Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Santander, Spain.
Division of Rheumatology, Hospital Doctor Negrín, Las Palmas de Gran Canaria, Spain.
Clin Exp Rheumatol. 2020 Jul-Aug;38(4):724-731. Epub 2020 Feb 14.
Subclinical atherosclerosis, defined as the presence of carotid plaques, is more frequently found in patients with axial spondyloarthritis (axSpA) than in healthy individuals. We sought to determine whether axSpA patients are more commonly reclassified into the very high cardiovascular risk category than controls after performing carotid ultrasound and if this can be linked to disease characteristics.
343 patients diagnosed with axSpA according to ASAS criteria and 177 controls were studied. Disease characteristics and Systematic Coronary Risk Evaluation (SCORE) were assessed in patients and controls. Presence of plaques and intima-media thickness (cIMT) was determined by carotid ultrasound. Multivariable regression analysis was performed to identify differences in the frequency of reclassification between patients and controls, as well as factors associated with reclassification in axSpA.
Carotid plaques (36% vs.25%, p=0.010) and higher cIMT (0.641± 0.121 vs. 0.602± 0.115 mm, p=0.001) were more common in patients than controls. Reclassification into the high-risk category was greater in patients (34% vs. 25%, p=0.037). Age (beta coefficient 2.74 [95%CI 1.34-5.62] vs. beta coef. 0.63 (95%CI 0.40-0.99) in patients, interaction p=0.001) and serum LDL-cholesterol (beta coef. 1.03 [95%CI 1.02-1.04] vs. beta coef. 1.00 [0.99-1.01], interaction p=0.029) showed a higher effect on reclassification in controls after multivariable analysis. Although reclassification in axSpA was associated with higher ASDAS-CRP, BASFI and BASMI scores, these associations were lost after adjusting for cardiovascular risk factors.
Patients with axSpA are more likely to be reclassified into the very-high risk category after carotid ultrasound than controls. The influence of traditional cardiovascular risk factors on this reclassification differs between patients and controls.
亚临床动脉粥样硬化定义为颈动脉斑块的存在，在患有中轴型脊柱关节炎（axSpA）的患者中比在健康个体中更为常见。我们旨在确定在进行颈动脉超声检查后，axSpA 患者是否比对照组更常被重新归类为极高心血管风险类别，以及这是否与疾病特征有关。
研究了根据 ASAS 标准诊断为 axSpA 的 343 例患者和 177 例对照组。评估了患者和对照组的疾病特征和系统性冠状动脉风险评估（SCORE）。通过颈动脉超声确定斑块和内膜中层厚度（cIMT）的存在。进行多变量回归分析以确定患者和对照组之间重新分类的频率差异，以及 axSpA 中与重新分类相关的因素。
与对照组相比，患者中颈动脉斑块更为常见（36%比 25%，p=0.010），cIMT 更高（0.641±0.121 比 0.602±0.115 mm，p=0.001）。患者中重新归类为高危类别更为常见（34%比 25%，p=0.037）。年龄（患者的β系数 2.74 [95%CI 1.34-5.62] 比 β 系数 0.63 [95%CI 0.40-0.99]，交互 p=0.001）和血清 LDL 胆固醇（β系数 1.03 [95%CI 1.02-1.04] 比 β 系数 1.00 [0.99-1.01]，交互 p=0.029）在多变量分析后对对照组的重新分类有更高的影响。尽管 axSpA 中的重新分类与更高的 ASDAS-CRP、BASFI 和 BASMI 评分相关，但在调整心血管危险因素后，这些关联消失。
与对照组相比，axSpA 患者在颈动脉超声检查后更有可能被重新归类为极高风险类别。传统心血管危险因素对这种重新分类的影响在患者和对照组之间有所不同。
