Asenjo-Lobos Claudia, González Leticia, Bulnes Juan Francisco, Roque Marta, Muñoz Venturelli Paula, Rodríguez Gonzalo Martínez
Centro de Estudios Clínicos, Instituto de Ciencias e Innovación en Medicina (ICIM), Facultad de Medicina Clínica Alemana Universidad de Desarrollo, Santiago, Chile.
Centro de Imágenes Biomédicas, Departamento de Radiología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Clin Res Cardiol. 2024 Feb;113(2):246-259. doi: 10.1007/s00392-023-02291-4. Epub 2023 Aug 31.
Chronic inflammation is considered a risk factor for the development of atherosclerosis and cardiovascular (CV) events. We seek to assess the risk of CV events in patients with Systemic autoimmune diseases (SAD), such as Systemic Lupus Erythematosus (SLE), Rheumatoid Arthritis (RA), Psoriasis (Ps) and Ankylosing Spondylitis (AS), compared with the general population.
A systematic search of MEDLINE from inception up to May 2021 was performed. Observational studies including individuals with and without autoimmune diseases (SLE, RA, Ps, AS), which reported a measure of association and variability for the effect of SAD on CV events, were included. The random effects meta-analysis was performed using the Hartung-Knapp-Sidik-Jonkman approach to obtain the pooled estimates. Cardiovascular Events including CV mortality, non-fatal myocardial infarction (MI), non-fatal stroke and coronary revascularization were the main outcomes evaluated. Fifty-four studies were selected, with a total of 24,107,072 participants. The presence of SAD was associated with an increased risk of CV mortality (HR 1.49 [95% CI 1.10-2.03]), non-fatal MI (HR 1.42 [95% CI 1.23-1.62]), and non-fatal stroke (HR 1.47 [95% CI 1.28-1.70]). RA, SLE, and Ps (particularly with arthritis) were significantly associated with a higher risk of MI and stroke. SAD was also associated with an increased risk of Major Adverse Cardiovascular Events (MACE) (HR 1.45 [95% CI 1.16-1.83]).
Patients with SAD present an increased risk of CV morbidity and mortality, which should be considered when establishing therapeutic strategies. These findings support the role of systemic inflammation in the development of atherosclerosis-driven disease.
慢性炎症被认为是动脉粥样硬化和心血管（CV）事件发生的危险因素。我们试图评估与普通人群相比，系统性自身免疫性疾病（SAD）患者，如系统性红斑狼疮（SLE）、类风湿关节炎（RA）、银屑病（Ps）和强直性脊柱炎（AS）发生CV事件的风险。
对MEDLINE从创刊至2021年5月进行了系统检索。纳入了观察性研究，这些研究包括患有和未患有自身免疫性疾病（SLE、RA、Ps、AS）的个体，报告了SAD对CV事件影响的关联度和变异性测量值。采用Hartung-Knapp-Sidik-Jonkman方法进行随机效应荟萃分析以获得合并估计值。评估的主要结局是心血管事件，包括CV死亡率、非致命性心肌梗死（MI）、非致命性中风和冠状动脉血运重建。选择了54项研究，共有24107072名参与者。SAD的存在与CV死亡率增加（HR 1.49 [95% CI 1.10 - 2.03]）、非致命性MI（HR 1.42 [95% CI 1.23 - 1.62]）和非致命性中风（HR 1.47 [95% CI 1.28 - 1.70]）风险增加相关。RA、SLE和Ps（特别是伴有关节炎）与MI和中风的较高风险显著相关。SAD还与主要不良心血管事件（MACE）风险增加相关（HR 1.45 [95% CI 1.16 - 1.83]）。
SAD患者发生CV发病和死亡的风险增加，在制定治疗策略时应予以考虑。这些发现支持了全身炎症在动脉粥样硬化驱动疾病发展中的作用。
