Monitoring and Managing Cardiovascular Risk in Immune Mediated Inflammatory Diseases

Abstract

Cardiovascular disease (CVD) is common in immune-mediated inflammatory diseases (IMIDs) and it is predominately attributed to the interplay between chronic inflammation and traditional CVD risk factors. CVD has significant impact on the survival of patients with IMIDs as it is associated with increased morbidity and mortality. Despite recommendations for monitoring and managing CVD in patients with IMIDs, the individual CVD risk assessment remains problematic as CVD risk calculators for the general population consistently underestimate the risk in patients with IMIDs. Application of new technologies utilizing artificial intelligence techniques have shown promising potential for tailoring predictive medicine to the individual patient, but further validation of their role in clinical decision-making is warranted. In the meantime, individuals with IMIDs should be encouraged to adopt behavioral interventions targeting at modifiable lifestyle CVD risk factors, whereas rheumatologists need to be well aware of the unfavorable effects of antirheumatic medication on various CVD risk factors and outcomes. In the current paper, we aim to provide an overview of current and emerging strategies for mitigating CVD risk in patients with IMIDs, based on a practical approach.

Keywords: cardiovascular risk assessment; chronic inflammatory diseases; lifestyle modifications; pharmacological management.

Figure 1

Factors implicated in the pathogenesis of increased cardiovascular disease (CVD) risk in patients with immune-mediated inflammatory diseases. Traditional CVD risk factors, disease-related factors triggered by the dysregulation of innate immunity, and the current and cumulative inflammatory burden, act synergistically and promote the pathophysiological processes of endothelial dysfunction, arterial stiffness and oxidative stress. The mutual interplay of these factors eventually leads to accelerated atherosclerosis, subclinical micro- and macrovascular damage and subsequently, clinically evident CVD.

Figure 2

The three pillars of cardiovascular disease (CVD) risk management in patients with IMIDs: 1) effective control of inflammation, 2) lifestyle modifications targeting at modifiable CVD risk factors, and 3) simultaneous control of cardiovascular comorbidities. Positive interactions between these interventions are expected not only towards modulation of CVD risk, but also towards substantial improvement of patients’ general health and well-being. At the same time, individual CVD risk needs to be determined and regularly reassessed according to the presence of cardiovascular comorbidities, the current and cumulative inflammatory load, and the cardiovascular effects of antirheumatic medication.