Remission is the goal for cardiovascular risk management in patients with rheumatoid arthritis: a cross-sectional comparative study

Provan, Sella Aarrestad; Semb, Anne Grete; Hisdal, Jonny; Stranden, Einar; Agewall, Stefan; Dagfinrud, Hanne; Angel, Kristin; Atar, Dan; Kvien, Tore K

doi:10.1136/ard.2010.141523

Cited by 108 publications

(75 citation statements)

References 51 publications

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“…Others have shown similar cardiovascular disease risk stratifications based on rheumatoid arthritis disease activity 174. In the RORA-AS trial, lower rheumatoid arthritis disease activity was associated with greater carotid plaque regression 164…”

Section: Management and Prevention Of Cardiovascular Disease In Rheummentioning

confidence: 92%

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

England

Thiele

Anderson

et al. 2018

BMJ

378

266

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Rheumatoid arthritis is a systemic autoimmune disease characterized by excess morbidity and mortality from cardiovascular disease. Mechanisms linking rheumatoid arthritis and cardiovascular disease include shared inflammatory mediators, post-translational modifications of peptides/proteins and subsequent immune responses, alterations in the composition and function of lipoproteins, increased oxidative stress, and endothelial dysfunction. Despite a growing understanding of these mechanisms and their complex interplay with conventional cardiovascular risk factors, optimal approaches of risk stratification, prevention, and treatment in the context of rheumatoid arthritis remain unknown. A multifaceted approach to reduce the burden posed by cardiovascular disease requires optimal management of traditional risk factors in addition to those intrinsic to rheumatoid arthritis such as increased disease activity. Treatments for rheumatoid arthritis seem to exert differential effects on cardiovascular risk as well as the mechanisms linking these conditions. More research is needed to establish whether preferential rheumatoid arthritis therapies exist in terms of prevention of cardiovascular disease. Ultimately, understanding the unique mechanisms for cardiovascular disease in rheumatoid arthritis will aid in risk stratification and the identification of novel targets for meaningful reduction of cardiovascular risk in this patient population.

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Section: Management and Prevention Of Cardiovascular Disease In Rheummentioning

confidence: 92%

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

England

Thiele

Anderson

et al. 2018

BMJ

378

266

View full text Add to dashboard Cite

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“…Some authors consider it to be a sensitive noninvasive predictor of subclinical CVD in these patients and a predictor of all-cause mortality independent of traditional CV risk factors [61]. There is evidence that NT-proBNP is increased in RA patients and it is associated with inflammatory markers [35,61]. However, some studies did not demonstrate relationship between NTproBNP levels and LV function in RA patients.…”

Section: Rheumatoid Arthritis and Heart Failurementioning

confidence: 96%

“…Dyslipidemia, commonly observed in patients with active RA, appears to be present very early in the disease development. Majority of studies detected lower total cholesterol (TC) levels as well as lower levels of highdensity lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) in RA patients as compared with non-RA subjects, although overall incidence of dyslipidemia was higher in RA [27,[33][34][35]. Only some studies demonstrated typical atherogenic lipid profile in these patients [36,37].…”

Section: Dyslipidemiamentioning

confidence: 97%

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

Lazúrová

Tomáš

2016

Clinic Rev Allerg Immunol

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There is evidence that rheumatoid arthritis (RA) is associated with higher overall and cardiovascular (CV) morbidity and mortality as compared with general population. Increased prevalence of traditional risk factors and chronic inflammation, that has been recognized as independent CV risk factor, may play an important role in atherosclerosis and subsequently ischemic heart disease development. However, myocardial dysfunction as a result of chronic inflammation and secondarily myocardial fibrosis markedly participates on heart failure development. Proinflammatory cytokines, such as C-reactive protein, tumor necrosis factor alpha (TNFα), interleukins 1 and 6, that are markedly increased in RA, play a role in the acceleration of atherosclerosis as well as myocardial fibrosis development. Several studies documented that increased CV risk was associated with seropositivity, disease activity score, citrullination, and duration of RA. Early detection of heart dysfunction is based on echocardiographic detection of diastolic dysfunction resulting from myocardial inflammation and fibrosis. Some studies showed also higher prevalence of left ventricular systolic dysfunction and increased prevalence of cardiac arrhythmias as compared to non-RA population. There are still controversies on the impact of NT-proBNP in predicting cardiac impairment in RA patients. Some authors consider it to be a sensitive noninvasive predictor of subclinical CV disease in these patients and also a predictor of all-cause mortality independently on traditional CV risk factors. However, the correlation with parameters of cardiac function was confirmed only in a few studies. The impact of biological treatment on progression of atherosclerosis and heart failure is still controversial and seems to be not harmful in young patients with normal left ventricular function. The effect of biologics, especially anti-TNFα drugs, is probably related to the cardiac function before treatment. Larger prospective clinical, echocardiographic, and magnetic resonance studies are needed.

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“…In addition, certain drugs may have additional benefits (and some harm) with regard to cardiovascular safety in RA. Provan et al [22 ] found that patients with active RA had significantly increased brachial and central systolic pressure compared to RA patients in remission and healthy controls [22 ]. In contrast, patients in remission did not differ from controls on most of the vascular function measures assessed but did have reduced aortic pulse wave velocity (PWV) when compared to healthy controls.…”

Section: Conventional Disease Modifying Antirheumatic Drugs and Cardimentioning

confidence: 96%

Cardiovascular risk factors in inflammatory arthritis

Mirjafari

Alhusain

Bruce

2011

Current Opinion in Lipidology

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Remission is the goal for cardiovascular risk management in patients with rheumatoid arthritis: a cross-sectional comparative study

Cited by 108 publications

References 51 publications

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

Increased cardiovascular risk in rheumatoid arthritis: mechanisms and implications

Cardiac Impairment in Rheumatoid Arthritis and Influence of Anti-TNFα Treatment

Cardiovascular risk factors in inflammatory arthritis

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