Warren Alpert Medical School, Brown University, Providence, RI, USA.
Center for Primary Care and Prevention, Brown University, Pawtucket, RI, USA.
Clin Rheumatol. 2024 Oct;43(10):3089-3104. doi: 10.1007/s10067-024-07092-2. Epub 2024 Aug 4.
This study aimed to examine the combined impact of diet quality and rheumatoid arthritis (RA) on development of cardiovascular and mortality outcomes among postmenopausal women.
A total of 99,840 women without baseline RA and 10,494 women with baseline RA were prospectively followed for an average of 12.7 years through the Women's Health Initiative. Diet quality was evaluated using food frequency questionnaires and the Healthy Eating Index 2015. Cardiovascular and mortality outcomes were identified through study follow-up. Four patient groups were used: Reference Group (no RA and healthy diet), Group 1 (no RA and unhealthy diet), Group 2 (RA and healthy diet), Group 3 (RA and unhealthy diet). Data was analyzed using multivariable Cox proportional regression models.
After adjustment for confounders, Groups 1 and 3 developed significantly more cardiovascular disease (CVD), coronary heart disease, and incident stroke as compared to the reference. All groups developed more CVD-related mortality and all-cause mortality as compared to the reference. Among patients who already have RA, the incidence of these poorer cardiovascular outcomes does not significantly increase based on diet quality.
While healthy diet quality is associated with reduced adverse cardiovascular and mortality outcomes, RA overpowers the benefits that may be attained through a healthy diet, resulting in the fact that diet quality does not significantly change cardiovascular and mortality outcome incidence in those who already have RA. Conversely, in those who do not have RA, the benefits of a healthy diet are realized with significant reduction of adverse cardiovascular and mortality outcomes as compared to those with an unhealthy diet. Key Points •Healthy diet quality is associated with reduced adverse cardiovascular and mortality outcomes. •RA is associated with increased adverse cardiovascular and mortality outcomes. •While diet quality does not significantly change cardiovascular and mortality outcomes in those who already have RA, those without RA experience significant reduction of these adverse outcomes by adhering to a healthy diet.
本研究旨在探讨饮食质量与类风湿关节炎（RA）对绝经后妇女心血管疾病和死亡结局的综合影响。
共有 99840 名无基线 RA 和 10494 名基线 RA 的女性前瞻性随访，平均随访时间为 12.7 年，随访途径为妇女健康倡议。通过食物频率问卷和健康饮食指数 2015 评估饮食质量。通过研究随访确定心血管疾病和死亡结局。共使用了 4 组患者：参照组（无 RA 和健康饮食）、组 1（无 RA 和不健康饮食）、组 2（RA 和健康饮食）、组 3（RA 和不健康饮食）。采用多变量 Cox 比例风险回归模型进行数据分析。
在调整混杂因素后，与参照组相比，组 1 和组 3 发生心血管疾病（CVD）、冠心病和新发中风的风险显著增加。所有组发生 CVD 相关死亡率和全因死亡率的风险均高于参照组。对于已经患有 RA 的患者，饮食质量对这些较差心血管结局的发生率没有显著影响。
虽然健康的饮食质量与减少不良心血管和死亡结局相关，但 RA 削弱了健康饮食可能带来的益处，导致饮食质量不会显著改变已经患有 RA 的患者的心血管和死亡结局发生率。相反，对于没有 RA 的患者，与不健康饮食相比，健康饮食可显著降低不良心血管和死亡结局的发生率，从而实现获益。关键点：•健康的饮食质量与减少不良心血管和死亡结局相关。•RA 与增加不良心血管和死亡结局相关。•虽然饮食质量不会显著改变已经患有 RA 的患者的心血管和死亡结局发生率，但对于没有 RA 的患者，通过坚持健康饮食可显著降低这些不良结局的发生率。
