Rheumatology Unit, First Department of Propaedeutic Internal Medicine, Joint Academic Rheumatology Program, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
Diabetes Center, First Department of Propaedeutic Internal Medicine, School of Medicine, National and Kapodistrian University of Athens, Laiko General Hospital, Athens, Greece.
Front Immunol. 2023 Jan 9;13:1077166. doi: 10.3389/fimmu.2022.1077166. eCollection 2022.
Cardiovascular disease (CVD) is the foremost cause of morbidity and deaths in antiphospholipid syndrome (APS), driven by thrombo-inflammation and atherothrombosis mechanisms. Metabolic syndrome (MetS) is a proinflammatory and prothrombotic state characterized by increased CVD risk. We aimed to evaluate the prevalence of MetS in APS patients compared to rheumatoid arthritis (RA) and diabetes mellitus (DM) and its associations with clinical and laboratory patient characteristics and vascular ultrasound (US) markers of subclinical atherosclerosis.
We included 414 patients in our study: 138 patients with APS (median age: 44.9 years, females 70%) and matched 1:1 for age and sex RA and DM subjects. Three sets of criteria were used for MetS diagnosis: Joint Interim Statement (JIS), International Diabetes Federation (IDF) and modified National Cholesterol Education Program Adult Treatment Panel III (NCEP-ATPIII). The demographic, clinical and laboratory characteristics of all participants were recorded and carotid and femoral US was performed in patients with APS. Multivariate regression models were applied.
Prevalence of MetS was 23.9%, 23.2%, 20.3% (based on JIS, IDF, modified NCEP-ATPIII criteria, respectively) in APS versus 17.4%, 17.4%, 13% in RA (p=0.181, p=0.231, p=0.106, respectively), and 44.2%, 44.2%, 40.6% in DM patients. In multivariate analysis, patients with systemic lupus erythematosus- related APS had an approximately 2.5-fold higher risk of MetS versus RA patients. MetS in APS was independently associated with arterial thrombosis (Odds ratio 3.5, p=0.030). Odds ratio for MetS was 1.16 for each one unit increase in C-reactive protein levels according to JIS and IDF criteria, and 1.49 and 1.47 for each one unit increase in uric acid levels using the IDF and modified NCEP-ATPIII models, respectively. APS patients with atherosclerotic carotid plaques had 4 to 6.5-fold increased risk of MetS. Odds for MetS were decreased by 26% with an increase in physical activity by one hour per week.
MetS is present in approximately one-fourth of APS patients at a comparable prevalence to that observed in patients with RA. MetS in APS is associated with arterial thrombosis, cardiovascular risk biomarkers, physical activity, and subclinical atherosclerosis, supporting its role in cardiovascular risk stratification and management in APS.
心血管疾病 (CVD) 是抗磷脂综合征 (APS) 患者发病和死亡的首要原因，其发病机制与血栓-炎症和动脉粥样硬化血栓形成有关。代谢综合征 (MetS) 是一种炎症前和血栓前状态，其特点是 CVD 风险增加。我们旨在评估与类风湿关节炎 (RA) 和糖尿病 (DM) 相比，APS 患者中 MetS 的患病率，并评估其与临床和实验室患者特征以及亚临床动脉粥样硬化的血管超声 (US) 标志物的关系。
我们纳入了 414 名患者进行研究：138 名 APS 患者（中位年龄：44.9 岁，女性占 70%），并按年龄和性别与 RA 和 DM 患者 1:1 匹配。使用三种标准来诊断 MetS：联合临时声明 (JIS)、国际糖尿病联盟 (IDF) 和改良国家胆固醇教育计划成人治疗专家组 III (NCEP-ATPIII)。记录所有参与者的人口统计学、临床和实验室特征，并对 APS 患者进行颈动脉和股动脉 US。应用多变量回归模型。
与 RA 患者相比，APS 患者的 MetS 患病率为 23.9%、23.2%、20.3%（基于 JIS、IDF、改良 NCEP-ATPIII 标准），而 RA 患者为 17.4%、17.4%、13%（p=0.181，p=0.231，p=0.106），DM 患者为 44.2%、44.2%、40.6%。多变量分析显示，与 RA 患者相比，系统性红斑狼疮相关的 APS 患者发生 MetS 的风险约高 2.5 倍。APS 中的 MetS 与动脉血栓形成独立相关（优势比 3.5，p=0.030）。根据 JIS 和 IDF 标准，C 反应蛋白水平每增加一个单位，MetS 的优势比为 1.16，根据 IDF 和改良 NCEP-ATPIII 模型，尿酸水平每增加一个单位，MetS 的优势比分别为 1.49 和 1.47。APS 患者存在颈动脉粥样硬化斑块时，MetS 的风险增加 4 至 6.5 倍。每周增加 1 小时的身体活动，MetS 的几率降低 26%。
约四分之一的 APS 患者存在 MetS，其患病率与 RA 患者相似。APS 中的 MetS 与动脉血栓形成、心血管风险生物标志物、身体活动和亚临床动脉粥样硬化有关，支持其在 APS 心血管风险分层和管理中的作用。
