Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China.
Department of Medicine and Geriatrics, Tuen Mun Hospital, Hong Kong, China.
Rheumatology (Oxford). 2023 Sep 1;62(9):2998-3005. doi: 10.1093/rheumatology/kead039.
This study explored whether the excess cardiovascular (CV) disease (CVD) risk in RA could be ameliorated by suppression of inflammation using a treat-to-target (T2T) approach. We compared the CV event (CVE) incidence among ERA patients managed by a T2T strategy with a CV risk factor-matched non-RA population and a historical RA cohort (HRA).
This was an observational study using the city-wide hospital data and the ERA registry. ERA patients received T2T management while HRA patients received routine care. Each ERA/HRA patient was matched to three non-RA controls according to age, gender and CV risk factors. Patients on antiplatelet/anticoagulant agents, with pre-existing CVD, chronic kidney disease or other autoimmune diseases were excluded. All subjects were followed for up to 5 years. The primary end point was the first occurrence of a CVE.
The incidence of CVE in the ERA cohort (n = 261) and ERA controls were similar with a hazard ratio of 0.53 (95% CI 0.15, 1.79). In contrast, the incidence of CVE in the HRA cohort (n = 268) was significantly higher than that of the HRA controls with a hazard ratio of 1.9 (95% CI 1.16, 3.13). The incidence of CVE in the ERA cohort was significantly lower than that of the HRA cohort and the difference became insignificant after adjusting for inflammation, the use of methotrexate and traditional CV risk factors.
ERA patients managed by a T2T strategy did not develop excess CVE compared with CV risk factor-matched controls over 5 years.
本研究旨在探讨通过靶向治疗（T2T）来抑制炎症是否能改善类风湿关节炎（RA）患者的心血管疾病（CVD）风险。我们比较了采用 T2T 策略管理的 RA 患者（ERA 患者）、CV 风险因素匹配的非 RA 人群以及历史 RA 队列（HRA）的 CV 事件（CVE）发生率。
这是一项基于全市医院数据和 ERA 登记的观察性研究。ERA 患者接受 T2T 管理，而 HRA 患者接受常规护理。根据年龄、性别和 CV 危险因素，将每个 ERA/HRA 患者与三名非 RA 对照者相匹配。排除正在使用抗血小板/抗凝药物、有预先存在的 CVD、慢性肾脏病或其他自身免疫性疾病的患者。所有患者均随访 5 年。主要终点为首次发生 CVE。
ERA 队列（n=261）和 ERA 对照组的 CVE 发生率相似，风险比为 0.53（95%CI 0.15，1.79）。相比之下，HRA 队列（n=268）的 CVE 发生率明显高于 HRA 对照组，风险比为 1.9（95%CI 1.16，3.13）。ERA 队列的 CVE 发生率明显低于 HRA 队列，调整炎症、甲氨蝶呤使用和传统 CV 危险因素后，差异无统计学意义。
在 5 年内，采用 T2T 策略管理的 ERA 患者与 CV 风险因素匹配的对照组相比，并未发生额外的 CVE。
