Entzündlich-rheumatische Erkrankungen und kardiovaskuläres Risiko: ernährungsmedizinische Aspekte

Zusammenfassung

Chronische Entzündung ist ein unabhängiger Risikofaktor für kardiovaskuläre Komplikationen bei rheumatischen Erkrankungen. Die erhöhte Mortalität kann durch eine effektive Krankheitskontrolle reduziert werden. Ernährungsmedizinische Ansätze zielen auf die Prävention und Therapie traditioneller kardiovaskulärer Risikofaktoren wie arterielle Hypertonie, Adipositas oder Hyperlipoproteinämie, können aber auch unmittelbar zur Senkung der Entzündungsaktivität beitragen.

Abstract

Chronic inflammation is an independent risk factor for cardiovascular comorbidity in rheumatic diseases. Effective disease-modifying drugs reduce this increased mortality. The targets of nutritional interventions are not only the traditional risk factors such as hypertension, obesity or hyperlipoproteinemia but also to achieve a reduction of the inflammation.

Schlüsselwörter

Entzündlich-rheumatische Erkrankungen - rheumatoide Arthritis - kardiovaskuläres Risiko - Komorbidität - Mortalität - Ernährung - Ernährungsmedizin - Diät

Key words

rheumatic diseases - rheumatoid arthritis - cardiovascular risks - comorbidity - mortality - nutrition - nutritional medicine - diet

