title: Cardiovascular risk and rheumatoid arthritis: clinical practice guidelines based on published evidence and expert opinion.
abstract: OBJECTIVE
  To develop clinical practice guidelines for the evaluation and management of cardiovascular risk in patients with rheumatoid arthritis (RA), using the evidence-based approach and expert opinion.
  
  
  METHODS
  Recommendations were developed using the evidence-based approach and expert opinion: A scientific committee used a Delphi procedure to select five questions, which formed the basis for developing the recommendations; Evidence providing answers to the five questions was sought in the literature; Based on this evidence, recommendations were developed by a panel of experts.
  
  
  RESULTS
  The recommendations were as follows: 1) In patients with RA, attention should be given to the risk of cardiovascular disease, which is responsible for an excess burden of morbidity and mortality; 2) It must be recognized that RA may be an independent cardiovascular risk factor. Persistent inflammation is an additional risk factor; 3) The cardiovascular risk should be evaluated, and modifiable risk factors should be corrected; 4) In patients with RA requiring glucocorticoid therapy, the need for cardiovascular risk minimization is among the reasons that mandate the use of the minimal effective dose; 5) It should be recognized that methotrexate may protect against cardiovascular mortality in patients with RA; 6) It should be recognized that TNFalpha antagonists remain contraindicated in patients with RA and severe heart failure. TNFalpha antagonists do not seem to worsen moderate heart failure and may protect against cardiovascular mortality; 7) AFSSAPS recommendations about LDL-cholesterol objectives should be followed, with active RA being counted as a cardiovascular risk factor; 8) In patients with RA, statin therapy should be considered only when cholesterol levels are elevated despite appropriate dietary treatment; 9) RA per se does not indicate aspirin for primary prevention. When aspirin is used for secondary prevention, it should be recognized that concomitant treatment with nonsteroidal antiinflammatory drugs (NSAIDs) may decrease the antiplatelet effects and increase the gastrointestinal side effects of aspirin therapy.
authors.affiliation: Service de rhumatologie, CHU de la Conception, Marseille, France.
authors.forename: Thao
authors.initials: T
authors.lastname: Pham
authors.forename: Laure
authors.initials: L
authors.lastname: Gossec
authors.forename: Arnaud
authors.initials: A
authors.lastname: Constantin
authors.forename: Stephan
authors.initials: S
authors.lastname: Pavy
authors.forename: Eric
authors.initials: E
authors.lastname: Bruckert
authors.forename: Alain
authors.initials: A
authors.lastname: Cantagrel
authors.forename: Bernard
authors.initials: B
authors.lastname: Combe
authors.forename: René-Marc
authors.initials: RM
authors.lastname: Flipo
authors.forename: Philippe
authors.initials: P
authors.lastname: Goupille
authors.forename: Xavier
authors.initials: X
authors.lastname: Le Loët
authors.forename: Xavier
authors.initials: X
authors.lastname: Mariette
authors.forename: Xavier
authors.initials: X
authors.lastname: Puéchal
authors.forename: Thierry
authors.initials: T
authors.lastname: Schaeverbeke
authors.forename: Jean
authors.initials: J
authors.lastname: Sibilia
authors.forename: Jacques
authors.initials: J
authors.lastname: Tebib
authors.forename: Daniel
authors.initials: D
authors.lastname: Wendling
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
mesh_terms: D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D015995:Prevalence; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000894:Anti-Inflammatory Agents, Non-Steroidal; D005938:Glucocorticoids; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007166:Immunosuppressive Agents; D008727:Methotrexate