Ferraz-Amaro Iván, Genre Fernanda, Blanco Ricardo, Corrales Alfonso, Mazón Iñigo González, Portilla Virginia, Aurrecoechea Elena, Mata Cristina, Hernández-Hernández Vanesa, Quevedo-Abeledo Juan Carlos, Rodríguez-Lozano Carlos, Lopez-Medina Clementina, Ladehesa-Pineda María Lourdes, Castañeda Santos, Vicente Esther F, Fernández-Carballido Cristina, Martínez-Vidal M Paz, Castro-Corredor David, Anino-Fernández Joaquín, Peiteado Diana, Plasencia-Rodríguez Chamaida, Vivar María Luz García, Galíndez-Agirregoikoa Eva, Vegas-Revenga Nuria, Urionagüena-Onaindia Irati, Perez Esther Montes, Díaz Carlos Fernández, González-Gay Miguel Ángel, Rueda-Gotor Javier
Rheumatology Division, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain.
IDIVAL, Research group on genetic epidemiology and atherosclerosis in systemic diseases and inmetabolic bone diseases of the musculoskeletal system, Santander, Spain.
Semin Arthritis Rheum. 2023 Jun;60:152198. doi: 10.1016/j.semarthrit.2023.152198. Epub 2023 Mar 29.
To determine the potential impact of sex-specific disease-related characteristics on cardiovascular (CV) disease in axial spondyloarthritis (axSpA).
Cross-sectional study of the Spanish AtheSpAin cohort to study CV disease in axSpA. Data on carotid ultrasound and CV disease and disease-related features were collected.
611 men and 301 women were recruited. Classic CV risk factors were significantly less prevalent in women, who also showed a lower frequency of carotid plaques (p = 0.001), lower carotid intima-media thickness (IMT) values (p<0.001) and CV events (p = 0.008). However, after adjustment for classic CV risk factors, only the differences with respect to carotid IMT remained statistically significant. Women showed higher ESR at diagnosis (p = 0.038), and more active disease (ASDAS, p = 0.012, and BASDAI, p<0.001). They had shorter disease duration (p<0.001), lower prevalence of psoriasis (p = 0.008), less structural damage (mSASSS, p<0.001), and less mobility limitation (BASMI, p = 0.033). To establish whether these findings could lead to sex differences in CV disease burden, we compared the prevalence of carotid plaques in men and women with the same level of CV risk stratified according to the Systematic Coronary Risk Evaluation (SCORE). Men included in the low-moderate CV risk SCORE category had more carotid plaques (p = 0.050), along with longer disease duration (p = 0.004), higher mSASSS (p = 0.001) and psoriasis (p = 0.023). In contrast, in the high-very high-risk SCORE category, carotid plaques were observed more frequently in women (p = 0.028), who were characterized as having worse BASFI (p = 0.011), BASDAI (p<0.001) and ASDAS (p = 0.027).
Disease-related features may influence the expression of atherosclerosis in patients with axSpA. This may be especially applicable to women at high CV risk, characterized by greater disease severity and more severe subclinical atherosclerosis than men, suggesting a stronger interaction between disease activity and atherosclerosis in women with axSpA.
确定特定性别的疾病相关特征对轴性脊柱关节炎（axSpA）中心血管（CV）疾病的潜在影响。
对西班牙AtheSpAin队列进行横断面研究，以研究axSpA中的CV疾病。收集了颈动脉超声、CV疾病及疾病相关特征的数据。
招募了611名男性和301名女性。经典CV危险因素在女性中的患病率显著较低，女性的颈动脉斑块频率也较低（p = 0.001），颈动脉内膜中层厚度（IMT）值较低（p<0.001），CV事件发生率较低（p = 0.008）。然而，在对经典CV危险因素进行调整后，仅颈动脉IMT方面的差异仍具有统计学意义。女性在诊断时的血沉较高（p = 0.038），疾病活动度更高（ASDAS，p = 0.012；BASDAI，p<0.001）。她们的病程较短（p<0.001），银屑病患病率较低（p = 0.008），结构损伤较少（mSASSS，p<0.001），活动受限较少（BASMI，p = 0.033）。为了确定这些发现是否会导致CV疾病负担的性别差异，我们比较了根据系统性冠状动脉风险评估（SCORE）分层的具有相同CV风险水平的男性和女性中颈动脉斑块的患病率。处于低-中度CV风险SCORE类别的男性有更多的颈动脉斑块（p = 0.050），病程更长（p = 0.004），mSASSS更高（p = 0.001），银屑病患病率更高（p = 0.023）。相反，在高-极高风险SCORE类别中，女性中颈动脉斑块的观察频率更高（p = 0.028），其特征为BASFI更差（p = 0.011），BASDAI更差（p<0.001），ASDAS更差（p = 0.027）。
疾病相关特征可能影响axSpA患者动脉粥样硬化的表现。这可能特别适用于CV高风险的女性，其疾病严重程度更高，亚临床动脉粥样硬化比男性更严重，表明axSpA女性中疾病活动与动脉粥样硬化之间的相互作用更强。
