Popescu Diana, Badescu Minerva Codruta, Rezus Elena, Tanase Daniela Maria, Ouatu Anca, Dima Nicoleta, Buliga-Finis Oana-Nicoleta, Gosav Evelina Maria, Costin Damiana, Rezus Ciprian
Department of Internal Medicine, "Grigore T. Popa" University of Medicine and Pharmacy, 16 University Street, 700115 Iasi, Romania.
IIIrd Internal Medicine Clinic, "Saint Spiridon" County Emergency Clinical Hospital, 700111 Iasi, Romania.
J Clin Med. 2025 Aug 1;14(15):5433. doi: 10.3390/jcm14155433.
Despite therapeutic advances, morbidity and mortality remain high in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), primarily due to increased cardiovascular risk. Our study aimed to evaluate the cardiovascular risk profile and biomarker dynamics in patients with RA and PsA treated with Janus kinase inhibitors (JAKis). To our knowledge, this is the first study assessing Lp(a) levels in this context. This prospective, observational study assessed 48 adult patients. The follow-up period was 12 months. Traditional cardiovascular risk factors and biological markers, including lipid profile, lipoprotein(a) [Lp(a)], and uric acid (UA), were assessed at baseline and follow-up. Correlations between JAKi therapy, lipid profile changes, and cardiovascular risk factors were investigated. Cox regression analysis was used to identify predictors of non-major cardiovascular events. A strong positive correlation was observed between baseline and 12-month Lp(a) levels (r = 0.926), despite minor statistical shifts. No major cardiovascular events occurred during follow-up; however, 47.9% of patients experienced non-major cardiovascular events (e.g., uncontrolled arterial hypertension, exertional angina, and new-onset arrhythmias). Active smoking [hazard ratio (HR) 9.853, = 0.005], obesity (HR 3.7460, = 0.050), and arterial hypertension (HR 1.219, = 0.021) were independent predictors of these events. UA (HR 1.515, = 0.040) and total cholesterol (TC) (HR 1.019, = 0.034) were significant biochemical predictors as well. Elevated baseline Lp(a) combined with these factors was associated with an increased event rate, particularly after age 60. Traditional cardiovascular risk factors remain highly prevalent and predictive, underscoring the need for comprehensive cardiovascular risk management. Lp(a) remained stable and may serve as a complementary biomarker for risk stratification in JAKi-treated patients.
尽管治疗取得了进展，但类风湿关节炎（RA）和银屑病关节炎（PsA）患者的发病率和死亡率仍然很高，主要原因是心血管风险增加。我们的研究旨在评估接受Janus激酶抑制剂（JAKis）治疗的RA和PsA患者的心血管风险概况和生物标志物动态变化。据我们所知，这是首次在这种情况下评估脂蛋白（a）[Lp（a）]水平的研究。这项前瞻性观察性研究评估了48名成年患者。随访期为12个月。在基线和随访时评估了传统心血管危险因素和生物标志物，包括血脂谱、脂蛋白（a）[Lp（a）]和尿酸（UA）。研究了JAKi治疗、血脂谱变化和心血管危险因素之间的相关性。采用Cox回归分析确定非重大心血管事件的预测因素。尽管有微小的统计学变化，但在基线和12个月时的Lp（a）水平之间观察到强正相关（r = 0.926）。随访期间未发生重大心血管事件；然而，47.9%的患者经历了非重大心血管事件（如未控制的动脉高血压、劳力性心绞痛和新发心律失常）。主动吸烟[风险比（HR）9.853，P = 0.005]、肥胖（HR 3.7460，P = 0.050）和动脉高血压（HR 1.219，P = 0.021）是这些事件的独立预测因素。UA（HR 1.515，P = 0.040）和总胆固醇（TC）（HR 1.019，P = 0.034）也是重要的生化预测因素。基线Lp（a）升高与这些因素相结合与事件发生率增加相关，尤其是在60岁以后。传统心血管危险因素仍然非常普遍且具有预测性，这突出了全面心血管风险管理的必要性。Lp（a）保持稳定，可作为JAKi治疗患者风险分层的补充生物标志物。
