The Impact of Traditional Cardiovascular Risk Factors on Cardiovascular Outcomes in Patients with Rheumatoid Arthritis: A Systematic Review and Meta-Analysis

Abstract

BackgroundRheumatoid arthritis (RA) is known to increase the risk of cardiovascular (CV) disease. However, the individual impact of traditional CV risk factors in RA is unknown.ObjectiveTo assess the strength of the association between individual CV risk factors and rate of either myocardial infarction (MI), combined CV morbidity (MI, angina pectoris, heart failure, stroke, and peripheral arterial disease (PAD)) or CV mortality in RA patients.MethodsRA studies reporting traditional CV risk factors [hypertension, type 2 diabetes (T2D), smoking, hypercholesterolaemia, obesity, and physical inactivity] as exposures and MI, CV morbidity (MI, angina, heart failure, stroke, and PAD combined) or CV mortality alone as outcomes were searched until March 2013 using MEDLINE, Scopus and Cochrane. Meta-analyses combined relative risk (RR) estimates from each study where either the RR and 95% confidence intervals or where raw counts were available.ResultsTen studies reporting sufficient data for inclusion into meta-analyses were identified. Relevant data was available for each risk factor and MI and CV morbidity but no studies reported on CV mortality. Risk of MI increased in RA patients with hypertension (RR 1.84, 95% CI 1.38, 2.46) and T2D (RR 1.89, 95% CI 1.36, 2.63). CV morbidity increased with hypertension (RR 2.24, 95% CI 1.42, 3.06), T2D (RR 1.94, 95% CI 1.58, 2.30), smoking (RR 1.50, 95% CI 1.15, 1.84), hypercholesterolaemia (RR 1.73, 95% CI 1.03, 2.44) and obesity (RR 1.16, 95% CI 1.03, 1.29) but not with physical inactivity (RR 1.00, 95% CI 0.71, 1.29).ConclusionHypertension, T2D, smoking, hypercholesterolaemia and obesity increased CV risk in patients with RA. These results highlight the importance of managing CV risk factors in RA, similarly to non-RA patients.

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

“…The risk is influenced by dose and treatment duration, although only within the last 6 months. Recent metaanalytic study showed that RA patients with T2DM were almost two times more likely to experience any CV event compared to non-diabetic patients with RA [25].…”

“…If present, AH may participate in increased CV morbidity and mortality as compared with non-hypertensive RA patients. Carotid intima-media thickness (IMT) was associated with age and systolic blood pressure in RA patients [25]. Moreover, anti-tumor necrosis factor alpha (anti-TNFα) therapy was associated with a significantly increased risk of developing AH in these subjects [31].…”

Prediction of Multifocal Atherosclerosis in Women With Rheumatoid Arthritis

“…Аутоиммунное воспаление при РА приводит к модификации и повышению атерогенности ряда традиционных ФР. В нашем исследовании показано, что комплекс ФР традиционных, гендерных, воспа-лительных влияет на развитие атеросклероза, что подтверждается и рядом других исследований [13]. В свете современной концепции о воспалитель-ной природе атеросклероза интерес представляет изучение кардиоваскулярных эффектов глюкокорти-коидов.…”

According to the Materials of the 2015/2016 New European League Against Rheumatism (Eular) Guidelines for Reducing Cardiovascular Risk in Patients With Inflammatory Arthritis: General Characterization and Discussion Problems

“…Очевидно, что эта область нуждается в проведении дальнейших исследований. АГ является одним из основных модифицируемых ФР ССЗ при ХВА [93]. У пациентов с РА диагностика АГ проводится недостаточно, а лечение гипотензивными пре-паратами не всегда эффективно.…”