Hernández-Camba Alejandro, Carrillo-Palau Marta, Ramos Laura, Hernández Alvarez-Buylla Noemi, Alonso-Abreu Inmaculada, Hernández-Pérez Anjara, Vela Milagros, Arranz Laura, Hernández-Guerra Manuel, González-Gay Miguel Ángel, Ferraz-Amaro Iván
Division of Gastroenterology, Hospital Universitario de Nuestra Señora de la Candelaria, 38010 Tenerife, Spain.
Division of Gastroenterology, Hospital Universitario de Canarias, 38320 Tenerife, Spain.
J Clin Med. 2021 Apr 13;10(8):1671. doi: 10.3390/jcm10081671.
The addition of carotid ultrasound into cardiovascular (CV) risk scores has been found to be effective in identifying patients with chronic inflammatory diseases at high-CV risk. We aimed to determine if its use would facilitate the reclassification of patients with inflammatory bowel disease (IBD) into the very high-CV-risk category and whether this may be related to disease features. In this cross-sectional study encompassing 186 IBD patients and 175 controls, Systematic Coronary Risk Evaluation (SCORE), disease activity measurements, and the presence of carotid plaques by ultrasonography were assessed. Reclassification was compared between patients and controls. A multivariable regression analysis was performed to evaluate if the risk of reclassification could be explained by disease-related features and to assess the influence of traditional CV risk factors on this reclassification. After evaluation of carotid ultrasound, a significantly higher frequency of reclassification was found in patients with IBD compared to controls (35% vs. 24%, = 0.030). When this analysis was performed only on subjects included in the SCORE low-CV-risk category, 21% IBD patients compared to 11% controls ( = 0.034) were reclassified into the very high-CV-risk category. Disease-related data, including disease activity, were not associated with reclassification after fully multivariable regression analysis. Traditional CV risk factors showed a similar influence over reclassification in patients and controls. However, LDL-cholesterol disclosed a higher effect in controls compared to patients (beta coef. 1.03 (95%CI 1.02-1.04) vs. 1.01 (95%CI 1.00-1.02), interaction = 0.035) after adjustment for confounders. In conclusion, carotid plaque assessment is useful to identify high-CV risk IBD patients.
已发现将颈动脉超声纳入心血管（CV）风险评分可有效识别具有高CV风险的慢性炎症性疾病患者。我们旨在确定其使用是否有助于将炎症性肠病（IBD）患者重新分类为极高CV风险类别，以及这是否可能与疾病特征有关。在这项涵盖186例IBD患者和175例对照的横断面研究中，评估了系统性冠状动脉风险评估（SCORE）、疾病活动度测量以及通过超声检查发现的颈动脉斑块情况。比较了患者和对照之间的重新分类情况。进行多变量回归分析以评估重新分类风险是否可由疾病相关特征解释，并评估传统CV风险因素对这种重新分类的影响。评估颈动脉超声后，发现IBD患者的重新分类频率显著高于对照（35%对24%，P = 0.030）。当仅对SCORE低CV风险类别中的受试者进行此分析时，21%的IBD患者与11%的对照（P = 0.034）被重新分类为极高CV风险类别。在完全多变量回归分析后，包括疾病活动度在内的疾病相关数据与重新分类无关。传统CV风险因素对患者和对照的重新分类影响相似。然而，在调整混杂因素后，低密度脂蛋白胆固醇对对照的影响高于患者（β系数1.03（95%CI 1.02 - 1.04）对1.01（95%CI 1.00 - 1.02），交互作用P = 0.035）。总之，颈动脉斑块评估有助于识别高CV风险的IBD患者。
