Inflammatory rheumatic diseases, particularly rheumatoid arthritis but also the spondyloarthropathies (SpA), associate with increased cardiovascular disease (CVD) morbidity and mortality. There appears to be a gradient, with the risk of CVD death being increased by 50-70% in RA compared to the general population, followed by smaller, but still significant increases in Psoriatic Arthritis and then Ankylosing spondylitis. The reasons for this have been subject to intensive scrutiny in the last decade, and a picture appears to be emerging. Classical CVD risk factors, including hypertension, dyslipidaemia, insulin resistance, altered body composition/obesity and decreased physical activity are more prevalent in these conditions and may contribute to the increased risk. Systemic inflammation, characteristic of all these conditions, also plays a role but it remains unclear whether this is due to direct effects on the vasculature or mediated through effects on the classical risk factors. Observational studies suggest that the more effective the control of inflammation, the better the cardiovascular outcomes appear to be, but this needs to be confirmed in prospective studies designed specifically for the purpose. Assessment of CVD risk in these conditions remains a challenge, as the widely used in the general population risk algorithms all underestimate actual risk in people with inflammatory rheumatic diseases: disease specific risk algorithms need to be developed and validated, so that they can then be used to inform effective prevention strategies. Such strategies also remain elusive and not validated at present, but they are likely to include a two-pronged approach: systematic identification and management of classical CVD risk factors, together with effective control of systemic inflammation.
Disclosure of Interest None Declared
Statistics from Altmetric.com
If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.