Patients with RA have increased mortality compared with the general population mostly due to higher cardiovascular disease (CVD), which is up to 50% more frequent . Even after adjusting for traditional cardiovascular risk factors such as smoking, diabetes and hypertension, the risk for CVD is increased by up to twofold compared with the normal population . Whilst traditional cardiovascular risk factors, contribute to the increased risk of mortality in RA patients, they do not fully explain increase in cardiovascular risk [3,4]. European League Against Rheumatism (EULAR) recommend regular assessment of cardiovascular risk in patients with RA . Since traditional cardiovascular risk factor assessment equations, such as Framingham and the Systematic Coronary Risk Evaluation Score (SCORE) models, underestimate cardiovascular risk in RA, EULAR recommends multiplying such traditional cardiovascular risk scores by 1.5 for patients with RA. Such adjustment operates at the population level. Ideally, cardiovascular biomarkers that can predict future cardiovascular event in the individual patient will improve screening and management.
Biomarkers of cardiovascular disease can be divided into five major categories: lipids, inflammation, endocrine, vascular and prothrombotic . HDL and LDL are used in routine clinical practice. However, they do not predict future cardiovascular events in patients with RA as the levels of HDL and LDL are suppressed during inflammation . The ratio of HDL/LDL or total cholesterol/HDL is less affected by inflammation. Other lipid biomarkers include apolipoprotein A-1, apolipoprotein B, cholesterol ester transfer protein lipoprotein-associated phospholipase A2, small-dense LDL and paraxonase-1. They have been measured in patients with RA but their precise value in predicting cardiovascular risk in RA has not been determined.
High level of inflammation as measured by ESR and CRP is associated with increased cardiovascular risk in patients with RA. EULAR recommended adequate suppression of inflammation as a key strategy to reduce cardiovascular events . Disease flares increased cumulative cardiovascular risk . Many inflammatory mediators are elevated in RA, whether they can add to traditional cardiovascular risk score to improve individual risk prediction should be evaluated.
The vascular biomarker of cardiovascular disease, VCAM-1, has also been shown to elevated in patients with RA. High level of VCAM-1 was associated with high cardiovascular risk score[ix].
Metabolic syndrome is common in patients with inflammatory arthritis. Insulin resistance is a feature of metabolic syndrome. Fibrinogen and other prothrombotic molecules are part of the acute phase response, their levels are elevated in RA. Neither endocrine nor prothrombotic factors have been studied systematically in RA.
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Disclosure of Interest E. Choy Grant/research support from: Roche, UCB, Pfizer, Biocancer, Consultant for: Amgen, Biogen, BMS, Boehringer Ingelheim, Celgene, Chugai Pharma, Eli Lilly, Hospita, I Janssen, Napp, Novimmune, Novartis, Pfizer, Regeneron, Roche, R-Pharm, Sanofi-Aventis, Tonix and UCB., Speakers bureau: Amgen, BMS, Boehringer Ingelheim, Chugai Pharma, Eli Lilly, Hospira, MSD, Novartis, Pfizer, Regeneron, Roche, Sanofi-Aventis, and UCB.