Cardiovascular Risk in Rheumatoid Arthritis: Considerations on Assessment and Management

Abstract

In the context of holistic therapeutic practices, the cardiovascular risk of patients with rheumatoid arthritis (RA) needs to be addressed as a major factor of compromised disease prognosis and increased mortality. The elevated prevalence of cardiovascular disease (CVD) by more than twofold in RA has been attributed, inter alia, to chronic inflammation exacerbating arterial stiffness, increased onset of hypertension, dyslipidaemia and diabetes mellitus, sedentary lifestyle, and antirheumatic drug complications. CVD risk in RA can be currently assessed by practitioners through accessible adapted calculators, but it remains problematic as their diagnostic accuracy is not superior to calculators designed for the general population. Implementation of guideline-oriented personalised interventions remains the cornerstone for cardiovascular risk management in RA. Remarkably, there is lack of a consortium that brings together different health care providers engaged in the care of patients with RA (e.g., rheumatologists, cardiologists, general practitioners, etc), to guide cardiovascular risk assessment and management. This narrative review aims at providing an overview of current CVD risk assessment and management options, highlighting their pivotal role in the comprehensive treatment of RA patients.

Keywords: cardiovascular risk; cardiovascular risk factors; inflammation; rheumatoid arthritis.

Figure 1.

Effective management of cardiovascular disease (CVD) risk in rheumatoid arthritis (RA) requires a multi-directional approach: 1) adequate management of inflammation and disease control with either conventional or biologic disease modifying antirheumatic drugs, or their combination, taking into account their potential cardiovascular effects, 2) early identification and adequate control of cardiovascular comorbidities (e.g., hypertension, diabetes, dyslipidaemia) with conventional medication (antihypertensive, hypoglycaemic and/or hypolipidemic treatment), and 3) lifestyle interventions aiming at smoking cessation, maintaining optimal body mass index, and adopting healthy diet and systematic exercise. It is important to assess CVD risk and screen for CVD comorbidities regularly in patients with RA, especially at times of flares or modification of antirheumatic treatment (upregulation or downtitration).