Literatur

• 1 Isomäki H A, Mutru O, Koota K. Death rate and causes of death in patients with rheumatoid arthritis.  Scand J Rheumatol. 1975;  4 205-208
• 2 Prior P, Symmons D P, Scott D L. et al . Cause of death in rheumatoid arthritis.  Br J Rheumatol. 1984;  23 92-99
• 3 Mutru O, Laakso M, Isomaki H. et al . Ten year mortality and causes of death in patients with rheumatoid arthritis.  Br Med J (Clin Res Ed). 1985;  290 1797-1799
• 4 Mitchell D M, Spitz P W, Young D Y. et al . Survival, prognosis, and causes of death in rheumatoid arthritis.  Arthritis Rheum. 1986;  29 706-714
• 5 Pinals R S. Survival in rheumatoid arthritis.  Arthritis Rheum. 1987;  30 473-475
• 6 Wolfe F, Mitchell D M, Sibley J T. et al . The mortality of rheumatoid arthritis.  Arthritis Rheum. 1994;  37 481-94
• 7 Riise T, Jacobsen B K, Gran J T. et al . Total mortality is increased in rheumatoid arthritis. A 17-year prospective study.  Clin Rheumatol. 2001;  20 123-127
• 8 Watson D J, Rhodes T, Guess H A. All-cause mortality and vascular events among patients with rheumatoid arthritis, osteoarthritis, or no arthritis in the UK General Practice Research Database.  J Rheumatol. 2003;  30 1196-1202
• 9 Goodson N J, Wiles N J, Lunt M. et al . Mortality in early inflammatory polyarthritis: cardiovascular mortality is increased in seropositive patients.  Arthritis Rheum. 2002;  46 2010-2019
• 10 Solomon D H, Karlson E W, Rimm E B. et al . Cardiovascular morbidity and mortality in women diagnosed with rheumatoid arthritis.  Circulation. 2003;  107 1303-1307
• 11 del Rincon I, Williams K, Stern M P. et al . High incidence of cardiovascular events in a rheumatoid arthritis cohort not explained by traditional cardiac risk factors.  Arthritis Rheum. 2001;  44 2737-2745
• 12 Gabriel S E, Crowson C S, Kremers H M. et al . Survival in rheumatoid arthritis: a population-based analysis of trends over 40 years.  Arthritis Rheum. 2003;  48 54-58
• 13 Maradit-Kremers H, Crowson C S, Nicola P J. et al . Increased unrecognized coronary heart disease and sudden deaths in rheumatoid arthritis: a population-based cohort study.  Arthritis Rheum. 2005;  52 402-411
• 14 Soubrier M, Zerkak D, Dougados M. Indications for Lowering LDL Cholesterol in Rheumatoid Arthritis: An Unrecognized Problem.  J Rheumatol. 2006;  33 1766-1769
• 15 Bessant R, Duncan R, Ambler G. et al . Prevalence of conventional and lupus-specific risk factors for cardiovascular disease in patients with systemic lupus erythematosus: A case-control study.  Arthritis Rheum. 2006;  55 892-899
• 16 De Leeuw K, Freire B, Smit A J. et al . Traditional and non-traditional risk factors contribute to the development of accelerated atherosclerosis in patients with systemic lupus erythematosus.  Lupus. 2006;  15 675-682
• 17 Maksimovicz-McKinnon K, Magder L S, Petri M. Predictors of Carotid Atherosclerosis in Systemic Lupus Erythematosus.  J Rheumatol. 2006;  33 2458-2463
• 18 De Leeuw K, Sanders J S, Stegeman C. et al . Accelerated atherosclerosis in patients with Wegener’s granulomatosis.  Annals of the Rheumatic Diseases. 2005;  64 753-759
• 19 Han C, Robinson D W, Hackett M V. et al . Cardiovascular Disease and Risk Factors in Patients with Rheumatoid Arthritis, Psoriatic Arthritis, and Ankylosing Spondylitis.  J Rheumatol. 2006;  33 2167-2172
• 20 Solomon D H. et al . Patterns of cardiovascular risk In rheumatoid arthritis.  Ann Rheum Dis. 2006;  65 1608-1612
• 21 Yalamanchili Jr K, Aronow W S, Kilaru R. et al . Coronary Artery Disease Is More Severe in Older Persons With Rheumatoid Arthritis Than in Older Persons Without Rheumatoid Arthritis.  Cardiology in Review. 2006;  14 55-56
• 22 Esdaile J M, Abrahamowicz M, Grodzicky T. et al . Traditional Framingham risk factors fail to fully account for accelerated atherosclerosis in systemic lupus erythematosus.  Arthritis Rheum. 2001;  44 (10) 2331-2337
• 23 Björnådal L, Brandt L, Klareskog L. et al . Impact of parental history on patients’ cardiovascular mortality in rheumatoid arthritis.  Annals of the Rheumatic Diseases. 2006;  65 741-745
