Ann Rheum Dis:银屑病关节炎心血管风险呈上升趋势

2013-01-23 Ann Rheum Dis CMT Jane译

  荷兰的一项研究表明,在大多数研究中,银屑病关节炎(PsA)的心血管风险呈上升趋势,与类风湿关节炎心血管风险水平大致相当,故应强调这两种疾病相似的心血管风险管理的需要。还需进一步的研究去证实,炎症抑制或传统心血管风险因素修正,或两者兼而有之,是否能降低心血管发生风险。该论文发表在《风湿病年鉴》[Ann Rheum Dis 2013;72:211-216]。

  荷兰的一项研究表明,在大多数研究中,银屑病关节炎(PsA)的心血管风险呈上升趋势,与类风湿关节炎心血管风险水平大致相当,故应强调这两种疾病相似的心血管风险管理的需要。还需进一步的研究去证实,炎症抑制或传统心血管风险因素修正,或两者兼而有之,是否能降低心血管发生风险。该论文发表在《风湿病年鉴》[Ann Rheum Dis 2013;72:211-216]。

  该研究从Medline、 EMBASE 和 Cochrane检索了1966年1月至2011年4月有关PsA心血管疾病和心血管风险因素的英文文献资料。综述、病例报告和单纯银屑病研究都不纳入该研究。

  该研究共纳入28篇文章。全因死亡率的研究提示了不同的结果。这些有关心血管疾病的资料似乎更趋于一致,提示银屑病关节炎的心血管死亡率和患病率增加。与之相应的,亚临床动脉粥样硬化、动脉硬化和心血管风险因素如高血压、血脂异常、肥胖和与代谢相关的因素这些替代标记物在银屑病关节炎中比在对照组中更为突出。在一些(无)对照研究中,抑制炎症可能使心血管替代标记物如颈动脉内膜厚度和内皮功能障碍获益。


Cardiovascular comorbidities in patients with psoriatic arthritis: a systematic review

Objective 
Data regarding cardiovascular comorbidity and cardiovascular risk factors in patients with psoriatic arthritis (PsA) are limited. To evaluate the cardiovascular risk profile, a systematic literature search was performed to provide an extensive summary of all studies available on cardiovascular risk in PsA.
Methods 
Medline, EMBASE and the Cochrane library were searched from January 1966 to April 2011 for English language articles on data concerning cardiovascular diseases and cardiovascular risk factors in PsA. Review articles, case reports and studies on psoriasis alone were excluded.
Results 
Twenty-eight articles were included in this review. Studies on all-cause mortality revealed mixed results. Available data on cardiovascular disease appeared more consistent, indicating an increased cardiovascular mortality and morbidity in PsA. Commensurate with this, surrogate markers of subclinical atherosclerosis, arterial stiffness and cardiovascular risk factors, for example hypertension, dyslipidaemia, obesity and metabolic-related factors, were more prominent in PsA compared with controls. Suppression of inflammation was linked with a favourable effect on cardiovascular surrogate markers, for example carotid intima media thickness and endothelial dysfunction, in several (un)controlled studies.
Conclusion 
Most studies point towards an increased cardiovascular risk in PsA, broadly on a par with the risk level in rheumatoid arthritis, emphasising the need for similar cardiovascular risk management in both conditions. Further studies are needed to indicate whether inflammatory suppression or modification of traditional cardiovascular risk factors, or both, will reduce cardiovascular risk.

    

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