Cardiovascular risk assessment in patients with rheumatoid arthritis: The relevance of clinical, genetic and serological markers

Abstract

Cardiovascular disease (CV) is the most common cause of premature mortality in patients with rheumatoid arthritis (RA). This is the result of an accelerated atherosclerotic process. Adequate CV risk stratification has special relevance in RA to identify patients at risk of CV disease. However, current CV risk screening and management strategies underestimate the actual CV risk in RA. Consequently, the search for additional tools that may help to identify those patients at high CV risk has become a key objective in the last years. In this regard, non-invasive surrogates, such as carotid ultrasonography, have been found to be excellent predictors of future CV events. In addition, several studies have revealed the relevance of a genetic component in the development of CV disease in RA patients. Besides an association with HLA-DRB1* shared epitope alleles other gene polymorphisms located inside and outside the HLA seem to influence the risk of cardiovascular disease in RA. Moreover, serum levels of some metabolic syndrome-related biomarkers, adipokines such as adiponectin and biomarkers of endothelial cell activation and inflammation such as Osteoprotegerin and Asymmetric dimethylarginine have recently been found useful for the prediction of CV disease in these patients. An update of the current knowledge on these potential markers, especially focused on new genetic and serological biomarkers is shown in this review.

HDL cholesterol efflux capacity in rheumatoid arthritis patients: contributing factors and relationship with subclinical atherosclerosis

“…Besides a genetic component and the influence of traditional cardiovascular risk factors [2], chronic inflammation seems to play a pivotal role in the process of accelerated atherogenesis observed in RA [3]. Several studies support the notion that RA leads to a more atherogenic lipid profile, which correlates with disease activity and improves after treatment with antirheumatic medications [4].…”

Influence of coronary artery disease and subclinical atherosclerosis related polymorphisms on the risk of atherosclerosis in rheumatoid arthritis

“…A genetic component influences the development of atherosclerosis in the general population and also in patients with rheumatoid arthritis (RA)12. Several pieces of evidence support the hypothesis that both pathologies share many similarities and exhibit analogous pathophysiological mechanisms3.…”

“…Several pieces of evidence support the hypothesis that both pathologies share many similarities and exhibit analogous pathophysiological mechanisms3. However, genetic polymorphisms associated with atherosclerosis in the general population are not always involved in the development of cardiovascular disease (CVD) in RA2. In this respect, a recent study performed in patients with RA from North-America did not disclose that a series of gene polymorphisms related to coronary artery disease in the general population4 were involved in the development of atherosclerotic disease in RA5.…”

Analysis on the Polymorphism of Chromosome Region 9p21 and the Susceptibility of Carotid Plaque

“…This is the result of an accelerated atherosclerotic process [23] . Besides traditional CV risk factors and inflammation, a genetic component appears to be crucial in this process [24] . Since RA and atherosclerosis share pathogenic mechanisms, several studies have postulated that a potential common genetic background may contribute to the development of both diseases.…”