类风湿性关节炎(RA)的死亡率比普通人群高1,3至3倍,心血管死亡率占病例的40-50%。目前,心血管疾病被认为是RA的关节外表现(OR:1,5-4,0).超声测量颈总动脉的内中膜厚度(IMT)和动脉粥样硬化斑块(AP)的存在是一种非侵入性方法,是亚临床动脉硬化的替代标志物。
目的:确定通过颈动脉超声检查发现的亚临床动脉硬化是否可以作为RA患者10年后心血管事件(CVE)发展的良好预测指标。
方法:对2013年在CastillaLaMancha某医院风湿病门诊就诊的一组RA患者进行了评估。对未来10年CVE的发展进行了前瞻性评估,并分析其与既往IMT和AP超声检查结果的相关性。
结果:8例(24%)患者出现CVE。三人(9%)有心力衰竭,三人(9%)中风,2例(6%)急性心肌梗死。与无CV并发症的RA患者(0,74+/-0.15mm)相比,出现CVE的RA患者具有更高的IMT(0,97+/-0.08mm)(p=0,003)。存在IMT≥0.9mm和AP的相对风险为12,25(p=0,012)和18,66(p=0,003),分别,用于开发CVE。
结论:RA患者的颈动脉超声可以在CVE发展之前早期发现亚临床动脉粥样硬化,IMT≥0.9mm是与CVE最密切相关的发现,不受年龄的影响。
Rheumatoid Arthritis (RA) has a mortality rate 1,3 to 3 times higher than the general population, with cardiovascular mortality accounting for 40-50% of cases. Currently, cardiovascular disease is considered an extraarticular manifestation of RA (OR: 1,5-4,0). Ultrasound measurement of the intima-media thickness (IMT) of the common carotid artery and the presence of atherosclerotic plaques (AP) is a non-invasive method and a surrogate marker of subclinical arteriosclerosis.
OBJECTIVE: To determine if subclinical arteriosclerosis findings through carotid ultrasound can serve as a good predictor of cardiovascular events (CVE) development in a cohort of RA patients over a 10-year period.
METHODS: A cohort of RA patients seen in the Rheumatology outpatient clinic of a hospital in Castilla La Mancha in 2013 was evaluated. A prospective evaluation for the development of CVE over the following 10 years was conducted, and its correlation with previous ultrasound findings of IMT and AP was analyzed.
RESULTS: Eight (24%) patients experienced a CVE. Three (9%) had heart failure, three (9%) had a stroke, and two (6%) experienced acute myocardial infarction. RA patients who developed a CVE had a higher IMT (0,97 +/- 0.08 mm) compared to the RA patients without CV complications (0,74 +/- 0.15 mm) (p = 0,003). The presence of IMT ≥ 0.9 mm and AP had a relative risk of 12,25 (p = 0,012) and 18,66 (p = 0,003), respectively, for the development of a CVE.
CONCLUSIONS: Carotid ultrasound in RA patients may allow for early detection of subclinical atherosclerosis before the development of CVE, with IMT ≥ 0.9 mm being the most closely associated finding with CVE, unaffected by age.