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Review
. 2021 May 13:16:e18.
doi: 10.15420/ecr.2020.44. eCollection 2021 Feb.

Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Impact of Inflammation and Antirheumatic Treatment

Anne Mirjam Kerola  1   2 , Silvia Rollefstad  1 , Anne Grete Semb  1
Affiliations
Review

Atherosclerotic Cardiovascular Disease in Rheumatoid Arthritis: Impact of Inflammation and Antirheumatic Treatment

Anne Mirjam Kerola et al. Eur Cardiol. .

Abstract

Patients with rheumatoid arthritis (RA) are at approximately 1.5-fold risk of atherosclerotic cardiovascular disease (CVD) compared with the general population, a phenomenon resulting from combined effects of traditional CVD risk factors and systemic inflammation. Rheumatoid synovitis and unstable atherosclerotic plaques share common inflammatory mechanisms, such as expression of proinflammatory cytokines interleukin (IL)-1, tumour necrosis factor (TNF)-α and IL-6. RA patients are undertreated in terms of CVD prevention, and structured CVD prevention programmes are warranted. Alongside management of traditional risk factors, suppressing systemic inflammation with antirheumatic medication is fundamental for the reduction of CVD risk among this high-risk patient group. Many antirheumatic drugs, especially methotrexate, TNF-α-inhibitors and IL-6-inhibitors are associated with reduced risk of CVD in observational studies among RA patients, but randomised controlled trials with hard CVD endpoints are lacking. In patients without rheumatic disease, anti-inflammatory therapies targeting nucleotide-binding oligomerisation domain, leucine-rich repeat and pyrin domain-containing protein 3 inflammasome and the IL-1/IL-6 pathway arise as potential therapies after an atherosclerotic CVD event.

Keywords: Rheumatoid arthritis; antirheumatic agents; atherosclerosis; cardiovascular disease; inflammation.

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Conflict of interest statement

Disclosure: This work was supported by research grants from the Foundation for Research in Rheumatology (FOREUM; AMK) and by grants from the South Eastern Regional Health Authorities of Norway (2016063 for SR and 2013064 for AGS). AMK has received speaker’s fees or congress sponsorship from Boehringer-Ingelheim, Pfizer, Celgene, UCB Pharma and Mylan, and attended advisory boards of Pfizer, Gilead and Boehringer-Ingelheim. AGS has received speaker honoraria and/or consulting fees from Sanofi, AbbVie, Novartis, Bayer and Lilly. SR has no conflicts of interest to declare.

Figures

Figure 1:
Figure 1:. Central Inflammatory Mediators in Rheumatoid Synovitis and Atherosclerosis
Figure 2:
Figure 2:. The Inverse Relationship Between Changes in Inflammatory and Lipid Parameters
Figure 3:
Figure 3:. The Interplay Between Synovial and Systemic Inflammation and Cardiovascular Risk Factors in Rheumatoid Arthritis
See this image and copyright information in PMC

References

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