Managing Cardiovascular Disease Risk in Rheumatoid Arthritis: Clinical Updates and Three Strategic Approaches

Abstract

The increase in cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) is well known; however, appropriate management of this elevated risk in rheumatology clinics is less clear. Purpose of Review By critically reviewing literature published within the past five years, we aim to clarify current knowledge and gaps regarding CVD risk management in RA. Recent Findings We examine recent guidelines, recommendations, and evidence, and discuss three approaches: (1) RA-specific management including treat-to-target and medication management, (2) assessment of comprehensive individual risk, and (3) targeting traditional CVD risk factors (hypertension, smoking, hyperlipidemia, diabetes, obesity and physical inactivity) at a population level. Considering that 75% of US RA visits occur in specialty clinics, further research is needed regarding evidence-based strategies to manage and reduce CVD risk in RA. Summary This review highlights clinical updates including US cardiology and international professional society guidelines, successful evidence-based population approaches from primary care, and novel opportunities in rheumatology care to reduce CVD risk in RA.

Cardiovascular risk assessment in rheumatoid arthritis with nodulosis: approach to primary prevention

“…Cardiovascular disease remains the most common cause of death in RA (28). Large meta-analyses identified an increase of 48% in cardiovascular events and a 50% higher incidence of mortality from cardiovascular causes in RA patients compared to the general population (29,30).…”

“…Decreasing cardiovascular risk in RA patients may be approached by 3 strategies, as recently proposed by Chodara et al (28): decreasing RA activity, assessing cardiovascular risk using risk calculators, and controlling traditional cardiovascular risk factors. These strategies also form the basis of the "EU-LAR recommendations for cardiovascular disease risk management in patients with RA and other forms of inflammatory joint disorders" (42).…”

Эндотелиотропные Эффекты Методжекта И Ритуксимаба У Больных Ревматоидным Артритом И Гипертонической Болезнью

“…Кроме того, у пациентов с ССЗ в бляшках были идентифицированы цитруллированные пептиды, против которых нацелен АЦЦП [15]. Поэтому на сегодняшний день одной из стратегий контроля над сердечно-сосудистым риском при РА -это контроль активности заболевания [9,14]. В эру раннего агрессивного использования синтетических и биологических базисных противовоспалителных препаратов (БПВП), неясно, изначально ли повышена частота кардиоваскулярных событий при РА или же она возрастает в течении заболевания, сопряженная с увеличением синтеза аутоантител.…”

Patient Perception of Cardiovascular Risk in Rheumatoid Arthritis

“…There are published guidelines for monitoring for CVD in RA (5). Appropriate treatment of RA is an important component of CV risk reduction (6). Studies have also shown improvement in CV health with management of traditional risk factors (4).…”