Кардиоваскулярный риск у больных ранним ревматоидным артритом до назначения базисной противовоспалительной терапии (предварительные данные исследования РЕМАРКА)

Цель исследования – определить уровень кардиоваскулярного риска у больных ранним ревматоидным артритом (РА) до начала терапии базисными противовоспалительными препаратами (БПВП).

Материал и методы. Обследовано 73 пациента с ранним РА, не принимавших ранее БПВП и глюкокортикоиды. Активность заболевания оценивали по индексам DAS28, SDAI и CDAI. Все пациенты осмотрены кардиологом, проведена оценка традиционных факторов риска (ФР) с определением суммарного коронарного риска по шкале SCORE в модификации, оценка степени риска сердечно-сосудистых осложнений (ССО), выполнены суточное мониторирование электрокардиограммы и артериального давления, эхокардиография (ЭхоКГ), дуплексное сканирование сонных артерий, определение кальциноза коронарных артерий по данным мультиспиральной компьютерной томографии, по показаниям выполнены стресс-ЭхоКГ и коронароангиография.

Результаты. Диагноз ишемической болезни сердца установлен у 13 пациентов. Хроническая сердечная недостаточность I или II функционального класса по NYHA диагностирована в 8, систолическая сердечная недостаточность (СН) в 2, СН с сохраненной фракцией выброса левого желудочка – в 6 случаях. Гипертрофия миокарда левого желудочка обнаружена у 22 (30,1%) больных, атеросклеротические бляшки в сонных артериях – у 26 (35,6%), кальциноз коронарных артерий – у 30 (41,1%), артериальная гипертензия – у 38 (52,1%); абдоминальное ожирение – у 34 (46,6%); дислипидемия – у 40 (54,8%); гиперхолестеринемия – у 37 (50,7%);
гипоальфалипопротеинемия – у 21 (28,8%); гипертриглицеридемия – у 12 (16,4%); гиподинамия – у 30 (41,1%) и курение – у 13 (17,8%). У 33 из 53 женщин была менопауза. Гипергликемия натощак выявлена у 11 (15,1%) пациентов, сахарный диабет 2-го типа – у 4 (5,5%). У 31 (42,5%) больного было не менее трех ФР. Согласно современной классификации степени кардиоваскулярного риска очень высокий риск ССО наблюдался у 58% больных РА, высокий – у 8%, умеренный – у 8%, низкий – у 26%.

Заключение. Большинство позитивных по ревматоидному фактору и антителам к циклическому цитруллинированному пептиду больных ранним РА с высокой активностью заболевания имеют высокий и очень высокий кардиоваскулярный риск.

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