基础慢性炎症性疾病患者的心血管疾病预防。

Cardiovascular disease prevention in individuals with underlying chronic inflammatory disease.

机构信息

Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.

出版信息

Curr Opin Cardiol. 2021 Sep 1;36(5):549-555. doi: 10.1097/HCO.0000000000000877.

Abstract

PURPOSE OF REVIEW

Patients with chronic inflammatory disease have an increased risk of cardiovascular disease. This article reviews the current evidence of cardiovascular prevention in three common systemic inflammatory disorders (SIDs): psoriasis, rheumatoid arthritis, and systemic lupus erythematosus.

RECENT FINDINGS

General population cardiovascular risk assessment tools currently underestimate cardiovascular risk and disease-specific risk assessment tools are an area of active investigation. A disease-specific cardiovascular risk estimator has not been shown to more accurately predict risk compared with the current guidelines. Rheumatoid arthritis-specific risk estimators have been shown to better predict cardiovascular risk in some cohorts and not others. Systemic lupus erythematosus-specific scores have also been proposed and require further validation, whereas psoriasis is an open area of active investigation. The current role of universal prevention treatment with statin therapy in patients with SID remains unclear. Aggressive risk factor modification and control of disease activity are important interventions to reduce cardiovascular risk.

SUMMARY

A comprehensive approach that includes cardiovascular risk factor modification, control of systemic inflammation, and increased patient and physician awareness is needed in cardiovascular prevention of chronic inflammation. Clinical trials are currently underway to test whether disease-specific anti-inflammatory therapies will reduce cardiovascular risk.

摘要

目的综述

慢性炎症性疾病患者的心血管疾病风险增加。本文综述了三种常见系统性炎症性疾病(SIDs)——银屑病、类风湿关节炎和系统性红斑狼疮——的心血管预防的现有证据。

最近的发现

目前的一般人群心血管风险评估工具低估了心血管风险,疾病特异性风险评估工具是一个活跃的研究领域。与现有指南相比,疾病特异性心血管风险估算器并未显示出更准确地预测风险的能力。类风湿关节炎特异性风险估算器在某些队列中能够更好地预测心血管风险,但在其他队列中则不然。也提出了系统性红斑狼疮特异性评分,需要进一步验证,而银屑病则是一个活跃的研究领域。目前SID 患者普遍使用他汀类药物进行预防治疗的作用仍不清楚。积极的危险因素修正和疾病活动的控制是降低心血管风险的重要干预措施。

总结

在慢性炎症的心血管预防中,需要采取综合方法,包括心血管危险因素修正、系统性炎症控制以及提高患者和医生的认识。目前正在进行临床试验,以测试疾病特异性抗炎治疗是否会降低心血管风险。

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