rspНаучно-практическая ревматологияRheumatology Science and Practice1995-44841995-4492IMA-PRESS, LLC10.14412/1995-4484-2018-184-188rsp-2523Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL RESEARCHРаспространенностьтрадиционных кардиоваскулярных факторов риска, субклинического атеросклероза сонных артерий, коронарного кальциноза упациентов сранним псориатическим артритом (исследование РЕМАРКА)THE PREVALENCE OF TRADITIONAL CARDIOVASCULAR RISK FACTORS, SUBCLINICAL CAROTID ATHEROSCLEROSIS, CORONARY ARTERY CALCIFICATION IN PATIENTS WITH EARLY PSORIATIC ARTHRITIS (A REMARCA STUDYМаркеловаЕ. И.MarkelovaE. I.

Евгения Иннокентьевна Маркелова.

115522, Москва, Каширское шоссе, 34А

Evgenia Markelova.

34A, Kashirskoe Shosse, Moscow 115522

evgeniai.m@yandex.ruНовиковаД. С.NovikovaD. S.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

КоротаеваТ. В.KorotaevaT. V.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ЛогиноваЕ. Ю.LoginovaE. Yu.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

КирилловаИ. Г.KirillovaI. G.

115522, Москва, Каширское шоссе, 34А

34A, Kashirskoe Shosse, Moscow 115522

ФГБНУ Научноисследовательский институт ревматологии им. В.А. НасоновойРоссияV.A.Nasonova Research Institute of RheumatologyRussian Federation201808052018562184188Copyright © Маркелова Е.И., Новикова Д.С., Коротаева Т.В., Логинова Е.Ю., Кириллова И.Г., 20182018Маркелова Е.И., Новикова Д.С., Коротаева Т.В., Логинова Е.Ю., Кириллова И.Г.Markelova E.I., Novikova D.S., Korotaeva T.V., Loginova E.Y., Kirillova I.G.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://rsp.mediar-press.net/rsp/article/view/2523

Сердечно-сосудистые осложнения (ССО) являются одной из самых распространенных причин смерти пациентов с псориатическим артритом (ПсА). Увеличение риска ССО при ПсА обусловлено сочетанием традиционных факторов риска (ТФР) сердечно-сосудистых заболеваний (ССЗ) и едиными иммуновоспалительными механизмами, лежащими в основе ПсА и атеросклероза.

Цель исследования – оценить распространенность ТФР ССЗ, субклинического атеросклероза, коронарного кальциноза у молодых больных ранним периферическим ПсА.

Материал и методы

Материал и методы. В исследование включено 25 больных ранним ПсА (13 мужчин, 12 женщин), принимавших участие в исследовании РЕМАРКА. Медиана возраста – 36 [27; 46] лет, длительности ПсА – 5 [3; 7] мес, длительности ПС – 13 [9; 84] мес, DAS – 3,8 [3,4; 5,4]. Всем больным проведена оценка ТФР ССЗ, выполнена ультразвуковая допплерография (УЗДГ) сонных артерий (СА), оценка кальциноза коронарных артерий (ККА) с использованием мультиспиральной компьютерной томографии (МСКТ), эхокардографии (ЭхоКГ), суточное мониторирование артериального давления (СМАД).

Результаты и обсуждение

Результаты и обсуждение. У больных ранним ПсА выявлены следующие ТФР ССЗ: артериальная гипертензия – у 11 (44%), абдоминальное ожирение – у 14 (56%), курение – у 16 (64%), отягощенная наследственность по ССЗ – у 6 (24%), менопауза – у 5 (20%), дислипидемия – у 14 (56%) человек. Один ТФР у выявлен у 7 (28%), два – у 6 (24%), три – у 2 (8%), четыре – у 4 (16%), пять – у 6 (24%) человек. Сочетание трех и более ТФР ССЗ обнаружено у 12 (48%) пациентов.

