First Clinic of Internal Medicine, Department of Internal Medicine, University of Genoa, Genoa, Italy.
Center for Molecular Cardiology, University of Zürich, 12 Wagistrasse, 8952, Schlieren, Switzerland.
Clin Rev Allergy Immunol. 2020 Feb;58(1):1-14. doi: 10.1007/s12016-018-8714-z.
Substantial epidemiological data identified cardiovascular (CV) diseases as a main cause of mortality in patients with rheumatoid arthritis (RA). In light of this, RA patients may benefit from additional CV risk screening and more intensive prevention strategies. Nevertheless, current algorithms for CV risk stratification still remain tailored on general population and are burdened by a significant underestimation of CV risk in RA patients. Acute CV events in patients with RA are largely related to an accelerated atherosclerosis. As pathophysiological features of atherosclerosis overlap those occurring in the inflamed RA synovium, the understanding of those common pathways represents an urgent need and a leading challenge for CV prevention in patients with RA. Genetic background, metabolic status, gut microbiome, and systemic inflammation have been also suggested as additional key pro-atherosclerotic factors. The aim of this narrative review is to update the current knowledge about pathophysiology of atherogenesis in RA patients and potential anti-atherosclerotic effects of disease-modifying anti-rheumatic drugs.
大量的流行病学数据表明，心血管（CV）疾病是类风湿关节炎（RA）患者死亡的主要原因。鉴于此，RA 患者可能受益于额外的 CV 风险筛查和更强化的预防策略。然而，目前用于 CV 风险分层的算法仍然针对普通人群量身定制，并存在对 RA 患者 CV 风险的显著低估。RA 患者的急性 CV 事件主要与动脉粥样硬化加速有关。由于动脉粥样硬化的病理生理特征与炎症性 RA 滑膜中发生的特征重叠，因此了解这些共同途径是 CV 预防 RA 患者的迫切需求和主要挑战。遗传背景、代谢状态、肠道微生物组和全身炎症也被认为是额外的促动脉粥样硬化因素。本叙述性综述的目的是更新关于 RA 患者动脉粥样硬化形成的病理生理学的现有知识，以及疾病修饰抗风湿药物的潜在抗动脉粥样硬化作用。
