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DOI 10.23648/UMBJ.2018.31.17210

УДК 616.13.002.2-004.6

 

АТЕРОСКЛЕРОЗ И КАРДИОВАСКУЛЯРНЫЙ РИСК ПРИ РЕВМАТИЧЕСКИХ ЗАБОЛЕВАНИЯХ

 

В.Н. Антипова, Л.Н. Гончарова

ФГБОУ ВО «Национальный исследовательский Мордовский государственный университет им. Н.П. Огарева», г. Саранск, Россия

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Ревматические болезни (РБ) в клинической практике нередко являются причиной смерти больных молодого и среднего возраста. В последние годы активно обсуждается высокая смертность больных РБ от сердечно-сосудистых катастроф. Исследования последних лет показали, что ведущей причиной снижения продолжительности жизни при РБ являются кардиоваскулярные осложнения, связанные с атеросклеротическим поражением сосудов. Доклинические формы атеросклероза (эндотелиальная дисфункция, утолщение комплекса интима-медиа, увеличение уровня коронарного кальция) у больных РБ выявляются значительно чаще, чем в общей популяции.
В многочисленных исследованиях показано, что у больных РБ риск сердечно-сосудистых заболеваний в 2–5 раз выше, чем в общей популяции. Это приводит к уменьшению продолжительности жизни данной категории пациентов в среднем на 5–10 лет. У больных ревматоидным артритом (РА) в 2 раза чаще, чем у больных без него, развивается инфаркт миокарда и имеет место внезапная коронарная смерть, уже за 2 года до установления диагноза РА эти пациенты в 3 раза чаще госпитализируются по поводу острого коронарного синдрома. Увеличение частоты факторов сердечно-сосудистого риска показано и при анкилозирующем спондилите, системной красной волчанке. Обсуждается несколько возможных причин и их взаимосвязей, приводящих к увеличению риска кардиоваскулярных катастроф на фоне ускоренного атеросклеротического поражения сосудов при РБ: накопление кардиоваскулярных факторов риска; общие иммуновоспалительные механизмы, лежащие в основе патогенеза РБ и атеросклероза; побочные эффекты лекарственной терапии; недостаточное внимание к необходимости профилактики кардиоваскулярных осложнений при этих заболеваниях; факторы, связанные с прогрессированием самих РБ.

Ключевые слова: ревматические болезни, атеросклероз, иммуновоспалительные механизмы, кардиоваскулярные факторы риска, эндотелиальные дисфункции, толщина комплекса интима-медиа.

 

Литература

  1. Насонов Е.Л., Насонова В.А., ред. Ревматология: национальное руководство. Москва: ГЭОТАР-Медиа; 2008. 720.

  2. Попкова Т.В., Новикова Д.С., Насонов Е.Л. Атеросклероз при ревматических заболеваниях. В кн.: Насонов Е.Л., ред. Ревматология: клинические рекомендации. Mосква: ГЭОТАР-Медиа; 2010: 678–702.

  3. Peters M.J., Symmons D.P., McCarey D.W. EULAR evidence-Based recommendation for cardiovascular risk management in patients whis rheumatoid arthritis and other types of inflammatory arthritis – TASK FORCE «Caidiovascular risk management in RA». Ann. Rheum. Dis. 2010; 69 (2): 325–331.

  4. Горбунова Ю.Н., Новикова Д.С., Попкова Т.В. Кардиоваскулярный риск у больных ранним ревматоидным артритом до назначения базисной противовоспалительной терапии (предварительные данные исследования РЕМАРКА). Научно-практическаяревматология. 2014; 52 (4): 381–386.

  5. Hollan I., Dessein P.H., Ronda N. Prevention of cardiovascular disease in rheumatoid arthritis. Autoimmun. Rev. 2015; 14 (10): 952–969. DOI: 10.1016/j.autrev.2015.06.004.

  6. Ambrosino P., Lupoli R., Di Minno A. Subclinical atherosclerosis in patients with rheumatoid arthritis. A meta-analysis of literature studies. Thromb. Haemost. 2015; 113 (5): 916–930. DOI: 10.1160/TH14-11-0921.

