Oiegar Ruxandra, Pop Dana
4th Department of Internal Medicine, Department of Cardiology Rehabilitation, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
Doctoral School, "Iuliu Hațieganu" University of Medicine and Pharmacy, 400012 Cluj-Napoca, Romania.
J Clin Med. 2025 Sep 13;14(18):6461. doi: 10.3390/jcm14186461.
Rheumatoid arthritis (RA) is a chronic inflammatory disease characterized by inflammation of the synovium. The inflammation accelerates the development and progression of atherosclerosis, a key phenomenon in the onset of cardiovascular diseases. The aim of this review was to synthetize the traditional and RA-specific cardiovascular risk (CVR) factors and the CVR assessment guidelines in RA patients. We performed a PubMed search using specific keywords. We synthetized the main findings. Although the risk factors are the traditional ones, with certain particularities, the mechanisms that lead to cardiovascular disease are distinguished. In RA, the "lipid paradox" occurs: low levels of total cholesterol and low-density lipoprotein (LDL)-cholesterol, and high levels of high-density lipoprotein (HDL)-cholesterol. Despite this phenomenon, patients have an elevated risk of cardiovascular events. This is due to inflammation, which increases cholesterol catabolism and interferes with the anti-oxidant properties of HDL-cholesterol. There is a significant association between serum C-reactive protein (CRP) value and cardiovascular risk: each 20 mg/L increase in CRP causes a 1% increase in cardiovascular risk. The evaluation of the CVR through standard matrices undervalues the risk in patients with RA. Various approaches have been suggested to improve the accuracy of cardiovascular risk appraisal: from multiplying standard scores, including specific biomarkers, to modifying the impact of certain parameters in risk calculation. RA inflammatory and autoimmune mechanisms increase the cardiovascular morbidity and mortality in this group of patients. Therefore, this category of patients requires a proper cardiovascular (CV) evaluation. Carotid ultrasound ensures a better classification of RA patients, especially women, in the cardiovascular risk categories.
类风湿关节炎（RA）是一种以滑膜炎症为特征的慢性炎症性疾病。这种炎症会加速动脉粥样硬化的发展和进程，而动脉粥样硬化是心血管疾病发病的关键现象。本综述的目的是综合传统的和RA特有的心血管风险（CVR）因素以及RA患者的CVR评估指南。我们使用特定关键词在PubMed上进行了检索。我们综合了主要研究结果。尽管风险因素是传统的那些，但有某些特殊性，导致心血管疾病的机制是有区别的。在RA中会出现“脂质悖论”：总胆固醇和低密度脂蛋白（LDL）胆固醇水平低，而高密度脂蛋白（HDL）胆固醇水平高。尽管有这种现象，但患者发生心血管事件的风险却升高。这是由于炎症增加了胆固醇分解代谢并干扰了HDL胆固醇的抗氧化特性。血清C反应蛋白（CRP）值与心血管风险之间存在显著关联：CRP每升高20mg/L，心血管风险增加1%。通过标准指标评估CVR会低估RA患者的风险。已经提出了各种方法来提高心血管风险评估的准确性：从乘以标准分数（包括特定生物标志物）到改变某些参数在风险计算中的影响。RA的炎症和自身免疫机制增加了这组患者的心血管发病率和死亡率。因此，这类患者需要进行适当的心血管（CV）评估。颈动脉超声能更好地将RA患者（尤其是女性）分类到心血管风险类别中。
