Cardiovascular risk factors in patients with axial spondyloarthritis


DOI: https://dx.doi.org/10.18565/therapy.2019.8.81-88

Vasilenko E.А., Gaydukova I.Z., Samigullina R.R., Dadalova A.M., Mazurov V.I.

I. I. Mechnikov North-Western State Medical University, St. Petersburg
The aim of the study was to assess of cardiovascular risk (CVR) in patients with axial spondyloarthritis (axSpA), fulfilling ASAS criteria (2009), and to compare different CVR scales (Reynolds Risk Score, QRISK3, SCORE).
Material and methods. The study included 124 patients with axSpA, at the age of 25–84. Cardiovascular risks were compared using the RRS (Reynolds Risk Score), QRISK3, SCORE.
Results. Three indices of cardiovascular risk (CVR) evaluation (indices of SCORE, Reynolds Risk Score, QRISK3) were used for evaluation. Patients with AxSpa at the age 45–65 years had a high and very high risk. Abnormal risk was found in 14, 65 and 69% of patients, respectively. Of the 46 patients examined in the age cohort from 25 to 40 years old, 14 patients (30,4%) had increased risks on the QRISK3 scale. That revealed a discrepancy between the degrees of risk between the SCORE and QRISK3 indices in 83,72.
Conclusion. When evaluating the CVR in patients with axial spondyloarthritis, there was a discrepancy in the severity of CVR calculated using different rating scales. The SCORE scale showed the lowest cardiovascular risk, the QRISK3 scale showed the greatest. 30,4% of patients with AxSpa had increased risks according to the QRISK3 scale already at the age of 25–40 years. Of the modifiable risk factors – smoking, obesity and arterial hypertension are most important.
Keywords: cardiovascular risk, axial spondyloarthritis, prevention of cardiovascular disease, SCORE, Reynolds Risk Score, QRISK
Read entire article

Literature


  1. Avina-Zubieta J.A., Thomas J., Sadatsafavi M. et al. Risk of incident cardiovascular events in patients with rheumatoid arthritis: a meta-analysis of observational studies. Ann Rheum Dis. 2012; 71(9): 1524–29. doi: 10.1136/annrheumdis-2011-200726.

  2. Lopez-Medina C., Jimenez-Gomez Y., Molto A. et al. Cardiovascular risk factors in patients with spondyloarthritis from Northern European and Mediterranean countries: an ancillary study of the ASAS-COMOSPA project. Joint Bone Spine. 2018; 5(4): 447–53. doi: 10.1016/j.jbspin.2017.07.006.

  3. Ребров А.П., Гайдукова И.З., Поддубный Д.А. Кардиоваскулярная патология у больных анкилозирующим спондилитом. Научно-практическая ревматология. 2012; 50(2): 100–05. doi: https://doi.org/10.14412/1995-4484-2012-1281.

  4. Кардиоваскулярная профилактика-2017. Российские национальные рекомендации. Российский кардиологический журнал. 2018; 6: 7–122. doi: https://doi.org/10.15829/1560-4071-2018-6-7-122.

  5. Оганов Р.Г., Мамедов М.Н. Национальные клинические рекомендации. В кн. Всероссийское научное общество кардиологов. Под. ред. Киселевой Н.В. Москва: МЕДИ Экспо. 2009; 8–11.

  6. Lloyd-Jones D., Adams R., Carnethon M. et al. Heart disease and stroke statistics – 2009 update: a report from the American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Circulation 2009; 119(3): 21–181. doi: https://doi.org/10.1161/CIRCULATIONAHA.108.191261.

  7. Брошюра регистра «Гиперион». Гипертоническая болезнь в условиях реальной клинической практики, приверженность к свободным и фиксированным комбинациям препаратов. Версия 1.1 от 29 июня 2016 г. Евразийская ассоциация терапевтов. Москва. 2016; 1 –12.

  8. Европейские рекомендации по профилактике сердечно-сосудистых заболеваний в клинической практике (пересмотр 2016 г.). Российский кардиологический журнал. 2017; 6(146): 7–85. doi:10.1093/eurheartj/ehw106.

  9. Sieper J., Rudwaleit M., Baraliakos X. et al. The Assessment of SpondyloArthritis international Society (ASAS) handbook: a guide to assess spondyloarthritis. Ann Rheum Dis. 2009; 68: 1–44. doi: 10.1136/ard.2008.104018.

  10. Lukas C., Landewe R., Sieper J. et al. Development of an ASAS-endorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis. 2009; 68: 18–24. doi: 10.1136/ard.2008.094870.

  11. Garrett S., Jenkinson T., Kennedy L.G. et al. A new approach to defining disease status in ankylosing spondylitis: the Bath Ankylosing Spondylitis Disease Activity Index. J Rheumatol. 1994; 21(12): 2286–91. PMid: 7699630.

  12. Machado P.M., Landewe R., van der Heijde D.V. Assessment of SpondyloArthritis international Society (ASAS). Ankylosing Spondylitis Disease Activity Score (ASDAS): 2018 update of the nomenclature for disease activity states. Annals of Rheumatic Diseases. 2018; 77(10): 1539–40. doi: 10.1136/annrheumdis-2018-213184.

  13. Бродская Т.А., Невзорова В.А., Репина Н.И. с соавт. Вопросы оценки сердечно-сосудистого риска в зависимости от этнической принадлежности и поражения органов-мишеней. Кардиоваскулярная терапия и профилактика. 2017; 16(4): 94. doi: https://doi.org/10.15829/1728-8800-2017-4-93-99.

