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Authors
Abstract(s)
Introdução: As doenças reumáticas inflamatórias estão associadas a maior risco
cardiovascular o que motivou a criação de recomendações pela European League against
Rheumatism para avaliação deste risco nos doentes com Artrite Reumatóide,
Espondilartrites e Artrite Psoriática em 2010 (e respetiva atualização em 2016). A
literatura tem mostrado um aumento do risco cardiovascular noutras doenças
reumáticas e mais recentemente, em 2021, a European League against Rheumatism fez
recomendações para a gestão do risco cardiovascular em doentes com Lúpus
Eritematoso Sistémico, Esclerose Sistémica e Síndrome de Sjögren primário. O risco
cardiovascular mais elevado nestes doentes não parece ser explicado apenas pelo
aumento da prevalência de fatores de risco tradicionais, mas estar associado a
inflamação crónica subjacente e à exposição a anti-inflamatórios e glucocorticóides.
Objetivos: Avaliar a prevalência de fatores de risco cardiovascular nas doenças do
tecido conjuntivo (Lúpus Eritematoso Sistémico, Esclerose Sistémica e Síndrome de
Sjögren primário). Calcular o risco cardiovascular e comparar esse risco cardiovascular
em doentes com Artrite Reumatóide comparativamente aos das outras doenças do tecido
conjuntivo, usando Systematic Coronary Risk Evaluation (SCORE) para países de baixo
risco, como recomendado pela European League against Rheumatism.
Material e métodos: Numa primeira fase foi feito um estudo observacional,
transversal e retrospetivo de doentes consecutivos, com o diagnóstico de Lúpus
Eritematoso Sistémico, Esclerose Sistémica e Síndrome de Sjögren Primário
acompanhados na consulta de Reumatologia de um hospital terciário com pelo menos
uma consulta entre 1 de outubro de 2021 e 1 de outubro de 2022. Os registos clínicos
desses doentes, incluídos no Reuma.pt, foram consultados e as seguintes variáveis foram
colhidas: idade, sexo, tabagismo, colesterol total, tensão arterial sistólica, história de
Diabetes Mellitus e história prévia de eventos cardiovasculares. O risco cardiovascular
individual foi calculado usando o SCORE. Foi considerado risco cardiovascular muito
elevado quando o SCORE = 10%, alto risco quando o SCORE = 5% e < 10%, risco
moderado se SCORE entre = 1% e < 5% e baixo risco se SCORE< 1%. Posteriormente, foi
realizado um estudo caso controlo da população de doentes com Doenças do Tecido
Conjuntivo em comparação com um controlo com Artrite Reumatoide do sexo feminino.
Os doentes foram emparelhados para a idade, numa proporção de 1 para 1. Fatores de risco cardiovascular foram colhidos e o risco cardiovascular foi calculado como descrito
acima. Por fim foram comparados ambos os grupos.
Resultados: Dos 93 doentes acompanhados no Serviço de Reumatologia com Doenças
do Tecido Conjuntivo, 49 foram excluídos por não estar na faixa etária de aplicação desta
calculadora cardiovascular (40-65 anos). 3 foram excluídos por já terem tido um evento
cardiovascular (2 enfartes miocárdio e uma tromboembolia pulmonar; nestes só um dos
doentes era ex-fumador, e não foram identificados outros fatores de risco
cardiovascular). 8 foram excluídos por serem do sexo masculino. 33 doentes foram
incluídos no estudo: 19 doentes com Lúpus Eritematoso Sistémico, 8 com Síndrome de
Sjögren e 6 com Esclerose Sistémica com idade média de 52,8 (± 7,03) anos, tensão
arterial sistólica média de 127,27 mmHg (±15,73%) e colesterol total médio de 181,36
(±35,93). Quanto aos hábitos tabágicos 3% são fumadores e 3% têm diabetes.
O SCORE foi calculado e 19 doentes dos casos apresentaram baixo risco cardiovascular
(12 de Lúpus Eritematoso Sistémico, 3 com Síndrome de Sjögren e 4 com Esclerose
Sistémica), 12 apresentam risco moderado (5 de Lúpus Eritematoso Sistémico, 5 com
Síndrome de Sjögren e 2 com Esclerose Sistémica) e 2 alto risco sendo ambos doentes de
Lúpus Eritematoso Sistémico. Quanto aos controlos 24 doentes apresentavam risco
baixo e 9 risco moderado. Nenhum controlo tinha risco alto ou muito alto.
