Targeting Inflammation as a Therapeutic Strategy in Accelerated Atherosclerosis in Rheumatoid Arthritis

Abstract

Rheumatoid arthritis (RA) is an autoimmune disease affecting approximately 1% of the population. Patients have reduced life expectancy and the leading cause of death is cardiovascular disease (CVD), with patients experiencing at least a 2‐fold increased risk of myocardial infarction. RA is recognized as an independent risk factor for CVD. Inflammation is a key contributor to the pathogenesis of atherosclerosis and cardiovascular events. As a common catalyst of both diseases, inflammation is the likely cause of increased prevalence of CVD in the RA population. Abating disease‐related inflammation in RA may be an effective strategy in reducing CVD risk. Several other therapies used to modify cardiovascular risk factors in the general population such as statins and angiotensin‐converting enzyme inhibitors are under investigation in patients with RA. This review discusses the parallels in the pathology of RA and atherosclerosis and discusses current therapies for RA and how they affect cardiovascular risk.

Rheumatoid arthritis and risk of acute myocardial infarction—A nationwide retrospective cohort study

“…Table 3 Comparison of AMI incidence by comorbidity and rheumatoid arthritis patients to controls incidence rate ratio and adjusted hazard ratio. with prothrombotic factors and endothelial dysfunction in the development of atherosclerotic CVD in RA patients [4,14,31,32]. Common pro-inflammatory cytokines can appear in the development and progression of both RA and atherosclerosis.…”

“…RA affects 0.5%-1% of the population in Western countries, higher than 0.1% in Taiwan [14][15][16]. In addition to infections and gastrointestinal hemorrhage because of non-steroidal anti-inflammatory drugs, cardiovascular mortality is increased in RA patients [17].…”

Determinants of Brachial-Ankle Pulse Wave Velocity in Chinese Patients with Rheumatoid Arthritis

“…RA patients have up to 3 times increased standard mortality rates in comparison to the general population, and today cardiovascular diseases (CVD) are the leading cause of death [17–19]. Vascular disease may account for one-third of all deaths in RA [20].…”

Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process

“…Although chronic inflammation probably contributes to premature atherosclerosis and endothelial dysfunction (2), improvements in treatment for RA have not consistently translated into reduced cardiovascular disease (CVD) events (3,4). Some authors have recently proposed there may be a trend towards a "widening mortality gap" in RA due to CVD, as survival rates from CV events have improved in the general population but have remained stagnant in RA populations (4,5).…”