Proteína C reactiva como marcador de riesgo cardiovascular en una cohorte de pacientes con artritis reumatoide.
Keywords:
Riesgo cardiovascular, Proteína C reactiva, Artritis ReumatoideAbstract
Antecedente: La proteína C reactiva es un reactante de fase aguda, que se ha asociado con el desarrollo de ateroesclerosis y con el riesgo cardiovascular.
Objetivo: Establecer la relación entre las concentraciones de la proteína C reactiva con el riesgo cardiovascular y el tratamiento de los pacientes con artritis reumatoide.
Métodos: Se realizó un estudio en 166 pacientes con el diagnostico de artritis reumatoide según los criterios ACR/EULAR 2010. Se determinaron las concentraciones séricas de proteína C reactiva ultrasensible y se compararon con los factores de riesgo cardiovascular tradicionales y no tradicionales, y con el tratamiento empleado.
Resultados: Se encontró diferencia significativa entre concentraciones elevadas de proteína C reactiva y valores elevados de c-HDL (< 0,000), edad (0,030), presencia de diabetes mellitus (0,026), factor reumatoide positivo (0,004), triglicéridos (< 0,003), mayor actividad de la enfermedad (0,001) y presencia de síndrome metabólico (0,032). Se encontró un riesgo cardiovascular de Framinghan bajo (0,004) con menores concentraciones de proteína C reactiva y riesgo moderado (0,032) a mayores concentraciones. Se encontró un índice bajo de Castellí (0,009) y de Kannel (< 0,000) a menores valores de proteína C reactiva. Los pacientes que emplearon hidroxicloroquina y metotrexato tuvieron menores concentraciones de proteína C reactiva, ocurriendo lo contrario con el empleo de glucocorticoides.
Conclusiones: Las concentraciones elevadas de proteína C reactiva se asocian con un mayor índice aterogénico y síndrome metabólico, así mismo el empleo de hidroxicloroquina y metotrexato al controlar la actividad de la enfermedad y la inflamación disminuyen el riesgo cardiovascular.
Downloads
References
Shadick NA, Cook NR, Karlson EW, Ridker PM, Maher NE, Manson JE, et al. C-Reactive Protein in the prediction of rheumatoid arthritis in women. Arch Intern Med. 2006; 166: 2490-4.
Plat MJ, Williams AL, O´Sullivan MM, Lewis PA, Coles EC, Jessop JD. Relationship between time-integrated c-reactive protein levels and radiologic progression in patiens with rheumatoid arthritis. Arthritis Rheum. 2000; 43; 1473-7.
Pepys MB, Hirschfield GM. C-reactive protein: a critical update. J Clin Invest. 2003; 111: 1805-12.
van Leeuwen MA, van der Heijde DM, van Rijswijk MH, Houtman PM, van Riel PL, van de Putte LB, et al. Interrelationships of outcome measures and process variables in early rheumatoid arthritis a comparison of radiological damage, physical disability, joint counts and acute phase reactants. J Rheumatol. 1994; 21: 425-9.
Li L, Roumeliotis N, Sawamura T, Renier G. C-reactive protein enhances LOX-1 expression in human aortic endothelial cells: relevance of LOX-1 to C-reactive protein-induced endothelial dysfunction. Circ Res. 2004; 95: 877-83.
Devaraj S, Xu DY, Jialal I. C-reactive protein increases plasminogen activator inhibitor-1 expression and activity in human aortic endothelial cells: implications for the metabolic syndrome and atherothrombosis. Circulation. 2003; 107: 398-404.
Danesh J, Wheeler J, Hirschfield G, Eda S, Eiriksdottir G, Rumley A, et al. C-reactive protein and other circulating markers of inflammation in the prediction of coronary heart disease. N Engl J Med. 2008; 350: 1387-97.
Skeoch S, Bruce I. Atherosclerosis in rheumatoid arthritis: is it all about inflammation?. Nat Rev Rheumatol. 2015; 11: 390-400.
Raggi P. Epicardial Adipose Tissue as a Marker of Coronary Artery Disease RisK. J Am Coll Cardiol. 2013; 61: 1396-139.
