Brigham and Women's Hospital, Boston, Massachusetts, and Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
Brigham and Women's Hospital, Boston, Massachusetts.
Arthritis Rheumatol. 2018 Sep;70(9):1392-1398. doi: 10.1002/art.40532. Epub 2018 Aug 1.
Current validated cardiovascular (CV) risk estimates were developed in populations with relatively stable levels of inflammation, whereas patients with rheumatoid arthritis (RA) routinely experience significant changes in inflammation. This study was undertaken to test whether changes in inflammation affect estimated CV risk as measured using validated population-based risk calculators.
Participants in a prospective RA cohort who experienced a decrease or an increase of ≥10 mg/liter in the C-reactive protein (CRP) level at 2 consecutive time points 1 year apart (CRP decrease group and CRP increase group, respectively) were included in this study. We estimated 10-year CV risk using the following calculators: Framingham Risk Score, 2013 American College of Cardiology/American Heart Association Atherosclerotic Cardiovascular Disease Risk Score, Reynolds Risk Score (RRS), and QRISK2. Of these calculators, only the RRS includes a variable addressing the CRP level. Paired t-tests were performed to compare risk scores at baseline and 1-year follow-up. We calculated the correlations between the changes in risk scores and changes in pro-B-type natriuretic peptide (pro BNP), a surrogate marker of CV risk.
One hundred eighty RA patients were included in the study (mean age 57.8 years, 84% female, 80% seropositive). Of the calculators studied, only the RRS was sensitive to changes in inflammation; an increase in inflammation was associated with increased estimated CV risk (P < 0.0001), and only the RRS was correlated with changes in proBNP (r = 0.17, P = 0.03).
Our data showed no significant change in CV risk estimated using validated general population CV risk calculators except for the RRS. These findings suggest that CV risk may be modulated by changes in inflammation in RA, which is not typically considered when using existing CV risk calculators.
目前已验证的心血管（CV）风险评估是在炎症水平相对稳定的人群中开发的，而类风湿关节炎（RA）患者的炎症水平通常会发生显著变化。本研究旨在检验炎症变化是否会影响使用基于人群的验证风险计算器评估的 CV 风险。
本研究纳入了前瞻性 RA 队列中的参与者，这些参与者在相隔 1 年的 2 个连续时间点上经历了 C 反应蛋白（CRP）水平下降或升高≥10mg/L（CRP 下降组和 CRP 升高组）。我们使用以下计算器估计 10 年 CV 风险：弗雷明汉风险评分、2013 年美国心脏病学会/美国心脏协会动脉粥样硬化性心血管疾病风险评分、雷诺兹风险评分（RRS）和 QRISK2。在这些计算器中，只有 RRS 包含一个反映 CRP 水平的变量。采用配对 t 检验比较基线和 1 年随访时的风险评分。我们计算了风险评分变化与替代 CV 风险的标志物 B 型利钠肽前体（pro BNP）变化之间的相关性。
本研究纳入了 180 例 RA 患者（平均年龄 57.8 岁，84%为女性，80%为血清阳性）。在所研究的计算器中，只有 RRS 对炎症变化敏感；炎症增加与估计的 CV 风险增加相关（P<0.0001），只有 RRS 与 proBNP 的变化相关（r=0.17，P=0.03）。
除 RRS 外，我们的数据显示，使用已验证的一般人群 CV 风险计算器评估的 CV 风险没有显著变化。这些发现表明，RA 中的炎症变化可能会调节 CV 风险，而这在使用现有 CV 风险计算器时通常不会考虑到。
