First Department of Cardiology, Athens School of Medicine, Hippokration Hospital, Athens, Greece.
Curr Vasc Pharmacol. 2020;18(5):488-506. doi: 10.2174/1570161118666200214115532.
The risk of cardiovascular (CV) disease is increased among patients with systemic autoimmune rheumatic diseases and remains an underserved area of medical need. Although traditional risk factors for CV disease, such as hypertension, smoking, dyslipidemia and obesity contribute to endothelial dysfunction in rheumatoid arthritis (RA), they are not enough on their own to explain the observed excess CV risk. Rather, systemic inflammation seems to play a pivotal role in both disease states. Considering the inflammatory process in autoimmune diseases, scientific interest has focused on recently introduced biologic disease-modifying agents (bDMARDS) such as inhibitors of Tumor Necrosis Factor- α (ΤΝF-α), Interleukins -1 (IL-1) and -6 (IL-6). Despite the widespread use of bDMARDS in RA and other chronic autoimmune inflammatory diseases, their precise impact on CV disease and outcome remains to be elucidated, while prospective randomized control trials assessing their impact on hard CV endpoints are scarce. In this review, we summarize current knowledge concerning the effect of bDMARDs on CV outcome and on the risk of developing CV disease in patients with systemic autoimmune rheumatic diseases.
患有系统性自身免疫性风湿病的患者心血管疾病风险增加，这仍然是医疗需求未得到满足的领域。尽管心血管疾病的传统危险因素，如高血压、吸烟、血脂异常和肥胖症，可导致类风湿关节炎（RA）中的内皮功能障碍，但仅凭这些因素本身并不能完全解释观察到的心血管疾病风险增加。相反，系统性炎症似乎在这两种疾病状态中都起着关键作用。鉴于自身免疫性疾病中的炎症过程，科学研究的兴趣集中在最近引入的生物疾病修饰剂（bDMARDs）上，如肿瘤坏死因子-α（TNF-α）、白细胞介素-1（IL-1）和 -6（IL-6）抑制剂。尽管 bDMARDs 在 RA 和其他慢性自身免疫性炎症性疾病中的广泛应用，但它们对心血管疾病和结局的确切影响仍有待阐明，而评估其对硬性心血管终点影响的前瞻性随机对照试验却很少。在这篇综述中，我们总结了目前关于 bDMARDs 对心血管结局以及对系统性自身免疫性风湿病患者发生心血管疾病风险的影响的相关知识。
