University of Birmingham and Queen Elizabeth Hospital Birmingham, Birmingham, UK.
University of Birmingham, Birmingham, UK.
Arthritis Rheumatol. 2021 Mar;73(3):504-511. doi: 10.1002/art.41529. Epub 2021 Jan 22.
Cardiovascular disease (CVD) is a major complication and cause of mortality in Takayasu arteritis (TAK), but population-based controlled studies from the UK are lacking. We undertook the present study to investigate the frequency of morbidity and mortality related to CVD, as well as to cerebrovascular and kidney disease, among patients with TAK in the UK.
Yearly cohort and cross-sectional studies were performed from 2000 to 2017 to estimate annual incidence and prevalence, respectively, of TAK. Using a UK primary care database (IQVIA Medical Research Data), an open retrospective matched cohort study was conducted to estimate risk of hypertension, diabetes, cardiovascular morbidity, chronic kidney disease (CKD), and all-cause mortality in TAK. Risk (adjusted hazard ratio [HR]) of the assessed comorbidities among patients with TAK compared to age- and sex-matched controls was estimated. Changes in medication prescription over time were examined in both groups.
One hundred forty-two patients with TAK (median age 53.4 years [interquartile range 33.8-70.7]) and 1,371 matched controls were included. The annual incidence and prevalence of TAK were 0.8 per million and 7.5 per million respectively. All-cause mortality was increased in TAK (adjusted HR 1.88 [95% confidence interval 1.29-2.76]). Patients with TAK had an increased risk of developing ischemic heart disease, stroke/transient ischemic attack, combined CVD, and peripheral vascular disease compared to controls, but no increase in risk of hypertension, CKD, heart failure, or diabetes. Only ~50% of patients with TAK requiring secondary CVD prevention were prescribed statins or antiplatelet agents within 1 year after study entry.
Cardiovascular morbidity was increased among patients with TAK receiving primary care services in the UK. Treatment with statins and antiplatelet agents in these patients was suboptimal.
心血管疾病（CVD）是 Takayasu 动脉炎（TAK）的主要并发症和死亡原因，但英国缺乏基于人群的对照研究。本研究旨在调查英国 TAK 患者 CVD 以及脑血管和肾脏疾病的发病率和死亡率。
2000 年至 2017 年进行了年度队列和横断面研究，分别估计 TAK 的年发病率和患病率。利用英国初级保健数据库（IQVIA Medical Research Data），进行了一项开放式回顾性匹配队列研究，以估计 TAK 患者高血压、糖尿病、心血管发病率、慢性肾脏病（CKD）和全因死亡率的风险。估计 TAK 患者与年龄和性别匹配的对照组相比，评估的合并症风险（调整后的危险比[HR]）。在两组中均检查了药物处方随时间的变化。
纳入 142 例 TAK 患者（中位年龄 53.4 岁[四分位间距 33.8-70.7]）和 1371 名匹配对照。TAK 的年发病率和患病率分别为 0.8/百万和 7.5/百万。TAK 的全因死亡率增加（调整后的 HR 1.88[95%置信区间 1.29-2.76]）。与对照组相比，TAK 患者发生缺血性心脏病、中风/短暂性脑缺血发作、合并 CVD 和外周血管疾病的风险增加，但高血压、CKD、心力衰竭或糖尿病的风险没有增加。仅约 50%需要二级 CVD 预防的 TAK 患者在研究入组后 1 年内被开具他汀类药物或抗血小板药物。
在接受英国初级保健服务的 TAK 患者中，心血管发病率增加。这些患者使用他汀类药物和抗血小板药物的治疗并不理想。
