Факторы риска сердечно-сосудистых заболеваний у пациентов с болезнью депонирования кристаллов пирофосфата кальция

Abstract

Calcium pyrophosphate\xa0 crystal deposition disease (CPCDD) is among the most common\xa0 inflammatory rheumatic diseases; however, studies of cardiovascular risks in CPCDD have not been conducted. Objective : to stratify a cardiovascular risk in patients with CPCDD according to the systematic coronary risk evaluation (SCORE)\xa0 algorithm that allows determination of an individual 10-year risk of cardiovascular death. Subjects and methods . The one-stage,\xa0 single-center\xa0 study of a cardiovascular risk enrolled 118 patients (43 men and 75 women) with CPCDD. Laboratory studies included determination of fasting serum glucose, total cholesterol, uric acid, magnesium,\xa0 phosphorus,\xa0 and total calcium. The level of C-reactive\xa0 protein (CRP)\xa0 was measured by a highly sensitive method;\xa0 CRP >5 mg/L was taken as a high level; parathyroid\xa0 hormone\xa0 was determined\xa0 by chemiluminescence immunoassay.\xa0 The SCORE\xa0 table was used to assess the total cardiovascular risk in all the patients. Results and discussion . The patients mean age was 60.7±12.4 years. According to the SCORE scale, very high and high risks of cardiovascular death were found in 59 (50%) and 6 (5%) patients, respectively; only in 10% of cases this risk was associated exclusively with age (> 65 years); 60 (50.8%) of the 118 patients did not have previous cardiovascular events or atherosclerosis risk factors. Coronary heart disease was detected in 28.8% of the 118 patients; hypertension was identified in 64%; diabetes mellitus (DM)\xa0 was found in almost 15%. The mean SCORE values did not signif icantly differ in men and women. The level of CRP was higher in men than that in women (8.6±4.6 and 7.3±3.5 mg/dL,\xa0 respectively; p = 0.04). Glomerular\xa0 filtration rate (GFR) 100 ml/min: 61% (60/98) and 25% (5/20) of patients, respectively (p = 0.003). Hyperparathyroidism (HPT)\xa0 was detected in 12 (10%) patients, and 7 of them were at a very high risk by the SCORE scale; however, hypercalcemia was diagnosed in only three cases. The results of the SCORE stratification of the whole group showed that 64 (54.2%) of the 118 patients with CPCDD were at a very high or high risk, the latter was very high in exactly half of the cases (n = 59. Conclusion . One-half of patients with CPCDD have a very high cardiovascular risk. In addition to the high detection\xa0 rate of traditional\xa0 cardiovascular risk factors (hypertension, smoking, hypercholesterolemia, and DM),\xa0 the presence of chronic microcrystalline\xa0 inflammation, concomitant metabolic disorders and diseases (hyperuricemia, HPT,\xa0 decreased renal function)\xa0 should be taken into account when determining the cardiovascular risk in patients with CPCDD.