Department of Medicine & Therapeutics, The Chinese University, Hong Kong, Hong Kong.
Department of Medicine & Therapeutics, The Chinese University, Hong Kong, Hong Kong
Ann Rheum Dis. 2023 Nov;82(11):1387-1393. doi: 10.1136/ard-2023-224185. Epub 2023 Jul 24.
Cardiovascular event (CVE) risk in rheumatoid arthritis (RA) was increased by glucocorticoids (GC) use. Whether there is a threshold dose and duration of GC use beyond which will increase CVE rate remains controversial. We studied the time-varying effect of GC and its dose on the risk of incident major adverse cardiovascular events (MACE) in patients with RA.
Patients with RA without MACE at baseline were recruited from a Hong Kong citywide database from 2006 to 2015 and followed till 2018. The primary outcome was the first occurrence of an MACE. Cox regression and inverse probability treatment weighting analyses with time-varying covariates were used to evaluate the association of GC and MACE, adjusting for demographics, traditional CV risk factors, inflammatory markers and the usage of antirheumatic drugs.
Among 12 233 RA patients with 105 826 patient-years of follow-up and a mean follow-up duration of 8.7 years, 860 (7.0%) developed MACE. In the time-varying analyses after controlling for confounding factors, a daily prednisolone dose of ≥5 mg significantly increased the risk of MACE (erythrocyte sedimentation rate model: HR 2.02, 95% CI 1.72 to 2.37; C reactive protein model: HR 1.87, 95% CI 1.60 to 2.18), while a daily dose below 5 mg was not associated with MACE risk, compared with no GC use. In patients receiving daily prednisolone ≥5 mg, the risk of incident MACE was increased by 7% per month.
GC was associated with a duration and dose-dependent increased risk of MACE in patients with RA. Very low dose prednisolone (<5 mg daily) did not appear to confer excessive CV risk.
类风湿关节炎（RA）患者使用糖皮质激素（GC）会增加心血管事件（CVE）风险。GC 使用是否存在一个剂量和时间的阈值，超过这个阈值会增加 CVE 发生率，目前仍存在争议。我们研究了 GC 及其剂量随时间变化对 RA 患者新发主要不良心血管事件（MACE）的风险的影响。
我们从 2006 年至 2015 年期间香港全市范围内的数据库中招募了基线时无 MACE 的 RA 患者，并随访至 2018 年。主要结局是首次发生 MACE。使用 Cox 回归和逆概率治疗加权分析，对 GC 与 MACE 之间的相关性进行评估，调整了人口统计学、传统心血管危险因素、炎症标志物和抗风湿药物的使用情况。
在 12233 例 RA 患者中，有 105826 人年的随访时间，平均随访时间为 8.7 年，有 860 例（7.0%）发生了 MACE。在控制混杂因素后的时间变化分析中，与不使用 GC 相比，每日泼尼松剂量≥5mg 显著增加了 MACE 的风险（红细胞沉降率模型：HR 2.02，95%CI 1.72 至 2.37；C 反应蛋白模型：HR 1.87，95%CI 1.60 至 2.18），而每日剂量<5mg 与 MACE 风险无关。在接受每日泼尼松剂量≥5mg 的患者中，MACE 的发生率每月增加 7%。
GC 与 RA 患者的 MACE 风险呈剂量和时间依赖性增加相关。非常低剂量的泼尼松（<5mg 每日）似乎不会增加过多的心血管风险。
