Corrao Salvatore, Calvo Luigi, Giardina Annarita, Cangemi Ignazio, Falcone Fabio, Argano Christiano
Department of Clinical Medicine, Internal Medicine Unit, National Relevance and High Specialization Hospital Trust ARNAS Civico, Di Cristina, Benfratelli, Palermo, Italy.
Department of Health Promotion Sciences, Maternal and Infant Care, Internal Medicine and Medical Specialties [PROMISE], University of Palermo, Palermo, Italy.
Front Med (Lausanne). 2024 Jul 24;11:1421328. doi: 10.3389/fmed.2024.1421328. eCollection 2024.
Rheumatoid Arthritis (RA) is associated with an increased risk of cardiovascular disease and mortality, however, traditional cardiovascular risk factors do not fully explain this relationship. This high risk of cardiovascular morbidity and mortality in RA has been increasingly acknowledged in past decades, with accumulating evidence that RA is an independent cardiovascular risk factor; RA is also associated with metabolic syndrome, which correlates with disease activity, contributing to the increased prevalence of coronary heart disease in RA patients. Moreover, multimorbidity, including the presence of long-term conditions, impacts adverse clinical outcomes in RA patients, emphasizing the need for holistic management that requires an understanding of shared pathophysiological mechanisms, such as systemic inflammation and immune dysregulation. For all these reasons, the management of RA patients with cardiometabolic comorbidities is a complex endeavor that requires a patient-centered, multidisciplinary approach. In this sense, there is a need to re-evaluate the approach toward a proactive model of care, moving away from a reactive medical paradigm to a multidimensional integrated management model, including aggressive screening, preventive strategies, and tailored therapeutic interventions. The aim of this review was to thoroughly review the literature on cardiometabolic comorbidities and related conditions linked to RA to enable us to identify the necessary actions required to effectively tackle the increasing burden of illness from a fully comprehensive perspective.
类风湿关节炎（RA）与心血管疾病风险及死亡率增加相关，然而，传统心血管危险因素并不能完全解释这种关系。在过去几十年里，RA患者心血管发病和死亡的高风险越来越受到认可，越来越多的证据表明RA是一个独立的心血管危险因素；RA还与代谢综合征相关，而代谢综合征与疾病活动相关，这导致RA患者冠心病患病率增加。此外，多种疾病并存，包括长期病症的存在，会影响RA患者的不良临床结局，这凸显了全面管理的必要性，而全面管理需要了解共同的病理生理机制，如全身炎症和免疫失调。基于所有这些原因，对患有心脏代谢合并症的RA患者进行管理是一项复杂的工作，需要以患者为中心的多学科方法。从这个意义上说，有必要重新评估对积极主动护理模式的方法，从被动的医疗模式转向多维综合管理模式，包括积极筛查、预防策略和量身定制的治疗干预措施。这篇综述的目的是全面回顾关于与RA相关的心脏代谢合并症及相关病症的文献，以便我们能够从全面的角度确定有效应对日益增加的疾病负担所需采取的必要行动。