  7. Meek I.L., Vonkeman H.E., van de Laar M.A.F.J. Cardiovascular case fatality in rheumatoid arthritis is decreasing; first prospective analysis of a current low disease activity rheumatoid arthritis cohort and review of the literature. BMC Musculoskelet Disord. 2014; 15: 142. DOI: 10.1186/1471-2474-15-142.

  8. Alemao E., Cawston H., Bourhis F. Cardiovascular risk factor management in patients with RA compared to matched non-RA patients. Rheumatology (Oxford). 2016; 55 (5): 809–816. DOI: 10.1093/rheumatology/kev427.

  9. Маслянский А.Л., Звартау Н.Э., Колесова Е.П. Субклиническое поражение сердечно-сосудистой системы у больных ревматологическими заболеваниями. Российский кардиологический журнал. 2015; 5 (121): 93–100.

  10. Попкова Т.В., Новикова Д.С., Насонов Е.Л. Сердечно-сосудистые заболевания при ревматоидном артрите: новые данные. Научно-практическаяревматология. 2016; 54 (2): 122–128.

  11. Arida A., Protogerou A.D., Konstantonis G. Atherosclerosis is not accelerated in rheumatoid arthritis of low activity or remission, regardless of antirheumatic treatment modalities. Rheumatology (Oxford). 2017; 56 (6): 934–939. DOI: 10.1093/rheumatology/kew506.

  12. Новикова Д.С., Попкова Т.В., Кириллова И.Г. Оценка кардиоваскулярного риска у больных ранним ревматоидным артритом в рамках исследования РЕМАРКА (предварительные данные). Научно-практическаяревматология. 2015; 53 (1): 24–31.

  13. Colombo Intima-media thickness: a marker of accelerated atherosclerosis in women with systemic lupus erythematosus. Ann. NY Acad. Sci. 2007; (1108): 121–126.

  14. Dessein P.H., Norton G.R., Woodiwiss A.J. Influence of nonclassical cardiovascular risk factors on the accuracy of predicting subclinical atherosclerosis in rheumatoid arthritis. Rheumatol. 2007; 34 (5):943–591.

  15. Roman M.J., Crow M.K., Lockshin M.D. Rate and determinants of progression of atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2007; 56 (10): 3412–3419.

  16. Leutermann D. Ankylosing spondylitis – cardiac manifestations. Clin. Exp. Rheumatol. 2002; 20 (6, Suppl. 28): 11–15.

  17. Baghdadi L.R., Woodman R.J., Shanahan E.M., Mangoni A.A. The impact of traditional cardiovascular risk factors on cardiovascular outcomes in patients with rheumatoid arthritis: a systematic review and meta-analysis. PLoS One. 2015; 10 (2): e0117952. DOI: 10.1371/journal.pone.0117952.

  18. Corrales A., Gonzalez-Juanatey C., Peiro M.E. Carotid ultrasound is useful for the cardiovascular risk stratification of patients with rheumatoid arthritis: results of a population-based study. Ann. Rheum. Dis. 2014; 73 (4): 722–727. DOI: 10.1136/annrheumdis-2012-203101.

  19. Dalbeni A., Giollo A., Tagetti A. Traditional cardiovascular risk factors or inflammation: Which factors accelerate atherosclerosis in arthritis patients? Int..J. Cardiol. 2017; Jan. 14. DOI: 10.1016/j.ijcard.2017.01.072.

  20. Ajeganova S., Andersson M.L., Hafstrцm I. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: a long-term followup from disease onset. Arthritis Care Res.(Hoboken). 2013; 65 (1): 78–87. DOI: 10.1002/acr.21710.

  21. Chung C.P., Avalos I., Raggi P., Stein C.M. Atherosclerosis and inflammation: insights from rheumatoid arthritis. Clin. Rheumatol. 2007; 26 (8): 1228–1233.

  22. Zhang J., Chen L., Delzell E. The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann. Rheum. Dis. 2014; 73 (7): 1301–1308. DOI: 10.1136/annrheumdis-2013-204715.

  23. Garcia-Gomez C., Bianchi M., de la Fuente D. Inflammation, lipid metabolism and cardiovascular risk in rheumatoid arthritis: A qualitative relationship? World J. Orthop. 2014; 5 (3): 304–311. DOI: 10.5312/wjo.v5.i3.304.

