Crowson Cynthia S, Rollefstad Silvia, Ikdahl Eirik, Kitas George D, van Riel Piet L C M, Gabriel Sherine E, Matteson Eric L, Kvien Tore K, Douglas Karen, Sandoo Aamer, Arts Elke, Wållberg-Jonsson Solveig, Innala Lena, Karpouzas George, Dessein Patrick H, Tsang Linda, El-Gabalawy Hani, Hitchon Carol, Ramos Virginia Pascual, Yáñez Irazú Contreras, Sfikakis Petros P, Zampeli Evangelia, Gonzalez-Gay Miguel A, Corrales Alfonso, Laar Mart van de, Vonkeman Harald E, Meek Inger, Semb Anne Grete
Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA.
Division of Rheumatology, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Ann Rheum Dis. 2018 Jan;77(1):48-54. doi: 10.1136/annrheumdis-2017-211735. Epub 2017 Sep 6.
Patients with rheumatoid arthritis (RA) have an excess risk of cardiovascular disease (CVD). We aimed to assess the impact of CVD risk factors, including potential sex differences, and RA-specific variables on CVD outcome in a large, international cohort of patients with RA.
In 13 rheumatology centres, data on CVD risk factors and RA characteristics were collected at baseline. CVD outcomes (myocardial infarction, angina, revascularisation, stroke, peripheral vascular disease and CVD death) were collected using standardised definitions.
5638 patients with RA and no prior CVD were included (mean age: 55.3 (SD: 14.0) years, 76% women). During mean follow-up of 5.8 (SD: 4.4) years, 148 men and 241 women developed a CVD event (10-year cumulative incidence 20.9% and 11.1%, respectively). Men had a higher burden of CVD risk factors, including increased blood pressure, higher total cholesterol and smoking prevalence than women (all p<0.001). Among the traditional CVD risk factors, smoking and hypertension had the highest population attributable risk (PAR) overall and among both sexes, followed by total cholesterol. The PAR for Disease Activity Score and for seropositivity were comparable in magnitude to the PAR for lipids. A total of 70% of CVD events were attributable to all CVD risk factors and RA characteristics combined (separately 49% CVD risk factors and 30% RA characteristics).
In a large, international cohort of patients with RA, 30% of CVD events were attributable to RA characteristics. This finding indicates that RA characteristics play an important role in efforts to reduce CVD risk among patients with RA.
类风湿关节炎（RA）患者患心血管疾病（CVD）的风险更高。我们旨在评估在一个大型国际RA患者队列中，包括潜在性别差异在内的CVD危险因素以及RA特异性变量对CVD结局的影响。
在13个风湿病中心，于基线时收集CVD危险因素和RA特征的数据。使用标准化定义收集CVD结局（心肌梗死、心绞痛、血运重建、中风、外周血管疾病和CVD死亡）。
纳入5638例无既往CVD的RA患者（平均年龄：55.3（标准差：14.0）岁，76%为女性）。在平均5.8（标准差：4.4）年的随访期间，148名男性和241名女性发生了CVD事件（10年累积发病率分别为20.9%和11.1%）。男性的CVD危险因素负担更高，包括血压升高、总胆固醇水平更高以及吸烟率高于女性（均p<0.001）。在传统的CVD危险因素中，吸烟和高血压在总体人群以及男女两性中的人群归因风险（PAR）最高，其次是总胆固醇。疾病活动评分和血清阳性的PAR在数值上与血脂的PAR相当。总共70%的CVD事件可归因于所有CVD危险因素和RA特征的综合作用（分别为49%归因于CVD危险因素，30%归因于RA特征）。
在一个大型国际RA患者队列中，30%的CVD事件可归因于RA特征。这一发现表明，RA特征在降低RA患者CVD风险的努力中起着重要作用。
