Solomon Ahmed, Stanwix Anne E, Castañeda Santos, Llorca Javier, Gonzalez-Juanatey Carlos, Hodkinson Bridget, Romela Benitha, Ally Mahmood M T M, Maharaj Ajesh B, Van Duuren Elsa M, Ziki Joyce J, Seboka Mpoti, Mohapi Makgotso, Jansen Van Rensburg Barend J, Tarr Gareth S, Makan Kavita, Balton Charlene, Gogakis Aphrodite, González-Gay Miguel A, Dessein Patrick H
Rheumatology Department, Charlotte Maxeke Johannesburg Academic Hospital, Faculty of Health Sciences, University of Witwatersrand, 80 Scholtz Road, Norwood, Johannesburg, 2190 South Africa.
Rheumatology Department, Hospital de la Princesa, IIS-Princesa, Cátedra UAM-ROCHE, EPID-Future, Department of Medicine, Universidad Autónoma de Madrid (UAM), Madrid, Spain.
BMC Rheumatol. 2020 Jun 16;4:42. doi: 10.1186/s41927-020-00139-2. eCollection 2020.
It is plausible that optimal cardiovascular disease (CVD) risk management differs in patients with rheumatoid arthritis (RA) from low or middle income compared to high income populations. This study aimed at producing evidence-based points to consider for CVD prevention in South African RA patients.
Five rheumatologists, one cardiologist and one epidemiologist with experience in CVD risk management in RA patients, as well as two patient representatives, two health professionals and one radiologist, one rheumatology fellow and 11 rheumatologists that treat RA patients regularly contributed. Systematic literature searches were performed and the level of evidence was determined according to standard guidelines.
Eighteen points to consider were formulated. These were grouped into 6 categories that comprised overall CVD risk assessment and management ( = 4), and specific interventions aimed at reducing CVD risk including RA control with disease modifying anti-rheumatic drugs, glucocorticoids and non-steroidal anti-inflammatory drugs ( = 3), lipid lowering agents ( = 8), antihypertensive drugs ( = 1), low dose aspirin ( = 1) and lifestyle modification ( = 1). Each point to consider differs partially or completely from recommendations previously reported for CVD risk management in RA patients from high income populations. Currently recommended CVD risk calculators do not reliably identify South African black RA patients with very high-risk atherosclerosis as represented by carotid artery plaque presence on ultrasound.
Our findings indicate that optimal cardiovascular risk management likely differs substantially in RA patients from low or middle income compared to high income populations. There is an urgent need for future multicentre longitudinal studies on CVD risk in black African patients with RA.
与高收入人群相比，中低收入的类风湿关节炎（RA）患者的最佳心血管疾病（CVD）风险管理可能有所不同。本研究旨在为南非RA患者的CVD预防提供循证要点以供参考。
五名风湿病学家、一名心脏病专家和一名在RA患者CVD风险管理方面有经验的流行病学家，以及两名患者代表、两名卫生专业人员和一名放射科医生、一名风湿病学研究员和11名经常治疗RA患者的风湿病学家参与其中。进行了系统的文献检索，并根据标准指南确定证据水平。
制定了18个需要考虑的要点。这些要点分为6类，包括总体CVD风险评估和管理（=4），以及旨在降低CVD风险的特定干预措施，包括使用改善病情抗风湿药物、糖皮质激素和非甾体抗炎药控制RA（=3）、降脂药物（=8）、抗高血压药物（=1）、低剂量阿司匹林（=1）和生活方式改变（=1）。每个需要考虑的要点与先前报道的高收入人群RA患者CVD风险管理建议部分或完全不同。目前推荐的CVD风险计算器不能可靠地识别南非黑人RA患者中由超声显示的颈动脉斑块所代表的极高风险动脉粥样硬化。
我们的研究结果表明，与高收入人群相比，中低收入RA患者的最佳心血管风险管理可能有很大差异。迫切需要未来对非洲黑人RA患者的CVD风险进行多中心纵向研究。