  24. Del Rincon I., Polak J.F., O’Leary D.H. Systemic inflammation and cardiovascular risk factors predict rapid progression of atherosclerosis in rheumatoid arthritis. Ann. Rheum. Dis. 2015; 74 (6): 1118–1123. DOI: 10.1136/annrheumdis-2013-205058.

  25. Skeoch S., Bruce I.N. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat. Rev.Rheumatol. 2015; 11: 390–400. DOI: 10.1038/nrrheum.2015.40.

  26. Mathieu S., Gossec L., Dougados M. Cardiovascular profile in ankylosing spondylitis: A systematic review and meta-analysis. Arthr. Care Res. 2011; 63 (4): 557–563.

  27. Van Halm V.P., van Denderen J.C., Peters M.J. Increased disease activity is associated with a deteriorated lipid profile in patients with ankylosing spondylitis. Ann. Rheum. Dis. 2006; 65: 1473–1477.

  28. Kang E., Choi S., Lee S., Park Y. Ftherogenic lipid profile in ankylosing spondylitis. Ann. Rheum. Dis. 2007; 66 (Suppl. II): 399.

  29. Антипова В.Н., Казеева М.В. Кардиоваскулярный риск и метаболический синдром у больных подагрой. Известия высших учеб. заведений. Поволжский регион. Мед. науки. 2015; 1 (33):108–117.

  30. Кондратьева Л.В., Попкова Т.В., Насонов Е.Л. Метаболический синдром при ревматоидном артрите. Научно-практическаяревматология. 2013; 51 (3): 302–312.

  31. Myasoedova S.E., Crowson C.S., Kremers H.M. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann. Rheum. Dis. 2011; 70 (3): 482–487. DOI: 10.1136/ard.2010.135871.

  32. Кондратьева Л.В., Горбунова Ю.Н., Попкова Т.В., Насонов Е.Л. Роль жировой ткани при ревматоидном артрите. Клиническаямедицина. 2014; 6: 62–66.

  33. Zhang J., Chen L., Delzell E. The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann. Rheum. Dis. 2014; 73 (7): 1301–1308. DOI: 10.1136/annrheumdis-2013-204715.

  34. Novikova D.S., Popkova T.V., Lukina G.V. The effects of rituximab on lipids, arterial stiffness, and carotid intima-media thickness in rheumatoid arthritis. J. Korean Med. Sci. 2016; 31: 202–207. DOI: 10.3346/jkms. 2016.31.2.202.

  35. Erhayiem B., Pavitt S., Baxter P. Coronary artery disease evaluation in rheumatoid arthritis (CADERA): study protocol for a randomized controlled trial. Trials. 2014; 15: 436. DOI: 10.1186/1745-6215-15-436.

  36. Buckley D.I., Fu R., Freeman M. C-reactive protein as a risk factor for coronary heart disease: a systematic review and metaanalyses for the U.S. Preventive Services Task Force. Ann. Intern. Med. 2009; 151: 483–495.

  37. Hingorani A.D., Casas J.P. The interleukin-6 receptor as a target for prevention of coronary heart disease: a Mendelian randomization analysis. Lancet. 2012; 379: 1214–1224. DOI: 10.1016/S0140-6736(12)60110-X.

  38. Шевченко А.В., Прокофьев В.Ф., Королев М.А., Омельченко В.О., Кононенков В.И. Полиморфизм генов эндотелиальной дисфункции, коактиваторов митохондриального биогенеза и плазминоген-плазминовой системы в развитии кардиоваскулярных осложнений при ревматоидном артрите. Научно-практическаяревматология. 2018; 1 (56): 55–59.

  39. Choy E., Sattar N. Interpreting lipid levels in the context of high-grade inflammatory states with a focus on rheumatoid arthritis: a challenge to conventional cardiovascular risk actions. Ann. Rheum. Dis. 2009; 68: 460–469.

  40. Chandra M., Miriyala S., Panchatcharam M. PPARг and Its Role in Cardiovascular Diseases. PPAR Res. 2017; 2017: 6404638. DOI: 10.1155/2017/6404638.

