The ClinicianThe ClinicianКлиницист1818-83382412-8775Publishing House ABV Press27310.17650/1818-8338-2016-10-3-26-31ORIGINAL INVESTIGATIONSОРИГИНАЛЬНОЕ ИССЛЕДОВАНИЕTHE RISK OF CORONARY ARTERY DISEASE DEVELOPMENT IN PATIENTS WITH ANKYLOSING SPONDYLITIS (BECHTEREW’S DISEASE) AND PSORIATIC ARTHRITIS: A 10-YEAR PROSPECTIVE FOLLOW-UP STUDYРИСК ПОЯВЛЕНИЯ ИШЕМИЧЕСКОЙ БОЛЕЗНИ СЕРДЦА У БОЛЬНЫХ АНКИЛОЗИРУЮЩИМ СПОНДИЛИТОМ (БОЛЕЗНЬЮ БЕХТЕРЕВА) И ПСОРИАТИЧЕСКИМ АРТРИТОМ ПО РЕЗУЛЬТАТАМ ДЕСЯТИЛЕТНЕГО ПРОСПЕКТИВНОГО НАБЛЮДЕНИЯ (ИССЛЕДОВАНИЕ ПРОГРЕСС)GaidukovaI. Z.ГайдуковаИ. З.
Russian Federation

112 Bol’shaya Kazach’ya St., Saratov 410012

410012 Саратов, ул. Большая Казачья, 112

ubp1976@list.ruRebrovA. P.РебровА. П.
Russian Federation

112 Bol’shaya Kazach’ya St., Saratov 410012

410012 Саратов, ул. Большая Казачья, 112

V.I. Razumovskiy Saratov State Medical University, Ministry of Health of RussiaФГБОУ ВО «Саратовский государственный медицинский университет им. В.И. Разумовского» Минздрава России1507201610326310101201701012017Copyright ©; 2016, Gaidukova I.Z., Rebrov A.P.Copyright ©; 2016, Гайдукова И.З., Ребров А.П.2016Gaidukova I.Z., Rebrov A.P.Гайдукова И.З., Ребров А.П.https://creativecommons.org/licenses/by/4.0https://klinitsist.abvpress.ru/Klin/article/view/273

Objective: assessment of coronary artery disease (CAD) incidence among patients with ankylosing spondylitis (AS) and psoriatic arthritis (PsA) without manifestation of cardiovascular diseases.

Materials and methods. We analyzed the data of 10-year prospective follow-up of the patient with AS (n = 278), psoriatic arthritis (n = 85) and healthy controls (n = 150) without any cardiovascular diseases. All groups were comparable in regard to cardiovascular risk factors. During these 10 years all new cases of CAD (verified by cardiologist) in the study population were tracked.

Results. New cases of CAD were fixed in 64 out of 278 patietns with AS and in 16 out of 150 controls (p = 0.0017). Using log-rank MantelCox test and logrank test for trend we demonstrated statistically significant differences in CAD incidence between patients without spondyloarthritis (SpA) and patients with AS and PsA (p < 0,0001). The risk of CAD development was higher in PsA group than in the control group; relative risk was 4.16 (95 % confidence interval (CI) 2.36–7.33), RR 6.1 (95 % CI 3.05–12.44) (p < 0.05). Increased risk of myocardial infarction was observed both in patients with AS (RR 4.98; 95 % CI 1.54–6.12) and patients with PsA (RR 5.2; 95 % CI 2.4–7.8) comparing to healthy controls. There was no significant difference between the AS-group and the control group in terms of risk of stenocardia development (p > 0.05).

Conclusion. The risk of exertional stenocardia in patients with AS was not higher than that in individuals without SpA. However, patients with AS have higher risk of myocardial infarction than those without SpA. PsA patients have increased risk of CAD development comparing to healthy controls and individuals with AS.

Цель исследования – оценка частоты появления новых случаев ишемической болезни сердца (ИБС) у больных анкилозирующим спондилитом (АС) и псориатическим артритом (ПсА) без манифестных сердечно-сосудистых заболеваний.

Материалы и методы. Выполнен анализ данных 10-летнего проспективного наблюдения за пациентами с АС (n = 278), псориатическим артритом (n = 85) и здоровыми лицами (n = 150) без сердечно-сосудистых заболеваний. Лица всех групп сопоставимы по факторам сердечно-сосудистого риска. Учитывали документально подтвержденные кардиологом новые случаи ИБС за 10 лет.

