Abstract
The objective was to evaluate the frequency of cardiovascular risk factors and hypertension in patients with rheumatoid arthritis depending on body weight. The study involved 100 patients with rheumatoid arthritis and stably selected therapy for more than 6 months at the age from 45 to 65 years (mean age 53,19 ± 5,40 years). Traditional cardiovascular risk was assessed, taking into account risk factors by SCORE scale and amended for patients with RA. The levels of total cholesterol, triglycerides, C-reactive protein, serum creatinine, body mass index, body area index were determined. Arterial hypertension was diagnosed in 41 (41%) patients with rheumatoid arthritis and was associated with traditional risk factors (age, obesity), rheumatoid factor, hyperuricemia and the duration of glucocorticoid therapy. Obesity and excess body mass occurred in the majority of patients with rheumatoid arthritis, herewith the highest level of inflammation indicators and risk of cardiovascular events was in overweight patients. Obesity was associated with duration of rheumatoid arthritis, the activity of the inflammatory process, the duration of glucocorticoids taking. It is found that the traditional SCORE scale does not fully reflect the risk of cardiovascular events in rheumatoid arthritis. Identification of hypertension and obesity increases the information content of the risk assessment of cardiovascular events in rheumatoid arthritis.
Highlights
Ɋɚɡɨɦ ɿɡ ɩɨɞɨɜɠɟɧɧɹɦ ɬɪɢɜɚɥɨɫɬɿ ɠɢɬɬɹ ɯɜɨɪɢɯ ɧɚ ɊȺ ɜɿɞɛɭɥɚɫɹ ɣ ɡɦɿɧɚ ɫɬɪɭɤɬɭɪɢ ɫɦɟɪɬɧɨɫɬɿ ɰɢɯ ɩɚɰɿɽɧɬɿɜ
