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Review
. 2010 Jan;69 Suppl 1(0 1):i61-64.
doi: 10.1136/ard.2009.119404.

Heart disease and rheumatoid arthritis: understanding the risks

S E Gabriel  1
Affiliations
Review

Heart disease and rheumatoid arthritis: understanding the risks

S E Gabriel. Ann Rheum Dis. 2010 Jan.

Abstract

Patients with rheumatoid arthritis (RA) are at increased risk of mortality compared with the general population. Evidence suggests that this increased mortality can largely be attributed to increased cardiovascular death. In a retrospective study of an inception cohort of RA patients in Rochester, MN, the contribution of traditional and RA-specific risk factors was investigated to this increased risk of cardiovascular morbidity and mortality. Several traditional cardiovascular risk factors were found to behave differently in RA patients. In addition, their associations with cardiovascular disease are weaker in RA patients as increased inflammation associated with RA also appears to contribute substantially to the increased cardiovascular mortality. Furthermore, the impact of disease-modifying antirheumatic drugs and biologicals on cardiovascular disease in RA patients is unclear. Cardiovascular risk scores for the general population may underestimate the risk for RA patients. Together with other studies that have demonstrated similar associations between RA and cardiovascular mortality, these data suggest that optimal control of cardiovascular risk factors is important, but not sufficient in RA patients. RA-specific cardiovascular risk prediction tools are needed, as well as clinical trials to assess the impact of therapies and tight control of inflammation in RA patients on cardiovascular outcomes and mortality.

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Figures

Figure 1
Figure 1
Relative Impact of Traditional CV Risk Factors on Combined CV Endpoint in RA and Non-RA Subjects[3].
Figure 2
Figure 2
Traditional CV Risk Factors in RA COMPARED TO NON RA SUBJECTS – Paradoxical effect of BMI. Arthritis Rheum 2004;50(11);3453. Permission to reprint requested from John Wiley & Sons, Inc.
Figure 3
Figure 3
Traditional CV Risk Factors – Paradoxical Effect of Lipids
Figure 4
Figure 4
How much of the Heart Failure Risk is Attributable to all CV Risk Factors and IHD together in RA compared to non RA subjects? Arthritis Rheum 2005;52(10);3042. Permission to reprint requested from John Wiley & Sons, Inc.
See this image and copyright information in PMC

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