Ateroskleróza a kardiovaskulární riziko u vybraných revmatických onemocnění.

• Název práce v češtině: Ateroskleróza a kardiovaskulární riziko u vybraných revmatických onemocnění.
• Název v anglickém jazyce: Atherosclerosis and cadiovascular risk in selected rheumatic diseases
• Klíčová slova: ateroskleróza, kardiovaskulární riziko, idiopatické zánětlivé myopatie, prevence
• Klíčová slova anglicky: atherosclerosis, cardiovascular risk, idiopathic inflammatory myopathies, prevention
• Akademický rok vypsání: 2015/2016
• Typ práce: disertační práce
• Jazyk práce: čeština
• Ústav: Revmatologická klinika 1. LF UK a Revmatologický ústav (11-00641)
• Vedoucí / školitel: prof. MUDr. Michal Tomčík, Ph.D.
• Řešitel: skrytý - zadáno a potvrzeno stud. odd.
• Datum přihlášení: 04.11.2015
• Datum zadání: 04.11.2015
• Datum potvrzení stud. oddělením: 04.11.2015
• Datum a čas obhajoby: 24.11.2023 11:00
• Místo konání obhajoby: Ruská 87, Praha 10, 3. lékařská fakulta UK
• Datum odevzdání elektronické podoby: 17.07.2023
• Datum proběhlé obhajoby: 24.11.2023
• Předmět: Obhajoba dizertační práce (B90002)
• Oponenti: prof. MUDr. Pavel Horák, CSc.

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Předběžná náplň práce

Kardiovaskulární (KV) nemoci na podkladě aterosklerózy jsou vedoucí příčinou morbidity a mortality ve světě. U pacientů s revmatickými nemocemi hrají roli kromě tzv. tradičních rizikových faktorů také netradiční rizikové faktory související se zánětlivým onemocněním. Na rozdíl od relativně častějších onemocnění pojiva je u vzácnějších nemocí nedostatek studií s touto problematikou.
Cílem této práce bylo zhodnotit KV riziko u 90 pacientů s idiopatickými zánětlivými myopatiemi (IZM) ve srovnání se 180 zdravými kontrolami (ZK) z běžné populace se srovnatelným věkem a poměrem pohlaví, bez anamnézy manifestního KV onemocnění.
Výsledky této průřezové kohortové studie ukázaly významně vyšší prevalenci tradičních rizikových faktorů a také subklinické aterosklerózy u pacientů s IZM oproti ZK. Skórovací systémy (SCORE, SCORE2 a modifikované SCORE) se v porovnání s nálezy na sonografii karotid ukázaly jako nepřesné při odhadu KV rizika, přičemž jako nejpřesnější se jeví SCORE2. Nejzávažnější KV rizikový profil byl patrný u pacientů se statiny indukovanou nekrotizující myopatií. Vyšší KV riziko u IZM bylo celkově asociované s vyšším věkem, aktivitou nemoci, parametry tělesného složení i vyšším krevním tlakem.
Potvrdili jsme vyšší KV riziko i prevalenci tradičních rizikových faktorů u pacientů s IZM proti běžné populaci. Do budoucna bude proto potřeba konkrétních doporučení ke sledování a řízení KV rizika u IZM i dalších vzácných onemocnění pojiva.

Předběžná náplň práce v anglickém jazyce

Cardiovascular (CV) diseases due to atherosclerosis are the leading cause of morbidity and mortality worldwide. CV risk in rheumatic patients is caused by both traditional and non-traditional risk factors associated with autoimmune diseases. Unlike the relatively more prevalent rheumatic disease, there is a lack of evidence on CV risk in rare rheumatic diseases.
The aim of this study was to evaluate the CV risk in 90 patients with idiopathic inflammatory myopathies (IIM), compared to 180 healthy controls (HC) with similar age and gender distribution, without clinically manifested CV diseases.
The results of this cross-sectional cohort study showed a significantly higher prevalence of traditional risk factors as well as of subclinical atherosclerosis in IIM compared to HC. In comparison to carotid ultrasonography, SCORE, SCORE2, and modified SCORE was proved to underestimate the CV risk, while SCORE2 appeared to be the most accurate. The most severe CV risk profile was observed in patients with statin-induced necrotizing myopathy. Overall, higher CV risk in IIM was associated with higher age, disease activity, body composition parameters, and higher blood pressure values.
We confirmed a higher CV risk as well as a higher prevalence of traditional risk factors in patients with IIM compared to the general population. Therefore, in the future, specific recommendations for CV risk management in IIM and other rare connective tissue diseases will be needed.