  41. Yamada Y., Eto M., Ito Y. Suppressive Role of PPARy-Reguated Endothelial Nitric Oxide Synthase in Adipocyte Lipolysis. PLoSOne. 2015; 10 (8): eDOI: 10.1371/journal.pone.0136597.

  42. Новикова Д.С., Попкова Т.В., Герасимов А.Н. Взаимосвязь кардиоваскулярных факторов риска с ригидностью артериальной стенки у женщин с высокой активностью ревматоидного артрита. Рациональная фармакотерапия в кардиологии. 2012; 8 (6): 756–765.

  43. Чураков О.Ю., Шилкина Н.П. Эхоструктурные изменения при ультразвуковом исследовании брахиоцефальных артерий у больных ревматоидным артритом. Архиввнутреннеймедицины. 2014; 5 (19): 59–61.

  44. Arida A., Zampeli E., Konstantonis G. Rheumatoid arthritis is sufficient to cause atheromatosis but not arterial stiffness or hypertrophy in the absence of classical cardiovascular risk factors. Clin. Rheumatol. 2015; 34 (5): 853–859. DOI: 10.1007/sl0067-0/5-2914-1.

 

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DOI 10.23648/UMBJ.2018.31.17210

Atherosclerosis and cardiovascular risk in rheumatic diseases

 

V.N. Antipova, L.N. Goncharova

Ogarev Mordovia State University, Saransk, Russia

e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

In clinical practice rheumatic diseases (RD) often cause death of young and middle-aged patients. In recent years, the high mortality rate of RD patients due to cardiovascular diseases has actively been discussed. Recent studies have shown that the leading causes of decline in life expectancy in RD patients are cardiovascular complications associated with atherosclerotic vascular lesions. Preclinical forms of atherosclerosis (endothelial dysfunction, thickening of the intima-media complex, increase in coronary calcium level) are much more often in RD patients than in the general population. Numerous studies have shown that the risk of cardiovascular diseases in RD patients is 2–5 times higher than in the general population. This leads to decline in life expectancy of these patients by 5–10 years averagely.Patients with rheumatoid arthritis (RA) suffer from myocardial infarction and sudden coronary death twice as frequently as patients without it. These patients are more likely to be hospitalized for acute coronary syndrome three times as often, even 2 years before they are diagnosed RA. Cardiovascular risks also increase in patients with ankylosing spondylitis and systemic lupus erythematosus. The authors discuss several possible causes that increase the risk of cardiovascular accidents in patients with accelerated atherosclerotic vascular disease and RD. They are the accumulation of cardiovascular risk factors; general immunoinflammatory mechanisms underlying the RD pathogenesis and atherosclerosis; side effects of drug therapy; insufficient attention to prevention of cardiovascular complications in patients with such diseases; factors associated with the RD progress.

Keywords: rheumatic diseases, atherosclerosis, immunoinflammatory mechanisms, cardiovascular risk factors, endothelial dysfunctions, thickness of the intima-media complex.

 

References

  1. Nasonov E.L., Nasonova V.A., red. Revmatologiya: natsional'noe rukovodstvo [Rheumatology: national guidelines]. Moscow: GEOTAR-Media; 2008. 720 (in Russian).

  2. Popkova T.V., Novikova D.S., Nasonov E.L. Ateroskleroz pri revmaticheskikh zabolevaniyakh [Atherosclerosis in rheumatic diseases]. V knige: Nasonov E.L. Revmatologiya: klinicheskie rekomendatsii [Rheumatology: Clinical recommendations]. Moscow: GEOTAR-Media; 2010: 678–702 (in Russian).

  3. Peters M.J., Symmons D.P., McCarey D.W. EULAR evidence-Based recommendation for cardiovascular risk management in patients whis rheumatoid arthritis and other types of inflammatory arthritis – TASK FORCE «Caidiovascular risk management in RA». Ann. Rheum. Dis. 2010; 69 (2): 325–331.

