戒烟与较低的疾病活动度相关，并可预测类风湿关节炎患者心血管风险的降低。

Smoking cessation is associated with lower disease activity and predicts cardiovascular risk reduction in rheumatoid arthritis patients.

机构信息

Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostup, Denmark.

Preventive Cardio-Rheuma Clinic, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.

出版信息

Rheumatology (Oxford). 2020 Aug 1;59(8):1997-2004. doi: 10.1093/rheumatology/kez557.

DOI:10.1093/rheumatology/kez557

PMID:31782789

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7382591/

Abstract

OBJECTIVES

Smoking is a major risk factor for the development of both cardiovascular disease (CVD) and RA and may cause attenuated responses to anti-rheumatic treatments. Our aim was to compare disease activity, CVD risk factors and CVD event rates across smoking status in RA patients.

METHODS

Disease characteristics, CVD risk factors and relevant medications were recorded in RA patients without prior CVD from 10 countries (Norway, UK, Netherlands, USA, Sweden, Greece, South Africa, Spain, Canada and Mexico). Information on CVD events was collected. Adjusted analysis of variance, logistic regression and Cox models were applied to compare RA disease activity (DAS28), CVD risk factors and event rates across categories of smoking status.

RESULTS

Of the 3311 RA patients (1012 former, 887 current and 1412 never smokers), 235 experienced CVD events during a median follow-up of 3.5 years (interquartile range 2.5-6.1). At enrolment, current smokers were more likely to have moderate or high disease activity compared with former and never smokers (P < 0.001 for both). There was a gradient of worsening CVD risk factor profiles (lipoproteins and blood pressure) from never to former to current smokers. Furthermore, former and never smokers had significantly lower CVD event rates compared with current smokers [hazard ratio 0.70 (95% CI 0.51, 0.95), P = 0.02 and 0.48 (0.34, 0.69), P < 0.001, respectively]. The CVD event rates for former and never smokers were comparable.

CONCLUSION

Smoking cessation in patients with RA was associated with lower disease activity and improved lipid profiles and was a predictor of reduced rates of CVD events.

摘要

目的

吸烟是心血管疾病（CVD）和类风湿关节炎（RA）发展的主要危险因素，可能导致抗风湿治疗反应减弱。我们的目的是比较吸烟状况对 RA 患者疾病活动度、CVD 危险因素和 CVD 事件发生率的影响。

方法

从 10 个国家（挪威、英国、荷兰、美国、瑞典、希腊、南非、西班牙、加拿大和墨西哥）无既往 CVD 的 RA 患者中记录疾病特征、CVD 危险因素和相关药物。收集 CVD 事件信息。采用调整后的方差分析、逻辑回归和 Cox 模型比较吸烟状况各分类的 RA 疾病活动度（DAS28）、CVD 危险因素和事件发生率。

结果

在 3311 例 RA 患者（1012 例曾吸烟者、887 例现吸烟者和 1412 例从不吸烟者）中，中位随访 3.5 年（四分位间距 2.5-6.1）期间有 235 例发生 CVD 事件。在入组时，现吸烟者与曾吸烟者和从不吸烟者相比，更有可能出现中度或高度疾病活动（两者均 P<0.001）。从不吸烟者到曾吸烟者再到现吸烟者，CVD 危险因素谱（脂蛋白和血压）逐渐恶化。此外，与现吸烟者相比，曾吸烟者和从不吸烟者的 CVD 事件发生率显著降低[风险比 0.70（95%CI 0.51,0.95），P=0.02；0.48（0.34,0.69），P<0.001]。曾吸烟者和从不吸烟者的 CVD 事件发生率相当。