Ross R. Atherosclerosis-an inflammatory disease. N Engl J Med. 1999; 340: 115-26.
Tornel PL, Abellán J, Cano CA, Martínez P. La proteína C reactiva como marcador del riesgo cardiovascular. Hipertension 2003; 20:74-81.
Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC, et al. A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med. 2000; 343: 1586-93.
Weinblatt ME, Kaplan H, Germain BF, Merriman RC, Solomon SD, Wall B, et al. Low-dose methotrexate compared with auranofin in adult rheumatoid arthritis. A thirty-six-week, double-blind trial. Arthritis Rheum. 1990; 33: 330-8.
Choi HK, Hernan MA, Seeger JD, Robins JM, Wolfe F. Methotrexate and mortality in patients with rheumatoid arthritis: A prospective study. Lancet. 2002; 359: 1173-7.
Grundy S, Brewer H, Cleeman J, Smith S, Lenfant C. For the Conference Participants. Definition of metabolic syndrome. Report of the National Heart, Lung, and Blood Institute/American Heart Association Conference on Scientific Issues Related to Definition. Circulation. 2004; 109: 433-8.
D’Agostino RB, Grundy S, Sullivan LM, Wilson P. Validation of the Framingham coronary heart disease prediction scores: results of a multiple ethnic groups investigation. JAMA. 2001; 286: 180-7.
Gonzalez-Gay M, Gonzalez-Juanatey C, Piñeiro A, Garcia-Porrua C, Testa A, Llorca J. High-grade C-reactive protein elevation correlates with accelerated atherogenesis in patients with rheumatoid arthritis. J Rheumatol. 2005; 32: 1219-23.
Myasoedova E, Gabriel S. Cardiovascular disease in rheumatoid arthritis: a step forward. Curr Opin Rheumatol. 2010; 22: 342-7.
Ridker PM, Hennekens CH, Buring JE, Rifai N. C reactive protein and other markers of inflammation in the prediction of cardivascular disease in women. N Engl J Med. 2000; 342: 836-43.
Meier-Ewert HK, Ridker PM, Rifai N, Price N, Dinges DF, Mullington JM. Absence of diurnal variation of C-reactive pro-tein in healthy human subjects. Clin Chem. 2001; 47: 426-30.
Gabay C, Kushner I. Acute-phase proteins and other systematic responses to inflammation. N Engl J Med. 1999; 340: 448-54.
Wener MH, Daum PR, Mc Quillan GM. The influence of age, sex, and race on the upper reference limit of serum C-reactive protein concentration. J Rheumatol. 2000; 27: 2351-9.
Feldman M, Sbong S. Is CRP, like ESR, Age and Gender Dependent?. Rheumatology (Sunnyvale). 2014; 4: 134.
Fröhlich M, Imhof A, Berg G, Hutchinson WI, Pepys MB; Boering H, et al. Association Between C-Reactive Protein and Features of the Metabolic Syndrome. Diabetes Care. 2000; 23: 1835-9.
Davis J, Maradit H, Crowson C, Nicola P, Ballman K, Therneau T, et al. Glucocorticoids and cardiovascular events in rheumatoid arthritis: a population-based cohort study. Arthritis Rheum. 2007; 56: 820-30.
Dessein P, Joffe B, Singh S. Biomarkers of endothelial dysfunction, cardiovascular risk factors and atherosclerosis in rheumatoid arthritis. Arthritis Res Ther. 2005; 7: 634-43.
den Engelsen C, Koekkoek PS, Gorter KJ, van den Donk M, Salomé PL, Rutten GE. High-sensitivity C-reactive protein to detect metabolic syndrome in a centrally obese population: a cross-sectional analysis. Cardiovas Diabetol. 2012; 11: 25.
Ridker PM, Buring JE, Rifai N, Cook NR. Development and validation of improved algorithms for the assessment of global cardiovascular risk in women: the Reynolds Risk Score. JAMA. 2007; 297: 611-9.