  4. Gorbunova Yu.N., Novikova D.S., Popkova T.V. Kardiovaskulyarnyy risk u bol'nykh rannim revmatoidnym artritom do naznacheniya bazisnoy protivovospalitel'noy terapii (predvaritel'nye dannye issledovaniya REMARKA) [Cardiovascular risk in patients with early rheumatoid arthritis before disease-modifying antirheumatic therapy (preliminary data of the REMARCA study)]. Nauchno-prakticheskaya revmatologiya. 2014; 52 (4): 381–386 (in Russian).

  5. Hollan, Dessein P.H., Ronda N. Prevention of cardiovascular disease in rheumatoid arthritis. Autoimmun Rev. 2015; 14 (10): 952–969. DOI: 10.1016/j.autrev.2015.06.004.

  6. Ambrosino P., Lupoli R., Di Minno A. Subclinical atherosclerosis in patients with rheumatoid arthritis. A meta-analysis of literature studies. Thromb. Haemost. 2015; 113 (5): 916–930. DOI: 10.1160/TH14-11-0921.

  7. Meek I.L., Vonkeman H.E., van de Laar M.A.F.J. Cardiovascular case fatality in rheumatoid arthritis is decreasing; first prospective analysis of a current low disease activity rheumatoid arthritis cohort and review of the literature. BMC Musculoskelet Disord. 2014; 15: 142. DOI: 10.1186/1471-2474-15-142.

  8. Alemao E., Cawston H., Bourhis F. Cardiovascular risk factor management in patients with RA compared to matched non-RA patients. Rheumatology (Oxford). 2016; 55 (5): 809–816. DOI: 10.1093/rheumatology/kev427.

  9. Maslyanskiy A.L., Zvartau N.E., Kolesova E.P. Subklinicheskoe porazhenie serdechno-sosudistoy sistemy u bol'nykh revmatologicheskimi zabolevaniyami [Subclinical lesion of cardiovascular system in patients with rheumatological diseases]. Rossiyskiy kardiologicheskiy zhurnal. 2015; 5 (121): 93–100 (in Russian).

  10. Popkova T.V., Novikova D.S., Nasonov E.L. Serdechno-sosudistye zabolevaniya pri revmatoidnom artrite: novye dannye [Cardiovascular diseases in rheumatoid arthritis: latest data]. Nauchno-prakticheskaya revmatologiya. 2016; 54 (2): 122–128 (in Russian).

  11. Arida A., Protogerou A.D., Konstantonis G. Atherosclerosis is not accelerated in rheumatoid arthritis of low activity or remission, regardless of antirheumatic treatment modalities. Rheumatology (Oxford). 2017; 56 (6): 934–939. DOI: 10.1093/rheumatology/kew506.

  12. Novikova D.S., Popkova T.V., Kirillova I.G. Otsenka kardiovaskulyarnogo riska u bol'nykh rannim revmatoidnym artritom v ramkakh issledovaniya REMARKA (predvaritel'nye dannye) [Cardiovascular risk assessment in patients with early rheumatoid arthritis within the REMARCA study: preliminary data]. Nauchno-prakticheskaya revmatologiya. 2015; 53 (1): 24–31 (in Russian).

  13. Colombo B.M., Murdaca G., Caiti M. Intima-media thickness: a marker of accelerated atherosclerosis in women with systemic lupus erythematosus. Ann. NY Acad. Sci. 2007; (1108): 121–126.

  14. Dessein P.H., Norton G.R., Woodiwiss A.J. Influence of nonclassical cardiovascular risk factors on the accuracy of predicting subclinical atherosclerosis in rheumatoid arthritis. Rheumatol. 2007; 34 (5): 943–591.

  15. Roman M.J., Crow M.K., Lockshin M.D. Rate and determinants of progression of atherosclerosis in systemic lupus erythematosus. Arthritis Rheum. 2007; 56 (10): 3412–3419.

  16. Leutermann D. Ankylosing spondylitis – cardiac manifestations. Clin. Exp. Rheumatol. 2002; 20 (6, Suppl. 28): 11–15.

  17. Baghdadi L.R., Woodman R.J., Shanahan E.M., Mangoni A.A. The impact of traditional cardiovascular risk factors on cardiovascular outcomes in patients with rheumatoid arthritis: a systematic review and meta-analysis. PLoS One. 2015; 10 (2): e0117952. DOI: 10.1371/journal.pone.0117952.