• 24 Wallberg-Jonsson S. et al . Extent of inflammation predicts cardiovascular disease and overall mortality in seropositive rheumatoid arthritis. A retrospective cohort study from disease onset.  J Rheumatol. 1999;  26 2562-2571
• 25 Liang K P. et al . Mayo Clinic and Mayo Graduate School of Medicine, Rochester, Minnesota: Incidence of noncardiac vascular disease in rheumatoid arthritis and relationship to extraarticular disease manifestations.  Arthritis Rheum. 2006;  54 (2) 642-648
• 26 Turesson C, McClelland R L, Christianson T J. et al . Severe extra-articular disease manifestations are associated with an increased risk of first ever cardiovascular events in patients with rheumatoid arthritis.  Ann Rheum Dis. 2007;  66 70-75
• 27 Roman M J, Moeller E, Davis A. et al . Preclinical Carotid Atherosclerosis in Patients with Rheumatoid Arthritis.  Annals of Internal Medicine. 2006;  144 249-256
• 28 del Rincon I, Freeman G L, Haas R W. et al . Relative contribution of cardiovascular risk factors and rheumatoid arthritis clinical manifestations to atherosclerosis.  Arthritis Rheum. 2005;  52 (11) 3413-3423
• 29 Del Rincon I, O’leary D H, Freeman G L. et al . Acceleration of atherosclerosis during the course of rheumatoid arthritis.  Atherosclerosis. 2006;  9 Epub ahead of print
• 30 Boers M, Nurmohamed M T, Doelman C J. et al . Influence of glucocorticoid and disease activity on total and high density lipoprotein cholesterol in patients with rheumatoid arthritis.  Ann Rheum Dis. 2003;  62 842-845
• 31 Situnayake R, Kitas G. Dyslipidemia and rheumatoid arthritis.  Ann Rheum Dis. 1997;  56 341-342
• 32 Park Y B, Lee S K, Lee W K. et al . Lipid profiles in untreated patients with rheumatoid arthritis.  J Rheumatol. 1999;  26 1701-1704
• 33 Lorber M, Aviram M, Linn S. et al . Hypocholesterolaemia and abnormal high-density lipoprotein in rheumatoid arthritis.  r J Rheumatol. 1985;  24 250-255
• 34 Frati E, Castagna M L, Bacarelli M R. et al . Plasma levels of apolipoprotein and HDL-cholesterol in patients with rheumatoid arthritis.  Boll Soc Ital Biol Sper. 1984;  60 1791-1796
• 35 Lazarevic M B, Vitic J, Mladenovic V. et al . Dyslipoproteinemia in the course of active rheumatoid arthritis.  Semin Arthritis Rheum. 1992;  22 172-178
• 36 Georgiadis A N, Papavasiliou E C, Lourida E S. et al . Atherogenic Lipid Profile is a Feature Characteristic of Patients With Early Rheumatoid Arthritis: Effect of Early Treatment - A Prospective, Controlled Study.  Arthritis Res Ther. 2006;  8 (3): R82. Epub 2006 Apr 28 , http://arthritis-research.com/content/8/3/R82
• 37 Halm V P, Nielen M M, Nurmohamed M T. et al . Lipids and inflammation: serial measurements of the lipid profile of blood donors who later developed rheumatoid arthritis.  Annals of the Rheumatic Diseases. 2007;  66 184-188
• 38 McCarey D W, McInnes I B, Madhok van R. et al . Trial of atorvastatin in rheumatoid arthritis (TARA): double-blind, randomized, placebo-controlled trial.  Lancet. 2004;  363 2015-1021
• 39 Riboldi P, Gerosa M, Meroni P L. Statins and autoimmune diseases.  Lupus. 2005;  14 765-768
• 40 Penney C J. Statins in rheumatology.  J Rheumatol. 2005;  32 17-19
• 41 Nagashima T, Okazaki H, Yudoh K. et al . Apoptosis of rheumatoid synovial cells by statins through the blocking of protein geranylgeranylation: A potential therapeutic approach to rheumatoid arthritis.  Arthritis Rheum. 2006;  54 (2) 579-586
• 42 Xu H, Liu P, Liang L. et al . RhoA-mediated, tumor necrosis factor alpha-induced activation of NF-kappaB in rheumatoid synoviocytes: inhibitory effect of simvastatin.  Arthritis Rheum. 2006;  54 (11) 3441-3451
• 43 Choi H K, Hernan M A, Seeger J D. et al . Methotrexate and mortality in patients with rheumatoid arthritis: a prospective study.  Lancet. 2002;  359 1173-1177
