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Patients with a range of rheumatic diseases are at increased risk of cardiovascular disorders towards a re-evaluation of the European League against Rheumatism (EULAR)’s recommendations for cardiovascular risk management?
  1. Nathalie Conrad1,
  2. Iain B McInnes2,
  3. John J V Mcmurray3,
  4. Naveed Sattar3
  1. 1 Department of Public Health and Primary Care, KU Leuven, Leuven, Flanders, Belgium
  2. 2 College of Medical, Veterinary & Life Sciences, University of Glasgow, Glasgow, UK
  3. 3 School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow, UK
  1. Correspondence to Professor Naveed Sattar, School of Cardiovascular & Metabolic Health, University of Glasgow, Glasgow G12 8TA, UK; Naveed.Sattar{at}; Dr Nathalie Conrad; nathalie.conrad{at}

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The notion that patients with rheumatic disorders are at increased risk of developing cardiovascular diseases has been ongoing for many years and has sparked much debate concerning whether and when to initiate cardiovascular prevention therapies.

The initiation of preventive therapies, such as blood pressure lowering drugs or statins, is usually recommended in patients at high risk of developing adverse cardiovascular outcomes. Accurately assessing an individual’s cardiovascular risk is hence important. Until now, the modest size and duration of follow-up of available cohorts have been a barrier to precise quantification of cardiovascular risk in specific rheumatic disorders.1 In particular, there is a lack of robust evidence about the rates of cardiovascular morbidity and mortality among people with diseases such as vasculitis, systemic sclerosis, or Sjögren’s syndrome, and emerging evidence for excess risk in patients with systemic lupus erythematosus has not been validated in external cohorts.2 The best evidence is available for rheumatoid arthritis, which has been shown to increase cardiovascular risk by approximately 50% beyond that explained by established risk factors.3 As a result, the current cardiovascular disease prevention guidelines from the European Society of Cardiology (2021) recommend a lower threshold for the initiation of preventive therapies in adults with rheumatoid arthritis, by multiplying patients’ calculated risk score by 1.5, but make no mention of risk multipliers for other rheumatic diseases.4 The recent update of the European Alliance of Associations for Rheumatology (EULAR)’s recommendations (2022) did not endorse the use of any specific cardiovascular risk assessment tool nor risk multipliers for conditions beyond rheumatoid arthritis—although a thorough assessment of cardiovascular risk is recommended.5

A recent large-scale epidemiological study brings new evidence to this important clinical challenge. Using electronic health record data from 22 million individuals in the UK,6 Conrad et al examined 19 autoimmune disorders, including …

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  • NC and NS contributed equally.

  • Contributors All authors contributed to designing the report, drafting the manuscript and the revisions. NS and NC had full access to the data in the study and had final responsibility for the decision to submit for publication. All authors gave final approval of the version to be published.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests NC declares support from European Union’s Horizon 2020 under the Marie Sklodowska-Curie Actions programme (grant agreement No 843267) and from European Society of Cardiology (grant number App000037070); grant funding paid to her institution from Research Foundation Flanders (FWO) (grant number 12ZU922N); and royalties on the intellectual property of a home-monitoring system for patients with heart failure paid to Oxford University Innovation. IBM declares honoraria from AbbVie; grant support paid to his university from AstraZeneca and Eli Lilly; participation on data safety monitoring boards/advisory boards of AstraZeneca, BMS, Eli Lilly, Novartis, Janssen, GSK, AbbVie, Cabaletta, Compugen, Causeway, Gilead, Moonlake, Reflexion, UCB, XinThera; patents from Novartis; leadership roles with Evelo, Versus Arthritis, and Greater Glasgow and Clyde Health Board; and stock or stock options with Evelo, Compugen, and Cabaletta. JJVM has received funding to his institution from Amgen and Cytokinetics for his participation in the Steering Committee for the ATOMIC-HF, COSMIC-HF, and GALACTIC-HF trials and meetings and other activities related to these trials; has received payments through Glasgow University from work on clinical trials, consulting and other activities from Alnylam, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol Myers Squibb, Cardurion, Dal-Cor, GlaxoSmithKline, Ionis, KBP Biosciences, Novartis, Pfizer, and Theracos; has received personal lecture fees from the Corpus, Abbott, Hikma, Sun Pharmaceuticals, Medscape/Heart.Org, Radcliffe Cardiology, Servier Director, and Global Clinical Trial Partners (GCTP). NS declares consulting fees and/or speaker honoraria from Abbott Laboratories, Afimmune, Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, Hanmi Pharmaceuticals, Janssen, Merck Sharp & Dohme, Novartis, Novo Nordisk, Pfizer, Roche Diagnostics, and Sanofi; and grant support paid to his university from AstraZeneca, Boehringer Ingelheim, Novartis, and Roche Diagnostics. The views expressed are those of the authors and not necessarily those of the funders.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Commissioned; externally peer reviewed.