腹部肥胖对类风湿关节炎心血管风险预测准确性的影响

George Karpouzas, Elizabeth Hernandez, Matthew Budoff, Sarah Ormseth
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引用次数: 0

摘要

目标。与超重或肥胖相比,体重过轻的类风湿关节炎患者的总死亡率和心血管死亡率更高。我们探讨了肥胖是否会混淆心血管风险评估,以及无创冠状动脉粥样硬化评估和心脏损伤生物标志物在优化类风湿关节炎肥胖患者风险预测中的潜在应用。方法。我们评估了150名接受冠状动脉计算机断层血管造影筛查动脉粥样硬化评估的参与者,随访时间超过6.0±2.4年。Framingham 2008改良一般心血管风险评分以基线计算。肥胖的定义是女性腰围为88厘米,男性腰围为102厘米。在基线时测定血清高敏感心肌肌钙蛋白I (hs-cTnI)和瘦素。结果。Framingham风险评分与肥胖在心血管风险方面存在交互作用(p=0.032);肥胖患者(曲线下面积-AUC 0.660, 95% CI 0.487-0.832)比非肥胖患者(AUC 0.952, 95% CI 0.897-1.007, p=0.002)的估计值更低。同样,高瘦素(>22.1 ng/ml)患者的风险估计低于低瘦素患者(AUC 0.618, 95% CI 0.393-0.842比0.874,95% CI 0.772-0.976, p=0.042)。在肥胖患者中,根据净重分类指数(1.093 95% CI 0.517-1.574)、综合区分改善(0.188,95% CI 0.060-0.526)和AUC (0.179, 95% CI 0.058-0.378, p=0.02)的变化,将最高的高敏感心肌肌钙蛋白I值和广泛的动脉粥样硬化斑块(>5段)信息依次添加到包括Framingham风险评分在内的基础模型中,显著改善了风险估计。最终的联合模型准确预测了83.9%的心血管事件。结论。肥胖降低类风湿关节炎患者心血管风险评估的准确性。采用无创评估冠状动脉粥样硬化负荷和血清心脏损伤生物标志物的风险优化可能值得进一步研究。
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The Influence of Abdominal Obesity on the Accuracy of Cardiovascular Risk Prediction in Rheumatoid Arthritis
Objectives. Underweight patients with rheumatoid arthritis incur greater total and cardiovascular mortality compared to overweight or obese. We explored whether obesity confounded cardiovascular risk estimates and the potential utility of noninvasive coronary atherosclerosis assessment and cardiac damage biomarkers in optimizing risk prediction in obese patients with rheumatoid arthritis. Methods. We evaluated 150 participants undergoing screening atherosclerosis evaluation with coronary computed tomography angiography and follow-up over 6.0±2.4 years. Framingham 2008 modified general cardiovascular risk score was computed at baseline. Obesity was defined as waist circumference >88 cm in females and >102 cm in males. Serum highly-sensitive cardiac troponin I (hs-cTnI) and leptin were measured at baseline. Results. An interaction between the Framingham risk score and obesity on cardiovascular risk was observed (p=0.032); lower estimates were seen in obese (area under the curve-AUC 0.660, 95% CI 0.487-0.832) vs. non-obese patients (AUC 0.952, 95% CI 0.897-1.007, p=0.002). Likewise, risk estimates were inferior in patients with high (>22.1 ng/ml) vs. low leptin (AUC 0.618, 95% CI 0.393-0.842 vs. 0.874, 95% CI 0.772-0.976, p=0.042). In obese patients, sequential addition of the top highly-sensitive cardiac troponin I tertile values and extensive atherosclerotic plaque (>5 segments) information to a base model including the Framingham risk score alone significantly improved risk estimates, based on changes in net reclassification index (1.093 95% CI 0.517-1.574), integrated discrimination improvement (0.188, 95% CI 0.060-0.526), and AUC (0.179, 95% CI 0.058-0.378, p=0.02). The final, combined model accurately predicted 83.9% of incident cardiovascular events. Conclusion. Obesity attenuated cardiovascular risk estimate accuracy in patients with rheumatoid arthritis. Risk optimization employing non-invasive assessment of coronary atherosclerosis burden and serum cardiac damage biomarkers may warrant further study.
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