По результатам расчета десятилетнего суммарного коронарного риска (по шкале SCORE) к группе низкого риска отнесено 17 (68%), умеренного – 6 (24%), высокого – 1 (4%), очень высокого – 1 (4%) человек с острым нарушением мозгового кровообращения в анамнезе. Анализ связи между активностью ПсА и уровнем суммарного коронарного риска (по шкале SCORE) не выявил достоверных различий. Так, у пациентов с умеренной активностью ПсА низкий коронарный риск встречался в 7 (70%), умеренный – в 2 (20%), высокий – в 1 (10%) случае. У пациентов с высокой активностью ПсА низкий коронарный риск встречался в 10 (66,7%), умеренный – в 4 (26,6%), очень высокий риск – в 1 (6,7%) случае. При проведении УЗДГ СА атеросклеротические бляшки (АТБ) выявлены у 8 (32%), увеличение толщины комплекса интима–медиа (ТКИМ) >0,9 мм – также у 8 (32%) больных. По данным МСКТ, признаки ККА были у 4 (16%) пациентов.

Обнаружена корреляция значений ТКИМ с уровнями липопротеидов низкой плотности (R=0,48; p=0,03), общего холестерина (R=0,53; p=0,01), систолическим артериальным давлением (R=0,59; p=0,02), наличием абдоминального ожирения (R=0,64; p=0,001); обратная связь между уровнем липопротеидов высокой плотности и С-реактивного белка (R=-0,52; p=0,03).

Заключение

Заключение. У молодых больных ПсА уже на ранней стадии заболевания отмечаются высокая распространенность ТФР ССЗ, атеросклеротические изменения СА и признаки ККА при относительно низких значениях суммарного коронарного риска по шкале SCORE, что может косвенно указывать на участие хронического воспаления в развитии атеросклероза.

Cardiovascular events (CVEs) are one of the most common causes of death in patients with psoriatic arthritis (PsA). The increased risk of CVEs in PsA is due to a combination of traditional cardiovascular risk factors (TCVRFs) and common inflammatory mechanisms underlying PsA and atherosclerosis.

Objective

Objective: to estimate the prevalence of TCVRFs, subclinical atherosclerosis, and coronary artery calcification in young patients with early peripheral PsA.

Subjects and methods

Subjects and methods. The investigation enrolled 25 patients (13 men, 12 women) with early PsA, who had participated in the REMARCA study. Their median age was 36 [27; 46] years; the duration of PsA and psoriasis was 5 [3; 7] and 13 [9; 84] months, respectively; DAS was 3.8 [3.4; 5.4].

All the patients underwent assessment of TCVRFs, Doppler ultrasound (DUS) of the carotid arteries (CA), evaluation of CA calcification (CAC) using multislice computed tomography (MSCT) and echocardiography, as well as 24-hour blood pressure monitoring.

Results and discussion

Results and discussion. The patients with early PsA were found to have the following TCVRFs: hypertension in 11 (44%), abdominal obesity in 14 (56%), smoking in 16 (64%), a family history of cardiovascular disease in 6 (24%), menopause in 5 (20%), and dyslipidemia in 14 (56%). There was one TCVRF in 7 (28%), two TCVRFs in 6 (24%), three TCVRFs in 2 (8%), four TCVRFs in 4 (16%), and five TCVRFs in 6 (24%). A combination of three or more TCVRFs was found in 12 (48%) patients.

Calculation of ten-year total coronary risk scores identified low [17 (68%)], moderate [6 (24%)], high [1 (4%)], and very high [1 (4%)] risk groups among the patients with a history of acute cerebrovascular accident. Analysis of the relationship between PsA activity and total coronary risk scores revealed no significant differences. Thus, the patients with moderate PsA activity showed low, moderate, and high coronary risks in 7 (70%), 2 (20%), and 1 (10%) cases, respectively.

Those with high PsA activity had low, moderate, high, and very high risks in 10 (66.7%), 4 (26.6%), and 1 (6.7%) cases, respectively. CA DUS revealed atherosclerotic plaques (ASPs) in 8 (32%) patients and increased CA intima-media thickness (IMT) values of >0.9 mm in 8 (32%). MSCT showed signs of CAC in 4 (16%) patients. There was a correlation of IMT values with low-density lipoprotein (r = 0.48; p = 0.03), total cholesterol (r = 0.53; p = 0.01), systolic blood pressure levels (r = 0.59; p = 0.02), and abdominal obesity (r = 0.64; p = 0.001) and an inverse correlation between high-density lipoproteins and C-reactive protein levels (r = -0.52; p = 0.03).

Young patients with PsA with early-stage disease have a high prevalence of TCVRFs, CA atherosclerotic changes, and CAC signs with relatively low total coronary risk scores, which may indirectly suggest that chronic inflammation is involved in the development of atherosclerosis.

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The authors declare that there are no conflicts of interest present.