Результаты. Новые случаи ИБС за 10 лет были зафиксированы у 64 из 278 пациентов с АС и у 16 из 150 лиц группы сравнения (p = 0,0017). Сравнение частоты появления ИБС с применением log-rank Mantel-Cox test и log-rank test for trend показало значимость различий между частотой появления ИБС у лиц без спондилоартрита (СпА), у лиц с АС и ПсА (p < 0,0001). Риск развития ИБС у больных ПсА превосходил риск развития ИБС у лиц контроля: отношение рисков (RR) составил 4,16 (95 % доверительный интервал (ДИ) 2,36–7,33), RR 6,1 (95 % ДИ 3,05–12,44) (p < 0,05). RR развития инфаркта миокарда относительно здоровых лиц был повышен как у больных АС (RR 4,98; 95 % ДИ 1,54–6,12), так и у больных ПсА (RR 5,2; 95 % ДИ 2,4–7,8). Риск развития стенокардии при АС не превышал показатели здоровых лиц (p > 0,05).

Заключение. Риск развития стенокардии напряжения у больных с АС не превышает аналогичный риск у лиц без СпА. При этом пациенты с АС имеют бóльший риск развития инфаркта миокарда, чем лица без СпА. Лица с ПсА имеют бóльший риск развития ИБС как по сравнению со здоровыми лицами, так и по сравнению с лицами, страдающими АС.

