通过主动脉僵硬度和系统性冠状动脉风险评估（SCORE）对银屑病关节炎患者进行心血管风险评估：前瞻性PSOCARD队列研究结果
Cardiovascular Risk Evaluation in Psoriatic Arthritis by Aortic Stiffness and the Systemic Coronary Risk Evaluation (SCORE): Results of the Prospective PSOCARD Cohort Study.
作者信息
Triantafyllias Konstantinos, Liverakos Stefanie, Muthuraman Muthuraman, Cavagna Lorenzo, Parodis Ioannis, Schwarting Andreas
机构信息
Rheumatology Center Rhineland-Palatinate, Bad Kreuznach, Germany.
Department of Internal Medicine I, Division of Rheumatology and Clinical Immunology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany.
出版信息
Rheumatol Ther. 2024 Aug;11(4):897-911. doi: 10.1007/s40744-024-00676-z. Epub 2024 May 31.
INTRODUCTION
Psoriatic arthritis (PsA) is associated with increased cardiovascular (CV) risk and mortality. Aortic stiffness measured by carotid-femoral pulse wave velocity (cfPWV) has been shown to predict CV risk in the general population. The present study aimed to examine cfPWV values of patients with PsA compared to healthy controls and to evaluate associations of cfPWV with patient- and disease-associated characteristics, as well as with an established traditional CV prediction score of the European Society of Cardiology (Systemic Coronary Risk Evaluation; SCORE), for the first time.
METHODS
cfPWV and SCORE were evaluated in patients with PsA and healthy controls, along with clinical and laboratory disease parameters. Differences in cfPWV measurements between the two groups and associations of cfPWV with patient- and disease-associated characteristics were statistically evaluated.
RESULTS
A total of 150 patients with PsA (PSOCARD cohort) and 88 control subjects were recruited. cfPWV was significantly higher in the PsA group compared to controls, even after adjustment for confounders (p = 0.034). Moreover, cfPWV was independently associated with disease duration (r = 0.304, p = 0.001), age (rho = 0.688, p < 0.001), systolic arterial pressure (rho = 0.351, p < 0.001), glomerular filtration rate (inverse: rho = - 0.264, p = 0.001), and red cell distribution width, a marker of major adverse CV events (MACE) (rho = 0.190, p = 0.02). SCORE revealed an elevated CV risk in 8.73% of the patients, whereas cfPWV showed increased aortic stiffness and end-organ disease in 16.00% of the same cohort.
CONCLUSIONS
In the largest cfPWV/PsA cohort examined to date, patients with PsA exhibited increased aortic stiffness compared to healthy controls. PsA duration was the most important independent disease-associated predictor of increased aortic stiffness, next to traditional CV risk factors. cfPWV measurements may help identify subclinical end-organ disease and abnormal aortic stiffness and thus assist CV risk classification in PsA.
引言
银屑病关节炎（PsA）与心血管（CV）风险增加及死亡率升高相关。通过颈股脉搏波速度（cfPWV）测量的主动脉僵硬度已被证明可预测一般人群的CV风险。本研究旨在首次比较PsA患者与健康对照者的cfPWV值，并评估cfPWV与患者及疾病相关特征的关联，以及与欧洲心脏病学会既定的传统CV预测评分（系统性冠状动脉风险评估；SCORE）的关联。
方法
对PsA患者和健康对照者进行cfPWV和SCORE评估，同时评估临床和实验室疾病参数。对两组之间cfPWV测量值的差异以及cfPWV与患者及疾病相关特征的关联进行统计学评估。
结果
共招募了150例PsA患者（PSOCARD队列）和88例对照者。即使在对混杂因素进行校正后，PsA组的cfPWV仍显著高于对照组（p = 0.034）。此外，cfPWV与疾病持续时间（r = 0.304，p = 0.001）、年龄（rho = 0.688，p < 0.001）、收缩动脉压（rho = 0.351，p < 0.001）、肾小球滤过率（反比：rho = -0.264，p = 0.001）以及主要不良CV事件（MACE）的标志物红细胞分布宽度（rho = 0.190，p = 0.02）独立相关。SCORE显示8.73%的患者CV风险升高，而在同一队列中，cfPWV显示16.00%的患者主动脉僵硬度增加和终末器官疾病。
结论
在迄今为止检测的最大的cfPWV/PsA队列中，与健康对照者相比，PsA患者表现出主动脉僵硬度增加。除传统CV危险因素外，PsA病程是主动脉僵硬度增加的最重要的独立疾病相关预测因素。cfPWV测量可能有助于识别亚临床终末器官疾病和异常主动脉僵硬度，从而辅助PsA的CV风险分类。
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