影像学轴性脊柱关节炎患者复发性心血管事件的发生率和肿瘤坏死因子抑制剂的作用。

Incidence rate of recurrent cardiovascular events in patients with radiographic axial spondyloarthritis and the effect of tumor necrosis factor inhibitors.

机构信息

Division of Rheumatology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, South Korea.

Biostatistics Collaboration Unit, Yonsei University College of Medicine, Seoul, South Korea.

出版信息

Arthritis Res Ther. 2024 Oct 4;26(1):174. doi: 10.1186/s13075-024-03405-7.

DOI:10.1186/s13075-024-03405-7

PMID:39367448

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11451105/

Abstract

BACKGROUND

Patients with radiographic axial spondyloarthritis (r-axSpA) are at increased risk of incident cardiovascular events. Tumor necrosis factor inhibitors (TNFi) have shown a protective effect against incident cardiovacular events. However, the incidence of recurrent cardiovascular events in patients with r-axSpA with a history of cardiovascular events, and the effect of TNFi on recurrent cardiovascular events remain unclear. We aimed to assess the incidence rate of recurrent cardiovascular events in patients with r-axSpA with a history of cardiovascular events and evaluate the effect of TNFi on the risk of recurrent cardiovascular events.

METHODS

This nationwide cohort study used data from the Korean National Claims Database. Data of patients with r-axSpA who had a history of cardiovascular events after being diagnosed with r-axSpA were extracted from the database. The outcome of interest was the recurrence of cardiovascular events (myocardial infarction or stroke). Patients were followed from the index date (date of the first cardiovascular event) to the date of cardiovascular event recurrence, the last date with claims data, or December 31, 2021, whichever occured first. The incidence rate of recurrent cardiovascular events was calculated. An inverse probability weighted Cox model was used to assess the effect of TNFi exposure on the risk of recurrent cardiovascular events.

RESULTS

This study included 413 patients (TNFi non-exposure, n = 338; TNFi exposure, n = 75). The incidence rate of recurrent cardiovascular events was 32 (95% confidence interval [CI] 22-42) per 1,000 person-years (TNFi non-exposure, 36 [95% CI 24-48] per 1,000 person-years; TNFi exposure, 19 [95% CI 2-35] per 1,000 person-years). In the inverse probability weighted Cox model, TNFi exposure was significantly associated with a lower risk of recurrent cardiovascular events (hazard ratio 0.33, 95% CI 0.12-0.94).

CONCLUSIONS

The incidence rate of recurrent cardiovascular events in patients with r-axSpA is substantial. TNFi exposure was associated with a lower risk of recurrent cardiovascular events.

摘要

背景

影像学轴向脊柱关节炎（r-axSpA）患者发生心血管事件的风险增加。肿瘤坏死因子抑制剂（TNFi）已显示出可预防心血管事件的发生。然而，有心血管事件史的 r-axSpA 患者发生复发性心血管事件的发生率以及 TNFi 对复发性心血管事件的影响尚不清楚。我们旨在评估有心血管事件史的 r-axSpA 患者发生复发性心血管事件的发生率，并评估 TNFi 对复发性心血管事件风险的影响。

方法

这是一项全国性的队列研究，使用了韩国国家索赔数据库的数据。从数据库中提取出在诊断出 r-axSpA 后有心血管事件史的 r-axSpA 患者的数据。感兴趣的结局是心血管事件（心肌梗死或中风）的复发。患者从索引日期（首次心血管事件发生日期）开始随访，直到发生心血管事件复发、最后一次索赔日期或 2021 年 12 月 31 日，以先到者为准。计算复发性心血管事件的发生率。采用逆概率加权 Cox 模型评估 TNFi 暴露对复发性心血管事件风险的影响。

结果

这项研究共纳入了 413 名患者（TNFi 未暴露组，n=338；TNFi 暴露组，n=75）。复发性心血管事件的发生率为 32（95%置信区间[CI] 22-42）/1000 人年（TNFi 未暴露组，36 [95% CI 24-48] /1000 人年；TNFi 暴露组，19 [95% CI 2-35] /1000 人年）。在逆概率加权 Cox 模型中，TNFi 暴露与复发性心血管事件的风险降低显著相关（风险比 0.33，95% CI 0.12-0.94）。