Ischemic Heart Disease and Rheumatoid Arthritis—Two Conditions, the Same Background

Abstract

Rheumatoid arthritis (RA) is one of the most frequent inflammatory rheumatic diseases, having a considerably increased prevalence of mortality and morbidity due to cardiovascular disease (CVD). RA patients have an augmented risk for ischemic and non-ischemic heart disease. Increased cardiovascular (CV) risk is related to disease activity and chronic inflammation. Traditional risk factors and RA-related characteristics participate in vascular involvement, inducing subclinical changes in coronary microcirculation. RA is considered an independent risk factor for coronary artery disease (CAD). Endothelial dysfunction is a precocious marker of atherosclerosis (ATS). Pro-inflammatory cytokines (such as TNFα, IL-1, and IL-6) play an important role in synovial inflammation and ATS progression. Therefore, targeting inflammation is essential to controlling RA and preventing CVD. Present guidelines emphasize the importance of disease control, but studies show that RA- treatment has a different influence on CV risk. Based on the excessive risk for CV events in RA, permanent evaluation of CVD in these patients is critical. CVD risk calculators, designed for the general population, do not use RA-related predictive determinants; also, new scores that take into account RA-derived factors have restricted validity, with none of them encompassing imaging modalities or specific biomarkers involved in RA activity.

Association of atherogenic indices with C-reactive protein and risk factors to assess cardiovascular risk in rheumatoid arthritis patient at Tikur Anbessa Specialized Hospital, Addis Ababa

“…On the other hand, the value of hsCRP showed a statistically significant elevation among patients as compared to controls ( Table 1 ). It may be due to chronic inflammation, which in turn leads to lipid metabolism derangement [ 13 ]. During the assessment of this study, AIP was also calculated by log (TG/HDL-C).…”

“…In RA patients, chronic inflammation activates dyslipidaemia, which is characterized by an elevated value of LDL-C and a decrease in HDL-C level [ 13 ]. The pathogenesis of RA is mainly associated with chronic inflammation, and it activates lipid profile derangement.…”

The Impaired Elasticity of Large Arteries in Systemic Sclerosis Patients

“…Rheumatic diseases, such as rheumatoid arthritis (RA), were widely studied as independent risk factors for the increase in cardiovascular risk, due to the chronic inflammatory state [ 33 , 34 , 35 ]. In the literature, increased incidence of major adverse cardiovascular events was largely demonstrated for RA patients, in association with long disease duration and scarce disease control [ 33 , 34 , 35 ]. Moreover, it is well known that the chronic inflammatory state leads to endothelial activation/lesion and surface expression of adhesion molecules for migration of leukocytes [ 36 ].…”

“…Moreover, it is well known that the chronic inflammatory state leads to endothelial activation/lesion and surface expression of adhesion molecules for migration of leukocytes [ 36 ]. The inflammatory infiltration of atherosclerotic plaques and progression of vascular injury through the inflammatory pathway may be considered as the primum movens of premature atherosclerosis in RA patients [ 33 , 34 , 35 , 36 ].…”

The Effect of TNF-α on CHD and the Relationship between TNF-α Antagonist and CHD in Rheumatoid Arthritis: A Systematic Review

“…RA is an independent risk factor for the development of CHD [ 127 ], and this can be explained by a prothrombotic state with abnormalities in the coagulation, fibrinolytic systems, and platelet reactivity [ 128 ]. The study provides evidence that the inhibition of fibrinolysis in patients with RA is reduced by TNF- α antagonist [ 129 ].…”