The risk for fatal and non-fatal cardiovascular disease (CVD) in patients with rheumatoid arthritis (RA) is doubled in comparison with the general population. This excess cardiovascular risk is largely due to CVD of atherosclerotic origin such as ischemic heart disease. Cardiovascular risk data in two other major chronic types of inflammatory arthritis, belonging to the spondyloarthropathies, i.e. ankylosing spondylitis (AS) and psoriatic arthritis (PsA), is much more limited than in RA, but there is accumulating evidence that the magnitude might approach that of RA. For RA there is evidence that this enhanced cardiovascular risk is similar to that of diabetes mellitus (DM), a well known and established cardiovascular risk factor.
Research has proven that risk factors for CVD, like high cholesterol, hypertension, smoking, obesity and diabetes are not the only factors responsible for the higher cardiovascular risk in RA, AS and PsA patients. Accumulating evidence indicates that inflammation plays an important role as atherosclerosis is in fact an inflammatory disease. Another important factor is undertreatment of cardiovascular comorbidity such as hypertension, for example, in RA there is accumulating evidence that hypertension is frequently undertreated (as well as unrecognized).
There are some indications that the cardiovascular mortality in patients with osteoarthritis (OA) is increased up to 70% in comparison with the general population. Remarkably, adequate data about the cardiovascular morbidity (i.e. non-fatal cardiovascular events) in OA are lacking. However, there is abundant evidence that traditional cardiovascular risk factors such as hypertension and dyslipidemia are more prevalent. In contrast to patients with inflammatory arthritis, there appears no independent role of OA itself towards its increased cardiovascular risk.
Recently, gout is emerging as an independent cardiovascular risk factor probably mediated by the toxic effect of uric acid on the vasculature.
Altogether, more cardiovascular attention is needed for the above-mentioned patient groups. This particularly holds true for inflammatory arthritis patients, for which the EULAR considers cardiovascular risk management (CV-RM) mandatory.This is generally done on the basis of the 10 years absolute risk for a (fatal) CV-event, which is calculated from a CV-risk formula, such as the Framingham risk calculator and the Systematic Coronary Risk Evaluation (SCORE), based on CV-risk factors. Statin and/or antihypertensive treatment is then only initiated above a certain threshold, e.g. a 10-year CV-mortality risk of 10% or more.
Obviously, CV-RM should be a collaborative effort of rheumatologists, vascular internists and/or cardiologists and general practitioners, in close collaboration with patients (organisations). The precise implementation might differ from country to country and even from practice to practice.
Disclosure of Interest None Declared
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