coronary artery diseasemyocardial infarctionstenocardiaarterial hypertensioncardiovascular riskspondyloarthritisankylosing spondylitispsoriatic arthritisC-reactive proteinnonsteroidal anti-inflammatory drugsantihypertensive therapyишемическая болезнь сердцаинфаркт миокардастенокардияартериальная гипертензиясердечно-сосудистый рискспондилоартританкилозирующий спондилитпсориатический артритС-реактивный белокнестероидные противовоспалительные препаратыгипотензивная терапия1. Фоломеева О.М., Галушко Е.А., Эрдес Ш.Ф. Распространенность ревматических заболеваний в популяциях взрослого населения России и США. Научно-практическая ревматология 2008;(4):4–13. [Folomeeva O.M., Galushko E.A., Erdes Sh.F. The prevalence of rheumatic diseases in populations of the adult population of Russia and the United States. Nauchno-prakticheskaya revmatologiya = Scientific and Practical Rheumatology 2008;(4):4–13. (In Russ.)].Фоломеева О.М., Галушко Е.А., Эрдес Ш.Ф. Распространенность ревматических заболеваний в популяциях взрослого населения России и США. Научно-практическая ревматология 2008;(4):4–13. [Folomeeva O.M., Galushko E.A., Erdes Sh.F. The prevalence of rheumatic diseases in populations of the adult population of Russia and the United States. Nauchno-prakticheskaya revmatologiya = Scientific and Practical Rheumatology 2008;(4):4–13. (In Russ.)].2. Han C., Robinson D.W. Jr., Hackett M.V. et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol 2006;33(11):2167–72.Han C., Robinson D.W. Jr., Hackett M.V. et al. Cardiovascular disease and risk factors in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis. J Rheumatol 2006;33(11):2167–72.3. Haroon N.N., Paterson J.M., Li P. et al. Рatients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality: a population-based study. Ann Intern Med 2015;163(6):409–16.Haroon N.N., Paterson J.M., Li P. et al. Рatients with ankylosing spondylitis have increased cardiovascular and cerebrovascular mortality: a population-based study. Ann Intern Med 2015;163(6):409–16.4. Ребров А.П., Гайдукова И.З., Поддубный Д.А. Кардиоваскулярная патология у больных анкилозирующим спондилитом. Научно-практическая ревматология 2012; (2):100–5. [Rebrov A.P., Gaydukova I.Z., Poddubnyy D.A. Cardiovascular disease in patients with ankylosing spondylitis. Nauchnoprakticheskaya revmatologiya = Scientific and Practical Rheumatology 2012;(2):100–5. (In Russ.)].Ребров А.П., Гайдукова И.З., Поддубный Д.А. Кардиоваскулярная патология у больных анкилозирующим спондилитом. Научно-практическая ревматология 2012; (2):100–5. [Rebrov A.P., Gaydukova I.Z., Poddubnyy D.A. Cardiovascular disease in patients with ankylosing spondylitis. Nauchnoprakticheskaya revmatologiya = Scientific and Practical Rheumatology 2012;(2):100–5. (In Russ.)].5. Heslinqa S.C., Van den Oever I.A., Van Sijl A.M. et al. Cardiovascular risk management in patients with active ankylosing spondylitis: a detailed evaluation. BMC Musculoskelet Disord 2015;16:80.Heslinqa S.C., Van den Oever I.A., Van Sijl A.M. et al. Cardiovascular risk management in patients with active ankylosing spondylitis: a detailed evaluation. BMC Musculoskelet Disord 2015;16:80.6. Brophy S., Cooksey R., Atkinson M. et al. No increased rate of acute myocardial infarction or stroke among patients with ankylosing spondylitis – a retrospective cohort study using routine data. Semin Arthritis Rheum 2012;42(2):140–5.Brophy S., Cooksey R., Atkinson M. et al. No increased rate of acute myocardial infarction or stroke among patients with ankylosing spondylitis – a retrospective cohort study using routine data. Semin Arthritis Rheum 2012;42(2):140–5.7. Гайдукова И.З., Ребров А.П., Лебединская О.А. и др. Кардиоваскулярная заболеваемость и смертность при анкилозирующем спондилите и псориатическом артрите – результаты одноцентрового четырехлетнего наблюдения. Практическая медицина 2015;3–2(88):123–9. [Gaydukova I.Z., Rebrov A.P., Lebedinskaya O.A. et al. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis – the results of a single-site four-year follow-up. Prakticheskaya meditsina = Practical Medicine 2015;3–2(88):123–9. (In Russ.)].Гайдукова И.З., Ребров А.П., Лебединская О.А. и др. Кардиоваскулярная заболеваемость и смертность при анкилозирующем спондилите и псориатическом артрите – результаты одноцентрового четырехлетнего наблюдения. Практическая медицина 2015;3–2(88):123–9. [Gaydukova I.Z., Rebrov A.P., Lebedinskaya O.A. et al. Cardiovascular morbidity and mortality in ankylosing spondylitis and psoriatic arthritis – the results of a single-site four-year follow-up. Prakticheskaya meditsina = Practical Medicine 2015;3–2(88):123–9. (In Russ.)].8. Sundström B., Johansson G., Johansson I., Wållberg-Jonsson S. Modifiable cardiovascular risk factors in patients with ankylosing spondylitis. Clin Rheumatol 2014;33(1):111–7.Sundström B., Johansson G., Johansson I., Wållberg-Jonsson S. Modifiable cardiovascular risk factors in patients with ankylosing spondylitis. Clin Rheumatol 2014;33(1):111–7.9. Berg I.J., Semb A.G., van der Heijde D. et al. Uveitis is associated with hypertension and atherosclerosis in patients with ankylosing spondylitis: a cross-sectional study. Semin Arthritis Rheum 2014;44(3):309–13.Berg I.J., Semb A.G., van der Heijde D. et al. Uveitis is associated with hypertension and atherosclerosis in patients with ankylosing spondylitis: a cross-sectional study. Semin Arthritis Rheum 2014;44(3):309–13.10. Поддубный Д.А., Ребров А.П. Традиционные и новые факторы риска развития сердечно-сосудистых заболеваний у больных анкилозирующим спондилитом (болезнь Бехтерева). Терапевтический архив 2007;79(5):20–4. [Poddubnyy D.A., Rebrov A.P. Traditional and new risk factors for cardiovascular disease in patients with ankylosing spondylitis (ankylosing spondylitis). Terapevticheskiy arkhiv = Therapeutic Archive 2007;79(5):20–4. (In Russ.)].Поддубный Д.