Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, Noord-Holland, the Netherlands.
Amsterdam Rheumatology and Immunology Center, Location VUmc and Reade, Amsterdam, Noord-Holland, the Netherlands; Amsterdam UMC Locatie VUmc, Department of Rheumatology, Amsterdam, Noord-Holland, the Netherlands.
Semin Arthritis Rheum. 2023 Feb;58:152132. doi: 10.1016/j.semarthrit.2022.152132. Epub 2022 Nov 12.
To extend our investigation of cardiovascular diseases (CVD) in rheumatoid arthritis (RA) patients to a follow up of more than 20 years, with a special focus on patients without prevalent CVD.
The CARRÉ study is an ongoing prospective cohort study on CV endpoints in RA patients. Results were compared to those of a reference cohort (n = 2484) enriched for type 2 diabetes mellitus (DM). Hazard ratios (HR) for RA and DM patients compared to non-RA/-DM controls were calculated with cox proportional hazard models, and adjusted for baseline SCORE1 (estimated 10-year CVD mortality risk based on CV risk factors).
238 RA patients, 117 DM patients and 1282 controls, without prevalent CVD at baseline were included. Analysis of events in these patients shows that after adjustment, no relevant 'RA-specific' risk remains (HR 1.16; 95%CI 0.88 - 1.53), whereas a 'DM-specific' risk is retained (1.73; 1.24 - 2.42). In contrast, adjusted analyses of all cases confirm the presence of an 'RA-specific' risk (1.50; 1.19 - 1.89).
In RA patients without prevalent CVD the increased CVD risk is mainly attributable to increased presence of traditional risk factors. After adjustment for these factors, an increased risk attributable to RA only was thus preferentially seen in the patients with prevalent CVD at baseline. As RA treatment has improved, this data suggests that the 'RA-specific' effect of inflammation is preferentially seen in patients with prevalent CVD. We suggest that with modern (early) treatment of RA, most of the current increased CVD risk is mediated through traditional risk factors.
将我们对类风湿关节炎（RA）患者心血管疾病（CVD）的研究扩展到 20 多年的随访，特别关注无明显 CVD 的患者。
CARRÉ 研究是一项正在进行的前瞻性队列研究，旨在研究 RA 患者的心血管终点事件。结果与一个参考队列（n=2484）进行了比较，该参考队列富集了 2 型糖尿病（DM）患者。使用 Cox 比例风险模型计算 RA 和 DM 患者与非 RA/非 DM 对照组的危险比（HR），并根据基线 SCORE1（基于心血管危险因素估计的 10 年 CVD 死亡率风险）进行调整。
共纳入 238 例 RA 患者、117 例 DM 患者和 1282 例无明显 CVD 的对照者。对这些患者的事件分析表明，调整后，无明显的“RA 特异性”风险（HR 1.16；95%CI 0.88-1.53），而保留了“DM 特异性”风险（1.73；1.24-2.42）。相比之下，对所有病例的调整分析均证实存在“RA 特异性”风险（1.50；1.19-1.89）。
在无明显 CVD 的 RA 患者中，CVD 风险增加主要归因于传统危险因素的增加。在调整这些因素后，仅归因于 RA 的风险仅在基线时患有明显 CVD 的患者中更明显。随着 RA 治疗的改善，这些数据表明，炎症的“RA 特异性”效应更优先地见于患有明显 CVD 的患者中。我们建议，通过现代（早期）RA 治疗，目前大多数增加的 CVD 风险是通过传统危险因素介导的。
