Garshick Michael, Underberg James A
Center for the Prevention of Cardiovascular Disease, New York University School of Medicine, New York City, NY, USA.
Leon H. Charney Division of Cardiology, New York University School of Medicine, 462 First Avenue, NBV-17 South Suite 5, New York City, NY, 10016, USA.
Curr Atheroscler Rep. 2017 Oct 17;19(12):48. doi: 10.1007/s11883-017-0685-7.
Many guidelines exist for the use of statins in the primary prevention of atherosclerotic cardiovascular disease (ASCVD). Few have focused on disease specific states that predispose to ASCVD. This review is intended to focus on the recommendations and evidence in inflammatory diseases that predispose to an increased risk of ASCVD beyond what conventional cardiac risk scores would predict.
Certain autoimmune inflammatory diseases such as rheumatoid arthritis (RA), systemic lupus erythematous (SLE), and psoriasis/psoriatic arthritis have all been shown to increase the risk of ASCVD. Other diseases such as human immunodeficiency virus (HIV) and mediastinal radiation have also been correlated with increased ASCVD. In RA and HIV, the evidence suggests a benefit to added statin therapy and society guidelines favor early initiation. The evidence for statin therapy in RA is limited to observational studies with small secondary analysis. In HIV, there is a large ongoing clinical trial to assess efficacy. In those with psoriasis and psoriatic arthritis, there is limited evidence for or against statin therapy independent of a calculated cardiac risk score. Finally, in SLE and in those with exposure to mediastinal radiation, cardiac events remain high, but evidence is limited on the beneficial effects of statin therapy. There are many individuals who have an increased risk for ASCVD above what is predicted from a cardiac risk score. It would be beneficial to create risk prediction models with statin therapy recommendations that are tailored to those predisposed to accelerated atherosclerosis.
关于他汀类药物在动脉粥样硬化性心血管疾病（ASCVD）一级预防中的应用，已有许多指南。很少有指南关注易患ASCVD的特定疾病状态。本综述旨在聚焦于炎症性疾病中的相关建议和证据，这些疾病易使ASCVD风险增加，超出传统心脏风险评分的预测范围。
某些自身免疫性炎症性疾病，如类风湿关节炎（RA）、系统性红斑狼疮（SLE）和银屑病/银屑病关节炎，均已显示会增加ASCVD风险。其他疾病，如人类免疫缺陷病毒（HIV）感染和纵隔放疗，也与ASCVD风险增加相关。在RA和HIV感染中，证据表明加用他汀类药物治疗有益，且社会指南支持早期开始用药。RA中他汀类药物治疗的证据仅限于小型二次分析的观察性研究。在HIV感染方面，正在进行一项大型临床试验以评估疗效。对于银屑病和银屑病关节炎患者，无论是否计算心脏风险评分，支持或反对他汀类药物治疗的证据都很有限。最后，在SLE患者以及接受纵隔放疗的患者中，心脏事件发生率仍然很高，但他汀类药物治疗的有益效果证据有限。有许多个体的ASCVD风险高于心脏风险评分的预测值。创建针对易患加速动脉粥样硬化人群的、包含他汀类药物治疗建议的风险预测模型将是有益的。
