Hatri A, Guermaz R, Laroche J-P, Zekri S, Brouri M
Unité de médecine vasculaire, clinique d'Elbiar, Alger, Algérie.
Service de médecine interne, EPH Elbiar, Alger, Algérie.
J Med Vasc. 2019 Sep;44(5):311-317. doi: 10.1016/j.jdmv.2019.07.002. Epub 2019 Aug 7.
Chronic inflammatory diseases such as systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA), are accompanied by high cardiovascular morbidity and mortality secondary to accelerated and premature atherosclerosis. Atherosclerosis is correlated with chronic systemic inflammation independently of the factors for cardiovascular risk. Vasculitis of large arteries such as Takayasu's disease, are characterized both by chronic systemic inflammation and local parietal vascular inflammation.
We prospectively analyzed in a case-control study, a group of 64 carriers of Takayasu's arteritis patients with a mean age of 41 years [±11.94], a group of 50 RA female patients aged 45 years [±10.27], and a control group with an average age of 44 years [±12.63]. We recorded classic cardiovascular risk factors and used the Framingham equation to calculate the risk. We measured the intima-media thickness (IMT) in the carotids and noted the presence of carotid, aortic and femoral atheroma.
The mean calculated cardiovascular risk was 3.5 % in the Takayasu's group. It was 4.4 % in the RA group, and 4.5 % in controls with no significant difference between the three groups (P=0.153). Subclinical atherosclerosis defined by IMT> 0.70mm and/or the presence of atheroma plaque was found in 87 % of Takayasu's patients versus 76 % of RA patients, (P=0.088) and 48 % of controls (P<0.001). Most atherosclerotic plaques were found in the Takayasu group. Compared to the control group the carotid intima-media thickness was significantly higher in the Takayasu group. The average IMT in the Takayasu group was 0.91mm [±0.368], 0.76mm [±0.151] for the PR group, and 0.71mm [±0.141] for controls.
Atherosclerosis observed in Takayasu's disease was accelerated and premature, occurring in young patients with a low overall cardiovascular risk. Recent data support the central role of inflammation in all stages of atherogenesis from endothelial dysfunction to plaque rupture. Systemic inflammation associated with local parietal inflammation observed in Takayasu's arteritis, appears to be responsible for accelerated and premature atherosclerosis. The results of our study and the literature review favor an active strategy for cardiovascular prevention in Takayasu's disease.
系统性红斑狼疮（SLE）和类风湿关节炎（RA）等慢性炎症性疾病，因加速和过早出现动脉粥样硬化而伴有较高的心血管发病率和死亡率。动脉粥样硬化与慢性全身性炎症相关，独立于心血管风险因素。大动脉血管炎如高安氏病，其特征为慢性全身性炎症和局部血管壁炎症。
我们在一项病例对照研究中进行前瞻性分析，一组64例高安氏动脉炎患者携带者，平均年龄41岁[±11.94]，一组50例45岁[±10.27]的RA女性患者，以及一组平均年龄44岁[±12.63]的对照组。我们记录了经典的心血管风险因素，并使用弗明汉方程计算风险。我们测量了颈动脉内膜中层厚度（IMT），并记录了颈动脉、主动脉和股动脉粥样硬化的存在情况。
高安氏组计算出的平均心血管风险为3.5%。RA组为4.4%，对照组为4.5%，三组之间无显著差异（P = 0.153）。IMT>0.70mm和/或存在动脉粥样硬化斑块定义的亚临床动脉粥样硬化，在87%的高安氏病患者中发现，而RA患者为76%（P = 0.088），对照组为48%（P<0.001）。大多数动脉粥样硬化斑块出现在高安氏组。与对照组相比，高安氏组的颈动脉内膜中层厚度明显更高。高安氏组的平均IMT为0.91mm[±0.368]，RA组为0.76mm[±0.151]，对照组为0.71mm[±0.141]。
高安氏病中观察到的动脉粥样硬化加速且过早出现，发生在总体心血管风险较低的年轻患者中。最新数据支持炎症在动脉粥样硬化从内皮功能障碍到斑块破裂的所有阶段中起核心作用。高安氏动脉炎中观察到的全身性炎症与局部血管壁炎症相关，似乎是加速和过早出现动脉粥样硬化的原因。我们的研究结果和文献综述支持对高安氏病采取积极的心血管预防策略。