  14. Conroy R.M., Pyorala K., Fitzgerald A.P. et al. Estimation of ten-year risk of fatal cardiovascular disease in Europe: the SCORE project. European Heart Journal. 2003; 24(11): 987–1003. doi: https://doi.org/10.1016/S0195-668X(03)00114-3

  15. The top 10 causes of death. World Health Organization. 2018. http://www.who.int/en/news-room/fact-sheets/detail/the-top-10-causes-of-death

  16. Ridker P.M., Paynter N.P., Rifai N. et al. C-reactive protein and parental history improve global cardiovascular risk prediction: the Reynolds Risk Score for men. Circulation. 2008; 118(22): 2243–51. doi: 10.1161/CIRCULATIONAHA.108.814251.

  17. Gonzalez-Gay M.A., Gonzalez-Juanatey C., Pineiro A. et al. High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis. J Rheumatol. 2005; 32(7): 1219–23. PMid: 15996055.

  18. Каратеев А.Е., Насонов Е.Л., Ивашкин В.Т. с соавт. Клинические рекомендации «Рациональное применение нестероидных противовоспалительных препаратов (НПВП) в клинической практике». Современная ревматология. 2015; 9(1): 4–23. doi: https://doi.org/10.14412/1996-7012-2015-1-4-23.

  19. Garcia Rodriguez L., Varas-Lorenz C., Maguire A. et al. Nonsteroidal anti-inflammatory drugs and the risk of myocardial infarction in the general population. Circulation. 2004; 109(24): 3000–06. doi: 10.1161/01.CIR.0000132491.96623.04.

  20. Scott P., Kingsley G., Scott D. Non-steroidal anti-inflammatory drugs and cardiac failure: meta-analyses of observational studies and randomised controlled trials. Eur J Heart Fail. 2008; 10(11): 1102–07. doi: 10.1016/j.ejheart.2008.07.013.

  21. Arts E.E., Popa C., Den Broeder A.A. et al. Performance of four current risk algorithms in predicting cardiovascular events in patients with early rheumatoid arthritis. Ann Rheum Dis. 2015; 74(4): 668–74. doi: 10.1136/annrheumdis-2013-204024.

  22. Eder L., Chandran V., Gladman D.D. The Framingham Risk Score underestimates the extent of subclinical atherosclerosis in patients with psoriatic disease. Ann Rheum Dis. 2014; 73(11): 1990–96. doi: 10.1136/annrheumdis-2013-203433.

  23. Lee C.J., Park S. The role of carotid ultrasound for cardiovascular risk stratification beyond traditional risk factors. Yonsei Med J. 2014; 55(3): 551–57. doi: 10.3349/ymj.2014.55.3.551.

  24. Гайдукова И.З., Ребров А.П., Оттева Э.Н. с соавт. Применение нестроидных противовоспалительных препаратов для лечения аксиальных спондилоартритов, включая анкилозирующий спондилит, мониторинг эффективности и безопасности (проект рекомендаций группы экспертов по диагностике и лечению спондилоартритов). Научно-практическая ревматология. 2016; 54(1S): 67–74. doi: https://doi.org/10.14412/1995-4484-2016-1S-67-74.

  25. Апаркина А.В., Акулова А.И., Спицына М.Ю. с соавт. Сбор субъективной информации у пациентов со спондилоартритами: современные реалии и перспективы. Бюллетень медицинских интернет-конференций. 2013; 3(2): 144–45. doi: 10.18821/0023-2149-2016-94-4-279-285.

  26. Гайдукова И.З., Ребров А.П., Полянская О.Л. с соавт. Длительное применение нимесулида в реальной клинической практике: вопросы безопасности. Русский медицинский журнал. Медицинское образование. 2013; 21(9): 433–37.

  27. Гайдукова И.З., Ребров А.П., Нам И.Ф. с соавт. Эторикоксиб в лечении активного сакроилиита у больных аксиальными спондилоартритами, включая анкилозирующий спондилит. Терапевтический архив. 2014; 86(12): 42–47. doi: 10.17116/terarkh2014861242-47.


About the Autors

Elizaveta A. Vasilenko, postgraduate student of the Department of therapy, rheumatology, temporary incapacity expertise and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya Str.
Tel.: +7 (921) 416-51-67. E-mail: md.vasilenkoea@gmail.com. ORCID ID https://orcid.org/0000-0003-2153-5429
Inna Z. Gaydukova, MD, professor of the Department of therapy, rheumatology, temporary incapacity and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia. Address: 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (903) 329-03-59.
E-mail: ubp1976@list.ru. ORCID ID https://orcid.org/0000-0003-3500-7256
Ruzana R. Samigullina, assistant of the Department of therapy, rheumatology, temporary incapacity and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia. Address: 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (981) 896-24-44.
E-mail: dr.samigullina@yandex.ru. ORCID ID https://orcid.org/0000-0002-6341-3334
Anna M. Dadalova, postgraduate student of the Department of therapy, rheumatology, temporary incapacity expertise and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia. Address: 191015, Saint Petersburg, 41 Kirochnaya Str. Tel.: +7 (981) 700-91-06. E-mail: dadalova-anna@mail.ru. ORCID ID https://orcid.org/0000-0001-5656-2916
Vadim I. Mazurov, MD, professor, head of St. Petersburg Center of autoimmune disease, Chief scientific adviser of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia, head of the Department of therapy, rheumatology, temporary incapacity and medical care quality expertise named after E.E. Eichwald of I.I. Mechnikov North-Western State medical University of the Ministry of Healthcare of Russia, Honoured worker of science of Russia, Academician RAS. Address: 191015, St. Petersburg, 41 Kirochnaya Str. Tel.: +7 (921) 951-71-88. E-mail: maz.nwgmu@yandex.ru. ORCID ID https://orcid.org/0000-0002-0797-2051.

Back to Content

Бионика Медиа