  18. Corrales A., Gonzalez-Juanatey C., Peiro M.E. Carotid ultrasound is useful for the cardiovascular risk stratification of patients with rheumatoid arthritis: results of a population-based study. Ann. Rheum. Dis. 2014; 73 (4): 722–727. DOI: 10.1136/annrheumdis-2012-203101.

  19. Dalbeni A., Giollo A., Tagetti A. Traditional cardiovascular risk factors or inflammation: Which factors accelerate atherosclerosis in arthritis patients? Int.. 2017; Jan.14. DOI: 10.1016/j.ijcard.2017.01.072.

  20. Ajeganova S., Andersson M.L., Hafstrцm I. Association of obesity with worse disease severity in rheumatoid arthritis as well as with comorbidities: a long-term followup from disease onset. Arthritis Care Res. (Hoboken). 2013; 65 (1): 78–87. DOI: 10.1002/acr.21710.

  21. Chung C.P., Avalos I., Raggi P., Stein C.M. Atherosclerosis and inflammation: insights from rheumatoid arthritis. Clin. Rheumatol. 2007; 26 (8): 1228–1233.

  22. Zhang J., Chen L., Delzell E. The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann. Rheum. Dis. 2014; 73 (7): 1301–1308. DOI: 10.1136/annrheumdis-2013-204715.

  23. Garcia-Gomez C., Bianchi M., de la Fuente D. Inflammation, lipid metabolism and cardiovascular risk in rheumatoid arthritis: A qualitative relationship? World J. Orthop. 2014; 5 (3): 304–311. DOI: 10.5312/wjo.v5.i3.304.

  24. Del Rincon I., Polak J.F., O’Leary D.H. Systemic inflammation and cardiovascular risk factors predict rapid progression of atherosclerosis in rheumatoid arthritis. Ann. Rheum. Dis. 2015; 74 (6): 1118–1123. DOI: 10.1136/annrheumdis-2013-205058.

  25. Skeoch S., Bruce I.N. Atherosclerosis in rheumatoid arthritis: is it all about inflammation? Nat. Rev. Rheumatol. 2015; 11: 390–400. DOI: 10.1038/nrrheum.2015.40.

  26. Mathieu S., Gossec L., Dougados M. Cardiovascular profile in ankylosing spondylitis: A systematic review and meta-analysis. Arthr. Care Res. 2011; 63 (4): 557–563.

  27. Van Halm V.P., van Denderen J.C., Peters M.J. Increased disease activity is associated with a deteriorated lipid profile in patients with ankylosing spondylitis. Ann. Rheum. Dis. 2006; 65: 1473–1477.

  28. Kang E., Choi S., Lee S., Park Y. Ftherogenic lipid profile in ankylosing spondylitis. Ann. Rheum. Dis. 2007; 66 (Suppl. II): 399.

  29. Antipova V.N., Kazeeva M.V. Kardiovaskulyarnyy risk i metabolicheskiy sindrom u bol'nykh podagroy [Cardiovascular risk and metabolic syndrome in patients with uratic arthritis]. Izvestiya vysshikh ucheb. zavedeniy. Povolzhskiy region. Med. nauki. 2015; 1 (33): 108–117 (in Russian).

  30. Kondrat'eva L.V., Popkova T.V., Nasonov E.L. Metabolicheskiy sindrom pri revmatoidnom artrite [Metabolic syndrome in rheumatoid arthritis]. Nauchno-prakticheskaya revmatologiya. 2013; 51 (3): 302–312 (in Russian).

  31. Myasoedova S.E., Crowson C.S., Kremers H.M. Lipid paradox in rheumatoid arthritis: the impact of serum lipid measures and systemic inflammation on the risk of cardiovascular disease. Ann. Rheum. Dis. 2011; 70 (3): 482–487. DOI: 10.1136/ard.2010.135871.

  32. Kondrat'eva L.V., Gorbunova YU.N., Popkova T.V., Nasonov E.L. Rol' zhirovoy tkani pri revmatoidnom artrite [Role of adipose tissue in rheumatoid arthritis]. Klinicheskaya meditsina. 2014; 6: 62–66 (in Russian).