ɊȿɁɍɅɖɌȺɌɂ ɌȺ Ȳɏ ɈȻȽɈȼɈɊȿɇɇə Ⱥɪɬɟɪɿɚɥɶɧɭ ɝɿɩɟɪɬɟɧɡɿɸ ɞɿɚɝɧɨɫɬɨɜɚɧɨ ɭ 41 ɯɜɨɪɨɝɨ ɧɚ ɊȺ (41%), ɡ ɧɢɯ ɭ 8 ɯɜɨɪɢɯ (19,51%) – ȱ ɫɬɚɞɿʀ, ɭ 33 (80,49%) – ȱȱ ɫɬɚɞɿʀ. ȱ ɫɬɭɩɿɧɶ ȺȽ ɜɫɬɚɧɨɜɥɟɧɢɣ ɭ 10 (24,39%) ɩɚɰɿɽɧɬɿɜ, ȱȱ ɫɬɭɩɿɧɶ – ɭ 26 (63,41%), ȱȱȱ ɫɬɭɩɿɧɶ – ɭ 5 (12,20%) ɯɜɨɪɢɯ. ɍ ɝɪɭɩɿ ɩɚɰɿɽɧɬɿɜ ɡ ɊȺ ɜ ɩɨɽɞɧɚɧɧɿ ɡ ȺȽ ɩɨɤɚɡɧɢɤ ɋȺɌ ɜ ɫɟɪɟɞɧɶɨɦɭ ɫɬɚɧɨɜɢɜ 142,8±16,5 ɦɦ ɪɬ. ɫɬ., ȾȺɌ – 85,73±9,25 ɦɦ ɪɬ. ɫɬ., ɭ ɝɪɭɩɿ ɯɜɨɪɢɯ ɧɚ ɊȺ ɛɟɡ ɫɭɩɭɬɧɶɨʀ ȺȽ – 120,34±10,99 ɬɚ 74,4±7,2 ɦɦ ɪɬ. ɫɬ. ɜɿɞɩɨɜɿɞɧɨ. ɑɚɫɬɨɬɚ ɜɢɹɜɥɟɧɧɹ ȺȽ ɧɟ ɡɚɥɟɠɚɥɚ ɜɿɞ ɬɪɢɜɚɥɨɫɬɿ ɊȺ (ɪ=0,23)
Ⱥɪɬɟɪɿɚɥɶɧɚ ɝɿɩɟɪɬɟɧɡɿɹ ɜɫɬɚɧɨɜɥɟɧɚ ɭ 41 (41%) ɯɜɨɪɨɝɨ ɧɚ ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ ɬɚ ɚɫɨɰɿɸɜɚɥɚɫɶ ɿɡ ɬɪɚɞɢɰɿɣɧɢɦɢ ɮɚɤɬɨɪɚɦɢ ɪɢɡɢɤɭ, ɫɟɪɨɩɨɡɢɬɢɜɧɿɫɬɸ ɡɚ ɪɟɜɦɚɬɨʀɞɧɢɦ ɮɚɤɬɨɪɨɦ, ɝɿɩɟɪɭɪɿɤɟɦɿɽɸ ɬɚ ɬɪɢɜɚɥɿɫɬɸ ɩɪɢɣɨɦɭ ɝɥɸɤɨɤɨɪɬɢɤɨʀɞɿɜ. 10-ɪɿɱɧɢɣ ɪɢɡɢɤ ɮɚɬɚɥɶɧɢɯ ɫɟɪɰɟɜɨɫɭɞɢɧɧɢɯ ɩɨɞɿɣ ɡɚ ɲɤɚɥɨɸ SCORE ɭ ɯɜɨɪɢɯ ɧɚ ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ ɫɬɚɧɨɜɢɜ 1,48±1,94%, ɡ ɭɪɚɯɭɜɚɧɧɹɦ ɤɨɟɮɿɰɿɽɧɬɭ 1,5 – 1,98±2,53%, ɳɨ ɜɜɚɠɚɽɬɶɫɹ ɫɟɪɟɞɧɿɦ ɪɿɜɧɟɦ ɪɢɡɢɤɭ
Summary
Ɋɚɡɨɦ ɿɡ ɩɨɞɨɜɠɟɧɧɹɦ ɬɪɢɜɚɥɨɫɬɿ ɠɢɬɬɹ ɯɜɨɪɢɯ ɧɚ ɊȺ ɜɿɞɛɭɥɚɫɹ ɣ ɡɦɿɧɚ ɫɬɪɭɤɬɭɪɢ ɫɦɟɪɬɧɨɫɬɿ ɰɢɯ ɩɚɰɿɽɧɬɿɜ. Ɇɟɬɚ ɞɨɫɥɿɞɠɟɧɧɹ – ɨɰɿɧɢɬɢ ɱɚɫɬɨɬɭ ɮɚɤɬɨɪɿɜ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɡɢɤɭ ɬɚ ɚɪɬɟɪɿɚɥɶɧɨʀ ɝɿɩɟɪɬɟɧɡɿʀ ɭ ɯɜɨɪɢɯ ɧɚ ɪɟɜɦɚɬɨʀɞɧɢɣ ɚɪɬɪɢɬ ɡɚɥɟɠɧɨ ɜɿɞ ɦɚɫɢ ɬɿɥɚ. Ɉɪɢ ɚɧɚɥɿɡɿ ɪɨɡɩɨɜɫɸɞɠɟɧɨɫɬɿ ɮɚɤɬɨɪɿɜ ɤɚɪɞɿɨɜɚɫɤɭɥɹɪɧɨɝɨ ɪɢɡɢɤɭ ɭ ɯɜɨɪɢɯ ɧɚ ɊȺ ɡɚɥɟɠɧɨ ɜɿɞ ɧɚɹɜɧɨɫɬɿ ȺȽ ɜɫɬɚɧɨɜɥɟɧɿ ɞɨɫɬɨɜɿɪɧɿ ɜɿɞɦɿɧɧɨɫɬɿ ɦɿɠ ɝɪɭɩɚɦɢ ɡɚ ɜɿɤɨɦ (ɪ=0,01), ɪɿɜɧɟɦ ɪɟɜɦɚɬɨʀɞɧɨɝɨ ɮɚɤɬɨɪɭ (ɪ=0,04) ɬɚ ɫɟɱɨɜɨʀ ɤɢɫɥɨɬɢ (ɪ=0,001).
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