Ferraz-Amaro Iván, Corrales Alfonso, Quevedo-Abeledo Juan Carlos, Atienza-Mateo Belén, Prieto-Peña Diana, Blanco Ricardo, Llorca Javier, González-Gay Miguel Á
Division of Rheumatology, Hospital Universitario de Canarias, 38320 Tenerife, Spain.
Division of Rheumatology, Hospital Universitario Marqués de Valdecilla, Universidad de Cantabria, 39008 Santander, Spain.
J Clin Med. 2020 Dec 16;9(12):4065. doi: 10.3390/jcm9124065.
Cardiovascular (CV) disease risk prediction models developed for use in the general population have suboptimal performance in patients with rheumatoid arthritis (RA). Vascular age (VA) is a new concept that has been proposed as a measure of CV 'relative' risk instead of the 'absolute' risk that current prediction models provide. In the present study we aim to study the performance of vascular age (VA) in the assessment of CV risk in patients with RA. We additionally aimed to analyze its relation with subclinical atherosclerosis as measured through carotid plaque ultrasound. A total of 1173 non-diabetic RA patients without previous CV events were included. Disease characteristics, SCORE, VA determined on SCORE and on carotid intima media thickness (cIMT), and the presence of plaque through carotid ultrasound were assessed. The interrelations of VA with SCORE, and its associations with subclinical carotid atherosclerosis were studied. On average, RA patients had both a SCORE determined VA (4.7 years) and a cIMT-based VA (2.4 years) significantly higher than the chronological age. When these differences were analyzed in different age intervals, while VA based on SCORE was significantly higher compared to chronological age in all age ranges, VA determined on cIMT was significantly elevated only in RA patients younger than 60 years. The area under the curve analysis for the association of SCORE and VA with the presence of carotid plaque disclosed no differences between both parameters. VA was associated with the presence of carotid plaque after multivariable regression analysis in patients younger than 60 years old. VA is significantly higher than chronological age in patients with RA. The performance of VA in its relation to carotid plaque is similar to that of the SCORE.
为普通人群开发的心血管（CV）疾病风险预测模型在类风湿性关节炎（RA）患者中的表现欠佳。血管年龄（VA）是一个新的概念，已被提议作为衡量CV“相对”风险的指标，而非当前预测模型所提供的“绝对”风险。在本研究中，我们旨在研究血管年龄（VA）在评估RA患者CV风险中的表现。我们还旨在分析其与通过颈动脉斑块超声测量的亚临床动脉粥样硬化的关系。总共纳入了1173例无既往CV事件的非糖尿病RA患者。评估了疾病特征、SCORE、基于SCORE和颈动脉内膜中层厚度（cIMT）确定的VA，以及通过颈动脉超声检测到的斑块情况。研究了VA与SCORE的相互关系，以及其与亚临床颈动脉粥样硬化的关联。平均而言，RA患者基于SCORE确定的VA（4.7岁）和基于cIMT的VA（2.4岁）均显著高于实际年龄。当在不同年龄区间分析这些差异时，虽然基于SCORE的VA在所有年龄范围内均显著高于实际年龄，但基于cIMT确定的VA仅在60岁以下的RA患者中显著升高。SCORE和VA与颈动脉斑块存在情况的曲线下面积分析显示，这两个参数之间没有差异。在60岁以下的患者中，多变量回归分析后VA与颈动脉斑块的存在相关。RA患者的VA显著高于实际年龄。VA与颈动脉斑块的关系表现与SCORE相似。
