纽约（路透社 健康）12月22日—据一项最新研究表明，心血管疾病患病率和其风险因素在类风湿性关节炎（RA），银屑病关节炎（PsA）及强直性脊柱炎（AS）患者中较非自身免疫性疾病患者高。研究结果发表于《风湿病学》杂志11月期上。
横断面调查研究中，宾夕法尼亚州Malvern Centocor公司Chenglong Han博士及其同事们对RA、PsA和AS患者及对照组患者心血管疾病患病率和风险因素进行比较。研究人员对符合RA，PsA和AS标准的患者（2001年1月1日—2002年12月31日期间持续对其预后进行登记）的数据进行评估。对照组以年龄、性别、地理位置及实验时间长度为基础同每一疾病（RA、PsA及AS）患者组进行配对。
研究者计算年龄及性别校正的心血管并发症患病率及风险因素。他们对患者组并发症患病率及风险因素同对照组进行比较。心血管药物应用在两者间进行比较。结果：28208名受试者患有RA，3066名受试者患有PsA，1843名患者患有AS。这些组中患者的平均年龄分别为51.9、49.7和47.3岁。同对照组相比，RA、PsA及AS患者有更高的缺血性心脏疾病发病率（分别为1.5，1.3，1.2），动脉粥样硬化发病率（分别为1.9，1.4，1.5），外周血管疾病（分别为2.4，1.6，1.6），充血性心力衰竭（分别为2.0，1.5，1.8），脑血管疾病（1.6，1.3，1.7），2型糖尿病（分别为1.4，1.5，1.2），高脂血症（分别为1.2，1.2，1.2）及高血压（分别为1.3，1.3，1.3）。RA、PsA及AS患者中， ACEI、钙通道阻滞剂、利尿剂、硝酸盐/血管扩张剂、抗凝剂及抗高血脂药的用量显著高于对照组患者。
“补充的证据进一步表明，心血管疾病可能是AS和PsA患者中的严重问题，”来自于曼彻斯特大学Tracey Farragher和Ian Bruce博士在一篇社论中提到。“需要设计完善的前瞻性实验进一步验证PsA和AS患者心血管疾病风险增高是否主要由传统的风险因素、慢性炎症或治疗干预引起。”
Cardiovascular Diseases More Common in Those With Autoimmune Disorders
NEW YORK (Reuters Health) Dec 22 - The prevalence of cardiovascular diseases and their risk factors is higher in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) than in subjects without these disorders, according to a new study.
In a cross-sectional study, Dr. Chenglong Han, of Centocor, Inc., Malvern, Pennsylvania, and colleagues compared the prevalence of cardiovascular diseases and their risk factors between patients with RA, PsA and AS and control subjects. The researchers evaluated data for patients continuously enrolled in an integrated outcomes database between January 1, 2001, and December 31, 2002, who met the criteria for RA, PsA, and AS. Control groups were matched for each patient group (1:4 ratio) on the basis of age, sex, geographic region, and length of time on plan.
The researchers calculated age- and sex-adjusted prevalence of cardiovascular comorbidities and risk factors. They estimated the prevalence of the comorbidities and risk factors for the patients groups compared with the control groups. The use of cardiovascular medications was compared between the groups. Results of the study are published in the November issue of the Journal of Rheumatology.
Overall, 28,208 subjects had RA, 3066 had PsA, and 1843 had AS. The mean ages of patients in these groups were 51.9, 49.7, and 47.3 years, respectively. Compared to controls, patients with RA, PsA, and AS had higher prevalence ratios of ischemic heart disease (1.5, 1.3, 1.2), atherosclerosis (1.9, 1.4, 1.5), peripheral vascular disease (2.4, 1.6, 1.6), congestive heart failure (2.0, 1.5, 1.8), cerebrovascular disease (1.6, 1.3, 1.7), type 2 diabetes (1.4, 1.5, 1.2), hyperlipidemia (1.2, 1.2, 1.2), and hypertension (1.3, 1.3, 1.3).
"In patients with RA, PsA, and AS, use of ACE inhibitors, calcium channel blockers, diuretics, nitrates/vasodilators, anticoagulants, and antihyperlipidemia agents was significantly higher in patients than control groups," Dr. Han's team writes.
The study "adds to the evidence that cardiovascular disease may well be a significant problem in AS and PsA," write Drs. Tracey Farragher and Ian Bruce, of the University of Manchester, in an accompanying editorial. "Well-designed prospective studies are now needed to confirm whether increased risk of cardiovascular disease in PsA and AS is primarily driven by traditional risk factors, chronic inflammation, or the consequences of treatment."
J Rheumatol 2006;33:2167-2172.
http://www.medscape.com/viewarticle/549840
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