Internal Medicine - Rheumatology, The Lundquist Institute, Torrance, California, USA
Rheumatology, Harbor-UCLA Medical Center, Torrance, California, USA.
RMD Open. 2024 Jul 23;10(3):e004546. doi: 10.1136/rmdopen-2024-004546.
Chronic inflammation promotes cardiovascular risk in rheumatoid arthritis (RA). Biological disease-modifying antirheumatic drugs (bDMARDs) improve disease activity and cardiovascular disease outcomes. We explored whether bDMARDs influence the impact of disease activity and inflammatory markers on long-term cardiovascular risk in RA.
We studied 4370 participants without cardiovascular disease in a 10-country observational cohort of patients with RA. Endpoints were (1) major adverse cardiovascular events (MACE) encompassing myocardial infarction, stroke and cardiovascular death; and (2) any ischaemic cardiovascular events (iCVE) including MACE plus revascularisation, angina, transient ischaemic attack and peripheral arterial disease.
Over 26 534 patient-years, 239 MACE and 362 iCVE occurred. The interaction between 28-joint Disease Activity Score with C-reactive protein (DAS28-CRP) and bDMARD use was significant for MACE (p=0.017), suggesting the effect of DAS28-CRP on MACE risk differed among bDMARD users (n=515) and non-users (n=3855). DAS28-CRP (per unit increase) is associated with MACE risk in bDMARD non-users (HR 1.21 (95% CI 1.07 to 1.37)) but not users (HR 0.69 (95% CI 0.40 to 1.20)). The interaction between CRP (per log unit increase) and bDMARD use was also significant for MACE (p=0.011). CRP associated with MACE risk in bDMARD non-users (HR 1.16 (95% CI 1.04 to 1.30)), but not users (HR 0.65 (95% CI 0.36 to 1.17)). No interaction was observed between bDMARD use and DAS28-CRP (p=0.167) or CRP (p=0.237) for iCVE risk.
RA activity and inflammatory markers associated with risk of MACE in bDMARD non-users but not users suggesting the possibility of biological-specific benefits locally on arterial wall independently of effects on systemic inflammation.
慢性炎症可增加类风湿关节炎（RA）的心血管风险。生物改善病情抗风湿药物（bDMARDs）可改善疾病活动度和心血管疾病结局。我们探讨了 bDMARDs 是否会影响疾病活动度和炎症标志物对 RA 患者长期心血管风险的影响。
我们研究了来自 10 个国家的 RA 患者观察性队列中的 4370 名无心血管疾病的参与者。终点为（1）主要不良心血管事件（MACE），包括心肌梗死、卒中和心血管死亡；（2）任何缺血性心血管事件（iCVE），包括 MACE 加血运重建、心绞痛、短暂性脑缺血发作和外周动脉疾病。
在超过 26534 患者年中，发生了 239 例 MACE 和 362 例 iCVE。28 关节疾病活动度评分与 C 反应蛋白（DAS28-CRP）和 bDMARD 使用之间的交互作用对 MACE 有显著影响（p=0.017），提示 DAS28-CRP 对 MACE 风险的影响在 bDMARD 使用者（n=515）和非使用者（n=3855）中不同。DAS28-CRP（每单位增加）与 bDMARD 非使用者的 MACE 风险相关（HR 1.21（95%CI 1.07 至 1.37）），但与使用者无关（HR 0.69（95%CI 0.40 至 1.20））。CRP（每对数单位增加）与 bDMARD 使用之间的交互作用对 MACE 也有显著影响（p=0.011）。CRP 与 bDMARD 非使用者的 MACE 风险相关（HR 1.16（95%CI 1.04 至 1.30）），但与使用者无关（HR 0.65（95%CI 0.36 至 1.17））。在 iCVE 风险方面，未观察到 bDMARD 使用与 DAS28-CRP（p=0.167）或 CRP（p=0.237）之间的交互作用。
RA 活动度和炎症标志物与 bDMARD 非使用者的 MACE 风险相关，但与使用者无关，这表明生物制剂可能具有局部作用于动脉壁的生物学特异性益处，而与对全身炎症的影响无关。
