类风湿关节炎的心血管风险

1、会计学1类风湿关节炎的心血管风险类风湿关节炎的心血管风险v类风湿关节炎类风湿关节炎(rheumatoid arthritis，RA)是一是一种导致关节功能障碍的慢性炎性疾病，病死率种导致关节功能障碍的慢性炎性疾病，病死率却明显高于普通人群。却明显高于普通人群。vRA增高的病死率很大部分归因于心血管疾病增高的病死率很大部分归因于心血管疾病( cardiovascular disease，CVD)。v近年来，越来越多的研究证明近年来，越来越多的研究证明RA患者心血管患者心血管事件发生率明显增高。事件发生率明显增高。vRA患者发生冠心病的风险比普通人群增加患者发生冠心病的风险比普通人群增加1.5到到

2、2倍，相似于糖尿病所增加的风险强度。倍，相似于糖尿病所增加的风险强度。v心血管病事件占心血管病事件占RA死因的死因的42，而且发生较，而且发生较早，使早，使RA患者生存期缩短患者生存期缩短515年年。v传统的心血管危险因素并不能完全解释传统的心血管危险因素并不能完全解释RA患患者心血管病变的高发情况者心血管病变的高发情况Avina-Zubieta JA et al, Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational stud

3、ies. Ann Rheum Dis. 2012 Sep;71(9):1524-9. vRA患者发生患者发生CVD的风险比普通人群增加的风险比普通人群增加1.5到到2倍，相似于糖尿病所增加的风险强度。倍，相似于糖尿病所增加的风险强度。v心血管事件心血管事件约占约占RA死因的死因的50，而且发生较，而且发生较早，使早，使RA患者生存期缩短患者生存期缩短515年年。传统传统危险危险因素因素动脉动脉粥样粥样硬化硬化治疗治疗药物药物影响影响运动减少运动减少高血压高血压吸烟吸烟胰岛素抵抗胰岛素抵抗和糖尿病和糖尿病血脂障碍血脂障碍肥胖肥胖传统危传统危险因素险因素Metsios GS et al. Asso

4、ciation of physical inactivity with increased cardiovascular risk in patients with rheumatoid arthritis. Eur J Cardiovasc Prev Rehabil. 2009 Apr;16(2):188-94.van den Oever IA et al. Management of cardiovascular risk in patients with rheumatoid arthritis: evidence and expert opinion. Ther Adv Musculo

5、skelet Dis. 2013 Aug;5(4):166-81. Vaudo G, et al. Endothelial dysfunction in young patients with rheumatoid arthritis and low disease activity. Ann Rheum Dis. 2004, 63:31-35.Rodrguez-Rodrguez L et al. Genetic markers of cardiovascular disease in rheumatoid arthritis. Mediators Inflamm. 2012;2012:574

6、817. Davis 3rd JM et al. Glucocorticoids and cardiovascular events in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 2007 Mar;56(3):820-30.Trelle S et al. Cardiovascular safety of non-steroidal anti-inflammatory drugs: network meta-analysis. BMJ. 2011 Jan 11;342:c7086. Goods

7、on NJ et al. Non-steroidal anti-inflammatory drug use does not appear to be associated with increased cardiovascular mortality in patients with inflammatory polyarthritis: results from a primary care based inception cohort of patients. Ann Rheum Dis. 2009 Mar;68(3):367-72.Micha R et al. Systematic r

8、eview and meta-analysis of methotrexate use and risk of cardiovascular disease. Am J Cardiol. 2011 Nov 1;108(9):1362-70. Barnabe C et al. Systematic review and meta-analysis: anti-tumor necrosis factor therapy and cardiovascular events in rheumatoid arthritis.Arthritis Care Res (Hoboken). 2011 Apr;6

9、3(4):522-9.Singh JA et al. Tocilizumab for rheumatoid arthritis: a Cochrane systematic review. J Rheumatol. 2011 Jan;38(1):10-20.Peters MJ et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010 Feb;69(2):325-31. Peters MJ et al. EULAR evidence-based recommendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflammatory arthritis. Ann Rheum Dis. 2010 Feb;69(2):325-31. 传统传统危险危险因素因素动脉动脉粥样粥样