Columbia University Irving Medical Center. Vagelos College of Physicians & Surgeons, New York, New York, USA.
Curr Opin Rheumatol. 2024 May 1;36(3):209-216. doi: 10.1097/BOR.0000000000001004. Epub 2024 Feb 9.
Rheumatoid arthritis (RA) patients remain at higher cardiovascular (CV) risk compared to non-RA patients, driven by accelerated atherosclerosis, leading to plaque rupture and acute CV events (CVE), including heart failure (HF). It has been hypothesized that chronic inflammation is the main driving force behind such outcomes. We summarize the current evidence supporting this hypothesis, focusing on arterial disease and myocardial disease.
RA patients demonstrate higher prevalence of subclinical atherosclerosis (high risk plaque and arterial inflammation) compared to non-RA patients, with RA disease activity correlating independently with CVE and death. Nonischemic HF with preserved ejection fraction (HFpEF) is more common in RA compared to non-RA, with subclinical myocardial structural and functional alterations also more prevalent in RA. HFpEF and myocardial remodeling and dysfunction bear a strong and independent association with inflammatory correlates.
All of this suggests that inflammation contributes to enhanced risk of CVE in RA. A more accurate and specific CV risk stratification tool for RA, incorporating biomarkers or imaging, is needed. Likewise, more prospective studies outlining the trajectory from preclinical to clinical HF, incorporating biomarkers and imaging, are also needed.
与非类风湿关节炎（RA）患者相比，类风湿关节炎（RA）患者的心血管（CV）风险仍然更高，这是由动脉粥样硬化加速引起的，导致斑块破裂和急性 CV 事件（CVE），包括心力衰竭（HF）。人们假设慢性炎症是导致这些结果的主要驱动力。我们总结了支持这一假设的当前证据，重点关注动脉疾病和心肌疾病。
与非 RA 患者相比，RA 患者表现出更高的亚临床动脉粥样硬化（高危斑块和动脉炎症）患病率，且 RA 疾病活动与 CVE 和死亡独立相关。与非 RA 相比，RA 中更常见射血分数保留的心力衰竭（HFpEF），RA 中也更常见亚临床心肌结构和功能改变。HFpEF 以及心肌重塑和功能障碍与炎症相关因素密切相关。
所有这些都表明炎症导致 RA 患者的 CVE 风险增加。需要一种更准确、更特异的 RA 心血管风险分层工具，纳入生物标志物或影像学检查。同样，也需要更多前瞻性研究来描述从临床前到临床 HF 的轨迹，纳入生物标志物和影像学检查。
