Centro Hospitalar do Porto, Porto, Portugal.
Instituto Gulbenkian de Ciência, Oeiras, Portugal.
Rheumatol Int. 2021 Feb;41(2):311-318. doi: 10.1007/s00296-020-04754-7. Epub 2021 Jan 3.
Cardiovascular diseases represent the first cause of death globally. Inflammatory rheumatic disease (IRMD) patients, due to their lifelong inflammatory status, are at increased risk of developing premature cardiovascular disease. We aimed to assess the risk for cardiovascular events (CVE) in a population-based study. We followed 10,153 adults from the EpiDoC Cohort, a large Portuguese population-based prospective study (2011-2016). IRMD patients were identified at baseline and followed during 5 years. CVE were defined as a composite of self-reported myocardial infarction or angina pectoris, arrhythmias, valvular disease, stroke or transient ischemic attack and peripheral artery disease. Statistical analysis was performed by utilizing multivariate logistic regression and goodness-of-fit and area under ROC curve. At baseline, IRMD patients had similar age as the non-IRMD participants (mean age 55 vs 53 years-old; 72.1% female); dyslipidaemia and sedentary lifestyle were more common (40.7% vs 31.4%, p = 0.033; 87.3% vs 67%, p = 0.016, respectively). During an average follow-up of 2.6 years, 26 CVE were reported among IRMD patients. IRMD patients had higher odd of CVE (OR 1.64, 95% CI 1.04-2.58; p = 0.03), despite comparable mortality rates (1.7% vs 0.7%, p = 0.806). A stepwise approach attained that gender, age, history of hypertension, body mass index, IRMD and follow-up time are the most important predictive variables of CVE (AUC 0.80). IRMD patients, at community level, have an increased short-term risk of major CVE when compared to non-IRMD, and that highlights the potential benefit of a systematic screening and more aggressive cardiovascular risk assessment and management of these patients.
心血管疾病是全球首要死因。由于终生存在炎症状态，炎症性风湿性疾病 (IRMD) 患者罹患心血管疾病的风险更高。我们旨在通过一项基于人群的研究评估心血管事件 (CVE) 的风险。我们对来自 EpiDoC 队列的 10153 名成年人进行了随访，这是一项大型葡萄牙基于人群的前瞻性研究（2011-2016 年）。在基线时确定 IRMD 患者，并在 5 年内进行随访。CVE 定义为自报告的心肌梗死或心绞痛、心律失常、瓣膜病、中风或短暂性脑缺血发作以及外周动脉疾病的复合症状。统计分析通过利用多变量逻辑回归和拟合优度以及 ROC 曲线下面积来进行。在基线时，IRMD 患者的年龄与非 IRMD 参与者相似（平均年龄 55 岁 vs 53 岁；72.1%为女性）；血脂异常和久坐的生活方式更为常见（40.7% vs 31.4%，p=0.033；87.3% vs 67%，p=0.016）。在平均 2.6 年的随访期间，IRMD 患者报告了 26 例 CVE。尽管死亡率相当（1.7% vs 0.7%，p=0.806），但 IRMD 患者发生 CVE 的可能性更高（OR 1.64，95%CI 1.04-2.58；p=0.03）。逐步方法表明，性别、年龄、高血压史、体重指数、IRMD 和随访时间是 CVE 的最重要预测变量（AUC 0.80）。与非 IRMD 患者相比，社区水平的 IRMD 患者发生重大 CVE 的短期风险增加，这突出了对这些患者进行系统筛查以及更积极的心血管风险评估和管理的潜在益处。
