Internal Medicine Department, University Hospital Dr. Jose Eleuterio Gonzalez UANL, Monterrey, Mexico.
Internal Medicine Department, Rheumatology Division, University Hospital Dr. Jose Eleuterio Gonzalez UANL, Monterrey, Mexico.
Clin Rheumatol. 2018 Sep;37(9):2373-2380. doi: 10.1007/s10067-018-4181-4. Epub 2018 Jul 2.
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of death in patients with rheumatoid arthritis (RA). Chronic inflammation and traditional risk factors increase cardiovascular risk (CVR) in these patients. Several CVR calculators are used in general population and in RA patients to predict cardiovascular outcomes and tailor therapy but the precision of these calculators in RA patients has yet to be determined. The aim of this study is to determine which risk calculator correlates best with carotid ultrasound (US) findings, specifically carotid plaque (CP) and carotid intima-media thickness (CIMT) in RA patients without clinical manifestations. This was a cross-sectional observational study relating CVR scores in RA patients with the presence of carotid US findings. A total of 97 patients 40 to 75 years old who fulfilled the 2010 ACR/EULAR and/or the 1987 ACR classification criteria for RA were selected. Clinical assessment of cardiovascular risk was performed using seven calculators and carotid US measurement of intima-media thickness and plaque. The tests with the highest sensitivity for CIMT were the Framingham BMI, Framingham lipids, ACC/AHA 2013, and QRISK2. In CP, the highest sensitivity was in QRISK2, SCORE, and ACC/AHA 2013. RA patients should be comprehensively evaluated to detect cardiovascular risk. Carotid US may be routinely recommended to detect subclinical atherosclerosis in RA patients. A lower cutoff point in CVR scales may be necessary to identify patients with a low and intermediate CVR to detect subclinical atherosclerosis earlier and personalize therapy.
动脉粥样硬化性心血管疾病（ASCVD）是类风湿关节炎（RA）患者的主要死亡原因。慢性炎症和传统危险因素会增加这些患者的心血管风险（CVR）。几种 CVR 计算器用于一般人群和 RA 患者，以预测心血管结局并调整治疗，但这些计算器在 RA 患者中的准确性尚未确定。本研究旨在确定哪种风险计算器与 RA 患者的颈动脉超声（US）结果相关性最佳，特别是在没有临床表现的 RA 患者中与颈动脉斑块（CP）和颈动脉内膜中层厚度（CIMT）相关。这是一项横断面观察性研究，将 RA 患者的 CVR 评分与颈动脉 US 结果的存在相关联。共选择了 97 名年龄在 40 至 75 岁之间的 RA 患者，这些患者符合 2010 年 ACR/EULAR 和/或 1987 年 ACR 分类标准。使用七种计算器和颈动脉 US 测量内膜中层厚度和斑块对心血管风险进行临床评估。对于 CIMT，灵敏度最高的测试是 Framingham BMI、Framingham 血脂、ACC/AHA 2013 和 QRISK2。在 CP 中，灵敏度最高的是 QRISK2、SCORE 和 ACC/AHA 2013。RA 患者应进行全面评估以检测心血管风险。颈动脉 US 可能会常规推荐用于检测 RA 患者的亚临床动脉粥样硬化。可能需要较低的 CVR 量表截止值来识别低和中等 CVR 的患者，以更早地检测亚临床动脉粥样硬化并个性化治疗。
