Yagensky Vasyl, Schirmer Michael
Department of Internal Medicine, Clinic II, Medical University of Innsbruck, Innsbruck, Austria.
Front Med (Lausanne). 2022 Feb 22;9:786776. doi: 10.3389/fmed.2022.786776. eCollection 2022.
It is well established that patients with inflammatory joint diseases (IJD) have an increased cardiovascular (CV) mortality and morbidity. According to the 2016 EULAR recommendations on CV risk management, rheumatologists should ensure appropriate management of CV risk in rheumatoid arthritis (RA) and other IJDs. The aim was to assess the CV risk and CV disease in Middle-European patients with IJD.
A retrospective chart review was performed for CV risk factors and CV disease in outpatients of a rheumatology outpatient clinic. CV risk was assessed according to the 2016 European Guidelines on CV disease prevention and also using 2 other approaches to compare the results with data from Norwegian and Spanish cohorts.
Out of 432 patients, the prevalence of CV disease reached from 8.7% in spondyloarthritis (SpA) and 12.8% in psoriatic arthritis (PsA) to 18.7% in patients with RA. The number of CV risk factors did not differ between patients with RA, SpA, PsA, and non-inflammatory rheumatic disease (NIRD) (with 1.68 ± 0.13, 1.70 ± 0.13, 2.04 ± 0.16, and 1.78 ± 0.34, respectively). CV risk assessment could be performed in 82 patients after exclusion because of missing data and age. Stratification according to ESC guidelines showed low in 50%, moderate in 12.2%, high in 20.7%, and very high CV risk in 17.1% of patients aged between 40 and 65 years. CV risk in the Middle-European patients with IJD was higher than in the German general population ( = 0.004), and similar to the Norwegian patients with IJD, although patients with Middle-European PsA were at higher risk than the Norwegian patients ( = 0.045). Compared to the Spanish patients, Middle-European patients with IJD were more likely assigned to the high- to a very high-risk group (34.2 vs. 16.2%, < 0.001), especially in RA disease (49.1 vs. 21%, respectively, < 0.001).
High prevalence of established CV disease together with high CV risk in patients with IJD urges for increased vigilance for CV risk factors followed by appropriate interaction by the treating physicians. The prospective use of an international CV risk assessment tool will allow not only estimation of the individual CV risk but also provide data for direct comparisons with the general population and other international cohorts.
炎症性关节疾病（IJD）患者的心血管（CV）死亡率和发病率升高已得到充分证实。根据2016年欧洲抗风湿病联盟（EULAR）关于CV风险管理的建议，风湿病学家应确保对类风湿关节炎（RA）和其他IJD患者的CV风险进行适当管理。目的是评估中欧IJD患者的CV风险和CV疾病。
对一家风湿病门诊的门诊患者的CV危险因素和CV疾病进行回顾性病历审查。根据2016年欧洲CV疾病预防指南评估CV风险，并使用另外两种方法将结果与挪威和西班牙队列的数据进行比较。
在432例患者中，CV疾病的患病率从脊柱关节炎（SpA）的8.7%、银屑病关节炎（PsA）的12.8%到RA患者的18.7%不等。RA、SpA、PsA和非炎性风湿性疾病（NIRD）患者的CV危险因素数量没有差异（分别为1.68±0.13、1.70±0.13、2.04±0.16和1.78±0.34）。由于数据缺失和年龄原因，排除后82例患者可进行CV风险评估。根据欧洲心脏病学会（ESC）指南进行分层，40至65岁患者中，50%为低风险，12.2%为中度风险，20.7%为高风险，17.1%为非常高的CV风险。中欧IJD患者的CV风险高于德国普通人群（P = 0.004），与挪威IJD患者相似，尽管中欧PsA患者的风险高于挪威患者（P = 0.045）。与西班牙患者相比，中欧IJD患者更有可能被归为高风险至非常高风险组（分别为34.2%对16.2%，P < 0.001），尤其是在RA疾病中（分别为49.1%对21%，P < 0.001）。
IJD患者中已确诊的CV疾病患病率高以及CV风险高，促使医生提高对CV危险因素的警惕，并进行适当干预。前瞻性地使用国际CV风险评估工具不仅可以估计个体CV风险，还可以提供与普通人群和其他国际队列进行直接比较的数据。
