Zhang Mei, Wang Manman, Tai Yu, Tao Juan, Zhou Weijie, Han Yongsheng, Wang Qingtong
Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, Anti-inflammatory Immune Drugs Collaborative Innovation Center, Institute of Clinical Pharmacology, Anhui Medical University, Hefei, China.
Department of Emergency Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, China.
Curr Probl Cardiol. 2022 Jun;47(6):100853. doi: 10.1016/j.cpcardiol.2021.100853. Epub 2021 Apr 6.
The risk of cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is higher than that in patients without RA, and it is even higher than that in patients with diabetes. Autoimmune-mediated inflammation is observed in patients with RA, resulting in endothelial dysfunction, oxidative stress and activation, and vascular migration of white blood cells. Traditionally, RA-associated CVD was assumed to be mediated by disease-related inflammation, resulting in atherosclerosis (AS). However, this concept has been challenged because treatment with anti-rheumatic drugs, such as methotrexate or proinflammatory cytokine antagonists, such as tumor necrosis factor-alpha (TNF-α) inhibitors, did not reduce the risk of CVD in patients with RA. Current cardiovascular guidelines recommend screening and treatment of CVD risk factors in patients with RA but without clear biomarkers and treatment goals. There is no scientific basis for establishing therapeutic targets for cardiovascular risk factors in RA. Numerous studies have shown that the mechanism of early cardiac dysfunction in patients with RA may occur prior to AS. Therefore, it is crucial to explore the related mechanisms to prevent early cardiac dysfunction in patients with RA.
类风湿关节炎（RA）患者患心血管疾病（CVD）的风险高于非RA患者，甚至高于糖尿病患者。RA患者存在自身免疫介导的炎症，导致内皮功能障碍、氧化应激与激活以及白细胞的血管迁移。传统上，RA相关的CVD被认为是由疾病相关炎症介导的，进而导致动脉粥样硬化（AS）。然而，这一概念受到了挑战，因为使用抗风湿药物（如甲氨蝶呤）或促炎细胞因子拮抗剂（如肿瘤坏死因子-α（TNF-α）抑制剂）进行治疗并未降低RA患者发生CVD的风险。当前的心血管指南建议对RA患者的CVD危险因素进行筛查和治疗，但缺乏明确的生物标志物和治疗目标。在RA中建立心血管危险因素治疗靶点尚无科学依据。大量研究表明，RA患者早期心脏功能障碍的机制可能在AS之前就已出现。因此，探索相关机制以预防RA患者早期心脏功能障碍至关重要。