Conclusão: O nosso estudo aponta para risco baixo a moderado nesta população entre
os 40 e os 65 anos. No entanto 3 doentes, desta faixa etária, já tinham sofrido eventos
cardiovasculares e apenas uma das doentes era ex-fumadora, não existindo outros
fatores de risco, o que relembra que nestas doenças o componente inflamatório pode
contribuir para um aumento do risco inflamatório, que geralmente não é incluído nos
scores de avaliação de risco cardiovascular. Para além disso, o grupo de controlos não
apresentou um maior risco cardiovascular como seria de esperar. Assim concluímos que
devem ser procurados outros fatores de risco específicos destas doenças e desenvolvidas
novas formas de avaliar o risco de forma a melhor gerir este risco e a prevenir a
mortalidade por causas cardiovasculares nestes doentes.
Introduction: Inflammatory rheumatic diseases are associated with increased cardiovascular risk. In 2010 recommendations to assess and manage cardiovascular risk were made by the European League Against Rheumatism in patients with rheumatoid arthritis, spondylarthritis, and psoriatic arthritis (and an update was made in 2016). The literature has shown an increased cardiovascular risk in other rheumatic diseases and more recently, in 2021, European League Against Rheumatism made new recommendations for the management of cardiovascular risk in patients with Systemic Lupus Erythematosus, Systemic Sclerosis, and primary Sjögren's Syndrome. The higher cardiovascular risk in these patients does not seem to be explained only by the increased prevalence of traditional risk factors, but can also be associated with underlying chronic inflammation and exposure to anti-inflammatories and glucocorticoids. Objectives: To assess the prevalence of cardiovascular risk factors in connective tissue diseases (Systemic Lupus Erythematosus, Systemic Sclerosis, and primary Sjögren's Syndrome). To calculate cardiovascular risk and compare this cardiovascular risk in patients with Rheumatoid Arthritis to those with other connective tissue diseases, using Systematic Coronary Risk Evaluation (SCORE) for low-risk countries, as recommended by the European League Against Rheumatism. Material and methods: In the first phase, an observational, cross-sectional, and retrospective study was carried out on consecutive patients diagnosed with Systemic Lupus Erythematosus, Systemic Sclerosis, and Primary Sjögren's Syndrome followed by the Rheumatology consultation of a tertiary hospital with at least one appointment between October 1, 2021, and October 1, 2022. Clinical records, including in Reuma.pt, were reviewed and the following variables were collected: age, sex, smoking, total cholesterol, systolic blood pressure, history of Diabetes Mellitus, and previous history of cardiovascular events. Individual cardiovascular risk was calculated using the SCORE. Very high cardiovascular risk was considered when SCORE = 10%, high risk when SCORE = 5% and < 10%, moderate risk if SCORE between = 1% and < 5%, and low risk if SCORE < 1%. Subsequently, a case-control study of the population of patients with Connective Tissue Diseases was carried out compared to a female control with rheumatoid arthritis. Patients were matched for age in a 1:1 ratio. Cardiovascular risk factors were collected and cardiovascular risk was calculated as described above. Finally, both groups were compared. Results: Of the 93 patients followed up at the Rheumatology Service with connective tissue diseases, 49 were excluded for not being in the age range for this cardiovascular calculator (40-65 years). 3 were excluded because they had already had a cardiovascular event (2 myocardial infarctions and one pulmonary thromboembolism; in these, only one of the patients was a former smoker, and no other cardiovascular risk factors were identified). 8 were excluded because they were male. 33 patients were included in the study: 19 patients with Systemic Lupus Erythematosus, 8 with Sjögren's Syndrome, and 6 with Systemic Sclerosis with a mean age of 52.8 (± 7.03) years, mean systolic blood pressure of 127.27 mmHg (± 15.73%) and mean total cholesterol of 181.36 (±35.93). 3% are smokers and 3% have diabetes. SCORE was calculated and 19 patients of the cases had low cardiovascular risk (12 of Systemic Lupus Erythematosus, 3 with Sjögren's Syndrome, and 4 with Systemic Sclerosis), 12 had moderate risk (5 of Systemic Lupus Erythematosus, 5 with Sjögren's Syndrome and 2 with Systemic Sclerosis) and 2 high risks being both patients with Systemic Lupus Erythematosus. As for the controls, 24 patients were at low risk and 9 at moderate risk. No controls were high or very high risk. Conclusion: Our study points to a low to moderate risk in this population between 40 and 65 years old. However, 3 patients in this age group had already suffered cardiovascular events and only one of the patients was a former smoker, with no other risk factors, which reminds us that in these diseases the inflammatory component can contribute to an increase in the inflammatory risk, which it is generally not included in cardiovascular risk assessment scores. Furthermore, the control group did not show an increased cardiovascular risk as expected. Therefore, we conclude that other risk factors specific to these diseases should be sought and new ways of assessing risk should be developed to manage this risk better and prevent mortality from cardiovascular causes in these patients.
