Preventive Cardio-Rheuma Clinic, Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Preventive Cardio-Rheuma Clinic, Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Int J Cardiol. 2019 Jan 1;274:311-318. doi: 10.1016/j.ijcard.2018.06.111. Epub 2018 Jul 2.
Patients with inflammatory joint diseases (IJD) have an increased risk of cardiovascular disease (CVD). Our goal was to examine indications for, and use of, lipid-lowering therapy (LLT) and antihypertensive treatment (AntiHT) in patients with IJD. Furthermore, to investigate the frequency of low-density lipoprotein cholesterol (LDL-c) and blood pressure (BP) goal attainment among IJD patients.
The cohort was derived from the NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR). Indications for AntiHT were: systolic/diastolic BP ≥ 140/90 mm Hg, self-reported hypertension or AntiHT. CVD risk was estimated by the systematic coronary risk evaluation (SCORE) algorithm. LDL-c goals were <2.6 mmol/L in case of diabetes, total cholesterol > 8 mmol/L or a SCORE estimate ≥ 5%, and <1.8 mmol/L for those with established CVD or SCORE ≥ 10%. Comparisons across IJD entities were performed using age and sex adjusted logistic regression.
In total, 2277 patients (rheumatoid arthritis: 1376, axial spondyloarthritis: 474, psoriatic arthritis: 427) were included. LLT and AntiHT were indicated in 36.1% and 52.6% of the patients, of whom 37.6% and 47.0% were untreated, respectively. LDL-c and BP targets were obtained in 26.2% and 26.3%, respectively. Guideline recommended treatment and/or corresponding treatment targets were not initiated or obtained in approximately 50%. Rheumatoid arthritis patients were particularly likely to be undertreated with LLT, whereas hypertension undertreatment was most common in psoriatic arthritis.
Inadequate CVD prevention encompasses all the three major IJD entities. The unmet need for CVD preventive measures is not only prevalent in RA, but exists across all the major IJD entities.
患有炎性关节疾病（IJD）的患者心血管疾病（CVD）的风险增加。我们的目标是检查 IJD 患者使用降脂治疗（LLT）和抗高血压治疗（AntiHT）的适应证。此外，研究 IJD 患者实现低密度脂蛋白胆固醇（LDL-c）和血压（BP）目标的频率。
该队列来自挪威风湿性关节疾病动脉粥样硬化协作研究（NOCAR）。AntiHT 的适应证为：收缩压/舒张压≥140/90mmHg，自述高血压或正在接受 AntiHT 治疗。使用系统性冠状动脉风险评估（SCORE）算法估计 CVD 风险。如果患有糖尿病、总胆固醇>8mmol/L 或 SCORE 估计值≥5%，则 LDL-c 目标为<2.6mmol/L；如果患有已确诊的 CVD 或 SCORE 估计值≥10%，则 LDL-c 目标为<1.8mmol/L。使用年龄和性别调整的逻辑回归对 IJD 实体之间进行比较。
共纳入 2277 例患者（类风湿关节炎：1376 例，中轴型脊柱关节炎：474 例，银屑病关节炎：427 例）。36.1%和 52.6%的患者需要接受 LLT 和 AntiHT 治疗，其中 37.6%和 47.0%的患者未接受治疗。分别有 26.2%和 26.3%的患者达到 LDL-c 和 BP 目标。约 50%的患者未开始或未达到指南推荐的治疗和/或相应的治疗目标。类风湿关节炎患者尤其可能未接受 LLT 治疗，而银屑病关节炎患者最常见的是高血压治疗不足。
CVD 预防措施不足涵盖了所有三种主要的 IJD 实体。CVD 预防措施的未满足需求不仅在 RA 中普遍存在，而且存在于所有主要的 IJD 实体中。