Van Halm V, Nielen M, Nurmohamed M, Van Schaardenburg D, Reesink H, Voskuyl A, et al. Lipids and inflammation: serial measurements of the lipid profile of blood donors who later developed rheumatoid arthritis. Ann Rheum Dis. 2007; 66: 184-8.
Sogut E, Avci E, Ustuner F, Arikan E. The evaluation of (TG/HDL-C) ratio as a serum atherogenic index. Turk Klinik Biyokimya Dergisi. 2006; 4: 1-8.
Arts E, Fransen J, Lemmers H, Stalenhoef A, Joosten L, van Riel P, et al. High-density lipoprotein cholesterol subfractions HDL2 and HDL3 are reduced in women with rheumatoid arthritis and may augment the cardiovascular risk of women with RA: a cross-sectional study. Arthritis Res Ther. 2012; 14: R116.
Kinlay S. Low-density lipoprotein-dependent and -independent effects of cholesterol-lowering therapies on C-reactive protein: a meta-analysis. J Am Coll Cardiol. 2007; 49: 2003-9.
Kim MA, Kim CJ, Seo JB, Chung WY, Kim SH, Zo JH, et al. The effect of aspirin on C-reactive protein in hypertensive patients. Clin Exp Hypertens. 2011; 33: 47-52.
Bisi M, Rossoni C, Waldemar M, Luiz H. Antimaláricos e perfil lipídico em pacientes com lúpus eritematoso sistémico. Rev Bras Reumatol. 2011; 51: 383.
Pareek A, Chandurkar N, Thulaseedharan NK, Legha R, Agarwal M, Mathur SL, et al. Efficacy and safety of fixed dose combination of atorvastatin and hydroxychloroquine: a randomized, double-blind comparison with atorvastatin alone among Indian patients with dyslipidemia. Curr Med Res Opin. 2015; 31: 2105-17.
Toms TE, Panoulas VF, John H, Douglas KMJ, Kitas GD. Methotrexate therapy associates with reduced prevalence of the metabolic syndrome in rheumatoid arthritis patients over the age of 60 More than just an anti-inflammatory effect? A cross sectional study. Arthritis Res Ther. 2009; 11: 110.
Zonana-Nacach A, Santana-Sahagun E, Jimenez-Balderas FJ, Camargo-Coronel A. Prevalence and factors associated with metabolic syndrome in patients with rheumatoid arthritis and systemic lupus erythematosus. J Clin Rheumatol. 2008; 14: 74-7.
Published
How to Cite
Issue
Section
License
Warning of rights of author
The authors that publish in this journal agree with the following terms:
The authors conserve the rights of author and concede to the journal the right of the first publication, fulfilling with the license Creative Commons Attribution License that allows to others share the work with recognition of the authorship of their articles, and the initial publication in this journal.
The authors can establish separately additional agreements for the no exclusive distribution of the version of the work published in the journal (for example, situate it in an institutional repository, in a personal blog or publish it partial or totally in a book), with a recognition of their initial publication in this journal.
To be able to send the manuscript or part of him passed three months of published, for his evaluation to other publishers, identifying it or not with the same title; whenever allusion is made to our journale and know it the new publisher.
The publishing committee of the Cuban Journal of Rheumatology authorizes to other publishers, to reproduce the articles published in our magazine, whenever it indicate the origin of the same.
The authors should send a document in Office Word application format through the electronic address of the magazine with a similar format to that we include next:
---------------------------------------------------------------------------------------------------------------------
Statement of authorship and cede of articles for the publication of the scientific work in the Cuban Journal of Rheumatology
Date:
Those who subscribe certify that are the authors of the work:
Of this form communicate the originality of our article clearing that the concepts and knowledges of other authors that have included in the text of the article, have been quoted properly in the bibliography.
We do proof besides that the article in question is original and has not been published, total neither partially, in another journal.
To be approved for his publication in the Cuban Journal of Rheumatology, do secession of the rights of publication to the same one through the method that realizes it usually.
In front of any catchword that exist by the article that send to evaluate, relieve of of the responsibility to the Cuban Journal of Rheumatology holding us responsible with all the difficulties that can berelated by any situation.
We include to continuation the name and the signature of all authors and collaborators of this article.
Name: Signature:
