類風(fēng)濕關(guān)節(jié)炎的心血管風(fēng)險

1、會計學(xué)1類風(fēng)濕關(guān)節(jié)炎的心血管風(fēng)險類風(fēng)濕關(guān)節(jié)炎的心血管風(fēng)險v類風(fēng)濕關(guān)節(jié)炎類風(fēng)濕關(guān)節(jié)炎(rheumatoid arthritis，RA)是一是一種導(dǎo)致關(guān)節(jié)功能障礙的慢性炎性疾病，病死率種導(dǎo)致關(guān)節(jié)功能障礙的慢性炎性疾病，病死率卻明顯高于普通人群。卻明顯高于普通人群。vRA增高的病死率很大部分歸因于心血管疾病增高的病死率很大部分歸因于心血管疾病( cardiovascular disease，CVD)。v近年來，越來越多的研究證明近年來，越來越多的研究證明RA患者心血管患者心血管事件發(fā)生率明顯增高。事件發(fā)生率明顯增高。vRA患者發(fā)生冠心病的風(fēng)險比普通人群增加患者發(fā)生冠心病的風(fēng)險比普通人群增加1.5到到

2、2倍，相似于糖尿病所增加的風(fēng)險強度。倍，相似于糖尿病所增加的風(fēng)險強度。v心血管病事件占心血管病事件占RA死因的死因的42，而且發(fā)生較，而且發(fā)生較早，使早，使RA患者生存期縮短患者生存期縮短515年年。v傳統(tǒng)的心血管危險因素并不能完全解釋傳統(tǒng)的心血管危險因素并不能完全解釋RA患患者心血管病變的高發(fā)情況者心血管病變的高發(fā)情況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患者發(fā)生患者發(fā)生CVD的風(fēng)險比普通人群增加的風(fēng)險比普通人群增加1.5到到2倍，相似于糖尿病所增加的風(fēng)險強度。倍，相似于糖尿病所增加的風(fēng)險強度。v心血管事件心血管事件約占約占RA死因的死因的50，而且發(fā)生較，而且發(fā)生較早，使早，使RA患者生存期縮短患者生存期縮短515年年。傳統(tǒng)傳統(tǒng)危險危險因素因素動脈動脈粥樣粥樣硬化硬化治療治療藥物藥物影響影響運動減少運動減少高血壓高血壓吸煙吸煙胰島素抵抗胰島素抵抗和糖尿病和糖尿病血脂障礙血脂障礙肥胖肥胖傳統(tǒng)危傳統(tǒng)危險因素險因素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. 傳統(tǒng)傳統(tǒng)危險危險因素因素動脈動脈粥樣粥樣