Introduction: Inflammatory rheumatic diseases are associated with increased cardiovascular risk. In 2010 recommendations to assess and manage cardiovascular risk were made by the European League Against Rheumatism in patients with rheumatoid arthritis, spondylarthritis, and psoriatic arthritis (and an update was made in 2016). The literature has shown an increased cardiovascular risk in other rheumatic diseases and more recently, in 2021, European League Against Rheumatism made new recommendations for the management of cardiovascular risk in patients with Systemic Lupus Erythematosus, Systemic Sclerosis, and primary Sjögren's Syndrome. The higher cardiovascular risk in these patients does not seem to be explained only by the increased prevalence of traditional risk factors, but can also be associated with underlying chronic inflammation and exposure to anti-inflammatories and glucocorticoids. Objectives: To assess the prevalence of cardiovascular risk factors in connective tissue diseases (Systemic Lupus Erythematosus, Systemic Sclerosis, and primary Sjögren's Syndrome). To calculate cardiovascular risk and compare this cardiovascular risk in patients with Rheumatoid Arthritis to those with other connective tissue diseases, using Systematic Coronary Risk Evaluation (SCORE) for low-risk countries, as recommended by the European League Against Rheumatism. Material and methods: In the first phase, an observational, cross-sectional, and retrospective study was carried out on consecutive patients diagnosed with Systemic Lupus Erythematosus, Systemic Sclerosis, and Primary Sjögren's Syndrome followed by the Rheumatology consultation of a tertiary hospital with at least one appointment between October 1, 2021, and October 1, 2022. Clinical records, including in Reuma.pt, were reviewed and the following variables were collected: age, sex, smoking, total cholesterol, systolic blood pressure, history of Diabetes Mellitus, and previous history of cardiovascular events. Individual cardiovascular risk was calculated using the SCORE. Very high cardiovascular risk was considered when SCORE = 10%, high risk when SCORE = 5% and < 10%, moderate risk if SCORE between = 1% and < 5%, and low risk if SCORE < 1%. Subsequently, a case-control study of the population of patients with Connective Tissue Diseases was carried out compared to a female control with rheumatoid arthritis. Patients were matched for age in a 1:1 ratio. Cardiovascular risk factors were collected and cardiovascular risk was calculated as described above. Finally, both groups were compared. Results: Of the 93 patients followed up at the Rheumatology Service with connective tissue diseases, 49 were excluded for not being in the age range for this cardiovascular calculator (40-65 years). 3 were excluded because they had already had a cardiovascular event (2 myocardial infarctions and one pulmonary thromboembolism; in these, only one of the patients was a former smoker, and no other cardiovascular risk factors were identified). 8 were excluded because they were male. 33 patients were included in the study: 19 patients with Systemic Lupus Erythematosus, 8 with Sjögren's Syndrome, and 6 with Systemic Sclerosis with a mean age of 52.8 (± 7.03) years, mean systolic blood pressure of 127.27 mmHg (± 15.73%) and mean total cholesterol of 181.36 (±35.93). 3% are smokers and 3% have diabetes. SCORE was calculated and 19 patients of the cases had low cardiovascular risk (12 of Systemic Lupus Erythematosus, 3 with Sjögren's Syndrome, and 4 with Systemic Sclerosis), 12 had moderate risk (5 of Systemic Lupus Erythematosus, 5 with Sjögren's Syndrome and 2 with Systemic Sclerosis) and 2 high risks being both patients with Systemic Lupus Erythematosus. As for the controls, 24 patients were at low risk and 9 at moderate risk. No controls were high or very high risk. Conclusion: Our study points to a low to moderate risk in this population between 40 and 65 years old. However, 3 patients in this age group had already suffered cardiovascular events and only one of the patients was a former smoker, with no other risk factors, which reminds us that in these diseases the inflammatory component can contribute to an increase in the inflammatory risk, which it is generally not included in cardiovascular risk assessment scores. Furthermore, the control group did not show an increased cardiovascular risk as expected. Therefore, we conclude that other risk factors specific to these diseases should be sought and new ways of assessing risk should be developed to manage this risk better and prevent mortality from cardiovascular causes in these patients.
Description
Keywords
Artrite Reumatóide Esclerose Sistémica Lúpus Eritematoso Sistémico Risco Cardiovascular Síndrome de Sjögren Primário