  33. Zhang J., Chen L., Delzell E. The association between inflammatory markers, serum lipids and the risk of cardiovascular events in patients with rheumatoid arthritis. Ann. Rheum. Dis. 2014; 73 (7): 1301–1308. DOI: 10.1136/annrheumdis-2013-204715.

  34. Novikova D.S., Popkova T.V., Lukina G.V. The effects of rituximab on lipids, arterial stiffness, and carotid intima-media thickness in rheumatoid arthritis. J. Korean Med. Sci. 2016; 31: 202–207. DOI: 10.3346/jkms. 2016.31.2.202.

  35. Erhayiem B., Pavitt S., Baxter P. Coronary artery disease evaluation in rheumatoid arthritis (CADERA): study protocol for a randomized controlled trial. Trials. 2014; 15: 436. DOI: 10.1186/1745-6215-15-436.

  36. Buckley D.I., Fu R., Freeman M. C-reactive protein as a risk factor for coronary heart disease: a systematic review and metaanalyses for the U.S. Preventive Services Task Force. Ann. Intern. Med. 2009; 151: 483–495.

  37. Hingorani A.D., Casas J.P. The interleukin-6 receptor as a target for prevention of coronary heart disease: a Mendelian randomization analysis. Lancet. 2012; 379: 1214–1224. DOI: 10.1016/S0140-6736(12) 60110-X.

  38. Shevchenko A.V., Prokof'ev V.F., Korolev M.A., Omel'chenko V.O., Kononenkov V.I. Polimorfizm genov endotelial'noy disfunktsii, koaktivatorov mitokhondrial'nogo biogeneza i plazminogen-plazminovoy sistemy v razvitii kardiovaskulyarnykh oslozhneniy pri revmatoidnom artrite [Gene polymorphisms of endothelial dysfunction, coactivators of mitochondrial biogenesis and plasminogen/plasmin system in the development of cardiovascular events in rheumatoid arthritis]. Nauchno-prakticheskaya revmatologiya. 2018; 1 (56): 55–59 (in Russian).

  39. Choy E., Sattar N. Interpreting lipid levels in the context of high-grade inflammatory states with a focus on rheumatoid arthritis: a challenge to conventional cardiovascular risk actions. Ann. Rheum. Dis. 2009; 68: 460–469.

  40. Chandra M., Miriyala S., Panchatcharam M. PPARг and Its Role in Cardiovascular Diseases. PPAR Res. 2017; 2017: 6404638. DOI: 10.1155/2017/6404638.

  41. Yamada Y., Eto M., Ito Y. Suppressive Role of PPARy-Reguated Endothelial Nitric Oxide Synthase in Adipocyte Lipolysis. PLoSOne. 2015; 10 (8): e0136597. DOI: 10.1371/journal.pone.0136597.

  42. Novikova D.S., Popkova T.V., Gerasimov A.N. Vzaimosvyaz' kardiovaskulyarnykh faktorov riska s rigidnost'yu arterial'noy stenki u zhenshchin s vysokoy aktivnost'yu revmatoidnogo artrita [Relationship of cardiovascular risk factors and arterial wall stiffness in women with high activity of rheumatoid arthritis]. Ratsional'naya farmakoterapiya v kardiologii. 2012; 8 (6): 756–765 (in Russian).

  43. Churakov O.YU., Shilkina N.P. Ekhostrukturnye izmeneniya pri ul'trazvukovom issledovanii brakhiotsefal'nykh arteriy u bol'nykh revmatoidnym artritom [Structural changes in ultrasound investigation of brachiocephalic arteries in patients with rheumatoid arthritis]. Arkhiv vnutrenney meditsiny. 2014; 5 (19): 59–61 (in Russian).

  44. Arida A., Zampeli E., Konstantonis G. Rheumatoid arthritis is sufficient to cause atheromatosis but not arterial stiffness or hypertrophy in the absence of classical cardiovascular risk factors. Clin. Rheumatol. 2015; 34 (5): 853–859. DOI: 10.1007/sl0067-0/5-2914-1.