• 44 Halm V P, Nurmohamed M T, Twisk J WR. et al . Disease-modifying antirheumatic drugs are associated with a reduced risk for cardiovascular disease in patients with rheumatoid arthritis: a case control study.  Research & Therapy. 2006;  8 R151
• 45 Jacobsson L T, Turesson van C, Gülfe A. et al . Treatment with tumor necrosis factor blockers is associated with a lower incidence of first cardiovascular events in patients with rheumatoid arthritis.  J Rheumatol. 2005;  32 1213-1218
• 46 Jacobsson L T, Turesson C, Nilsson J A. et al . Treatment with TNF-blockers and mortality risk in patients with rheumatoid arthritis.  Ann Rheum Dis. 2006;  11 Epub ahead of print , http://ard.bmj.com/cgi/content/abstract/ard.2006.062497v1
• 47 Bilsborough W, Keen H, Taylor A. et al . Anti-tumour necrosis factor-alpha therapy over conventional therapy improves endothelial function in adults with rheumatoid arthritis.  Rheumatol Int. 2006;  26 (12) 1125-1131
• 48 Dixon W G, Symmons D PM. What effects might anti-TNF-alpha-therapy be expected to have on cardiovascular morbidity and mortality in rheumatoid arthritis? A review of the role of TNF-alpha in cardiovascular pathophysiology.  Ann Rheum Dis. 2007;  24 Epub ahead of print , http://ard.bmj.com/cgi/content/abstract/ard.2006.063867v1
• 49 Boers M, Nurmohamed M T, Doelman C J. et al . Influence of glucocorticoids and disease activity on total and high density lipoprotein cholesterol in patients with rheumatoid arthritis.  Ann Rheum Dis. 2003;  62 842-845
• 50 Spanakis E, Sidiropoulos P, Papadakis J. et al . Modest But Sustained Increase of Serum High Density Lipoprotein Cholesterol Levels in Patients with Inflammatory Arthritides Treated with Infliximab.  J Rheumatol. 2006;  33 (12) 2440-2446
• 51 Kiortsis D N, Mavridis A K, Filippatos T D. et al . Effects of infliximab treatment on lipoprotein profile in patients with rheumatoid arthritis and ankylosing spondylitis.  J Rheumatol. 2006;  33 (5) 921-923
• 52 Popa C, Netea M G, Radstake T. et al . Influence of anti-tumour necrosis factor therapy on cardiovascular risk factors in patients with active rheumatoid arthritis.  Ann Rheum Dis. 2005;  64 303-305
• 53 Popa C, Hoogen F H, Radstake T R. et al . Modulation of lipoprotein plasma concentrations during long-term anti-TNF therapy in patients with active rheumatoid arthritis.  Ann Rheum Dis. Published Online First: 1 May 2007;  , http://ard.bmj.com/cgi/content/abstract/ard.2006.066191v1
• 54 Adam van der O, Beringer C, Kless T. et al . Anti-inflammatory effects of a low arachidonic acid diet and fish oil in patients with rheumatoid arthritis.  Rheumatol Int. 2003;  23 27-36
• 55 Keysser G. Klinische Studien entzündlich-rheumatischer Erkrankungen in der Ernährungsmedizin.  Akt Rheumatol. 2007;  32 194-199
• 56 Sundström B, Stålnacke K, Hagfors L. et al . Supplementation of omega-3 fatty acids in patients with ankylosing spondylitis.  Scandinavian Journal of Rheumatology. 2006;  35 359-362
• 57 Cleland L G, Caughey G E, James M J. et al . Reduction of cardiovascular risk factors with longterm fish oil treatment in early rheumatoid arthritis.  J Rheumatol. 2006;  33 1973-1979
• 58 GISSI-Prevenzione Investigators . Dietary suplementation with n-3 polyunsaturated fatty acids and vitamin E after myocardial infarction: results of the GISSI-Prevenzione trial.  Lancet. 1999;  354 447-455
• 59 Pham T, Gossec L, Constantin A. et al . Cardiovascular risk and rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion.  Joint Bone Spine. 2006;  73 379-387
• 60 Chung C P, Oeser A, Avalos I. et al . Utility of the Framingham risk score to predict the presence of coronary atherosclerosis in patients with rheumatoid arthritis.  Arthritis Res Ther. 2006;  8 R186
• 61 Wilson P WF, D’Agostino R B, Levy D. et al . Prediction of coronary heart disease using risk factor categories.  Circulation. 1998;  97 1837-1847

1 Der Framingham-Score [60] ermöglicht auch bei Patienten mit einer rheumatoiden Arthritis eine Abschätzung des kardiovaskulären Risikos [61]. Eine Anleitung für die Kalkulation steht online zur Verfügung [62].