92 (1.26-2.92)) and diabetes (OR = 3.62 (95% CI 1.13-11.64)) were significant. In older (>50.19 years) individuals, only smoking (OR = 1.74 (1.24-2.45)) was significantly associated with increased risk of future RA, whereas in younger individuals the significant factors were elevated ApoB/ApoA1 ratio (OR = 1.39 (1.00-1.93)), BMI ≥ 25.0 (OR = 1.45 (1.04-2.02)) and smoking (OR = 2.11 (1.51-2.95)). Pre-symptomatic individuals had a higher frequency of risk factors: 41.5% had ≥3 compared with 30.4% among matched controls (OR = 2.81 (1.78-4.44)).
Several risk factors for CVD were present in pre-symptomatic individuals and significantly associated with increased risk for future RA. These factors differed in women and men. The CVD risk factors had a greater impact in younger individuals. These results urge an early analysis of cardiovascular risk factors for proposed prevention in patients with early RA.
类风湿关节炎（RA）患者发生心血管疾病（CVD）的风险增加。我们的目的是评估CVD相关因素，如吸烟、血脂水平、高血压、体重指数（BMI）和糖尿病，在RA症状出现之前对个体的影响。
进行了一项巢式病例对照研究，纳入了547名症状出现前个体的数据（即那些在瑞典北部症状出现前参与过人群调查的个体，症状出现的中位时间为5.0（四分位间距2.0 - 9.0）年）以及1641名匹配对照。在调查中，对症状出现前进行了健康检查，分析血样中的血糖和血脂，并通过问卷调查收集生活方式因素的数据。提取CVD危险因素，并使用条件逻辑回归模型进一步分析其与随后RA发生的关联，包括高血压、载脂蛋白（Apo）B/ApoA1比值·、BMI、糖尿病和吸烟习惯。
吸烟和BMI≥25（比值比（OR）（95%置信区间（CI））分别为1.86（1.48 - 2.35）和OR = 1.28（1.01 - 1.62））与未来发生RA的风险增加相关。在女性中，升高的ApoB/ApoA1比值（OR = 1.36（1.03 - 1.80））和吸烟（OR = 1.82（1.37 - 2.41））与RA症状出现前显著相关，而在男性中，吸烟（OR = 1.92（1.26 - 2.92））和糖尿病（OR = 3.62（95% CI 1.13 - 11.64））显著相关。在年龄较大（>50.19岁）的个体中，只有吸烟（OR = 1.74（1.24 - 2.45））与未来RA风险增加显著相关，而在较年轻个体中，显著因素是升高的ApoB/ApoA1比值（OR = 1.39（1.00 - 1.93））、BMI≥25.0（OR = 1.45（1.04 - 2.02））和吸烟（OR = 2.11（1.51 - 2.95））。症状出现前个体的危险因素频率更高：41.5%的人有≥3个危险因素，而匹配对照中这一比例为30.4%（OR = 2.81（1.78 - 4.44））。
症状出现前个体中存在几种CVD危险因素，且与未来RA风险增加显著相关。这些因素在女性和男性中有所不同。CVD危险因素在较年轻个体中影响更大。这些结果促使对早期RA患者进行心血管危险因素的早期分析，以进行预防。