А., Ребров А.П. Традиционные и новые факторы риска развития сердечно-сосудистых заболеваний у больных анкилозирующим спондилитом (болезнь Бехтерева). Терапевтический архив 2007;79(5):20–4. [Poddubnyy D.A., Rebrov A.P. Traditional and new risk factors for cardiovascular disease in patients with ankylosing spondylitis (ankylosing spondylitis). Terapevticheskiy arkhiv = Therapeutic Archive 2007;79(5):20–4. (In Russ.)].11. Brooks W.B., Jordan J.S., Divine G.W. et al. The impact of psychologic factors on measurement of functional status. Assessment of the sickness impact profile. Med Care 1990;28(9):793–804.Brooks W.B., Jordan J.S., Divine G.W. et al. The impact of psychologic factors on measurement of functional status. Assessment of the sickness impact profile. Med Care 1990;28(9):793–804.12. Van der Linden S., Valkenburg H.A., Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27(4):361–8.Van der Linden S., Valkenburg H.A., Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum 1984;27(4):361–8.13. Taylor W., Gladman D., Helliwell P. et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006;54(8):2665–73.Taylor W., Gladman D., Helliwell P. et al. Classification criteria for psoriatic arthritis: development of new criteria from a large international study. Arthritis Rheum 2006;54(8):2665–73.14. 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.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):2286–91.15. Lukas C., Landewé R., Sieper J. et al. Development of an ASASendorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68(1):18–24.Lukas C., Landewé R., Sieper J. et al. Development of an ASASendorsed disease activity score (ASDAS) in patients with ankylosing spondylitis. Ann Rheum Dis 2009;68(1):18–24.16. Wells G., Becker J.C., Teng J. et al. Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis 2009;68(6):954–60.Wells G., Becker J.C., Teng J. et al. Validation of the 28-joint Disease Activity Score (DAS28) and European League Against Rheumatism response criteria based on C-reactive protein against disease progression in patients with rheumatoid arthritis, and comparison with the DAS28 based on erythrocyte sedimentation rate. Ann Rheum Dis 2009;68(6):954–60.17. Реброва О.Ю. Статистический анализ медицинских данных. М.: Медиа Сфера, 2002. [Rebrova O.Yu. Statistical analysis of medical data. Moscow: MediaSfera, 2002. (In Russ.)].Реброва О.Ю. Статистический анализ медицинских данных. М.: Медиа Сфера, 2002. [Rebrova O.Yu. Statistical analysis of medical data. Moscow: MediaSfera, 2002. (In Russ.)].18. Heredia E., Zhu B., Lefevre C. et al. Prevalence and incidence rates of cardiovascular, autoimmune, and other diseases in patients with psoriatic or psoriatic arthritis: a retrospective study using Clinical Practice Research Datalink. Edson- J Eur Acad Dermatol Venereol 2015;29(5): 955–63.Heredia E., Zhu B., Lefevre C. et al. Prevalence and incidence rates of cardiovascular, autoimmune, and other diseases in patients with psoriatic or psoriatic arthritis: a retrospective study using Clinical Practice Research Datalink. Edson- J Eur Acad Dermatol Venereol 2015;29(5): 955–63.19. Favarato M.H., Mease P., Gonçalves C.R. et al. Hypertension and diabetes significantly enhance the risk of cardiovascular disease in patients with psoriatic arthritis. Clin Exp Rheumatol 2014;32(2):182–7.Favarato M.H., Mease P., Gonçalves C.R. et al. Hypertension and diabetes significantly enhance the risk of cardiovascular disease in patients with psoriatic arthritis. Clin Exp Rheumatol 2014;32(2):182–7.20. Peters M.J., van der Horst-Bruinsma I.E., Dijkmans B.A., Nurmohamed M.T. Cardiovascular risk profile of patients with spondyloarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Arthritis Rheum 2004;34(3):585–92.Peters M.J., van der Horst-Bruinsma I.E., Dijkmans B.A., Nurmohamed M.T. Cardiovascular risk profile of patients with spondyloarthropathies, particularly ankylosing spondylitis and psoriatic arthritis. Arthritis Rheum 2004;34(3):585–92.21. Mathieu S., Gossec L., Dougados M., Soubrier M. Cardiovascular profile in ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 2011;63(4):557–63.Mathieu S., Gossec L., Dougados M., Soubrier M. Cardiovascular profile in ankylosing spondylitis: a systematic review and meta-analysis. Arthritis Care Res (Hoboken) 2011;63(4):557–63.22. Mathieu S., Soubrier M. Cardiovascular risk in ankylosing spondylitis. Presse Med 2015;44(9):907–11.Mathieu S., Soubrier M. Cardiovascular risk in ankylosing spondylitis. Presse Med 2015;44(9):907–11.23. Mathieu S., Pereira B., Soubrier M. Cardiovascular events in ankylosing spondylitis: an updated meta-analysis. Semin Arthritis Rheum 2015;44(5):551–5.Mathieu S., Pereira B., Soubrier M. Cardiovascular events in ankylosing spondylitis: an updated meta-analysis. Semin Arthritis Rheum 2015;44(5):551–5.24. Hung Y.M., Chang M.P., Wei J.C. et al. Midlife Ankylosing Spondylitis Increases the Risk of Cardiovascular Diseases in Males 5 Years Later: A National Population-Based Study. Medicine (Baltimore) 2016;95(18):e3596.Hung Y.M., Chang M.P., Wei J.C. et al. Midlife Ankylosing Spondylitis Increases the Risk of Cardiovascular Diseases in Males 5 Years Later: A National Population-Based Study. Medicine (Baltimore) 2016;95(18):e3596.25. Buckley C., Cavill C., Taylor G. et al. Mortality in рsoriatic arthritis – аsinglecenter Study from the UK. J Rheumatol 2010;37(10):2141–4.Buckley C., Cavill C., Taylor G. et al. Mortality in рsoriatic arthritis – аsinglecenter Study from the UK. J Rheumatol 2010;37(10):2141–4.26. Kondratiouk S., Udaltsova M., Klatsky A.L. Associations of psoriatic arthritis and cardiovascular conditions in a large population. Perm J 2008;12(4):4–8.Kondratiouk S., Udaltsova M., Klatsky A.L. Associations of psoriatic arthritis and cardiovascular conditions in a large population. Perm J 2008;12(4):4–8.