Rheumatoid arthritis and cardiovascular disease.
Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting approximately 1% of the adult general population. Cardiovascular disease is recognized as the leading cause of death in RA patients, accounting for nearly 40% of their mortality. Patients with RA are at a twofold increased risk for myocardial infarction and stroke, with risk increasing to nearly threefold in patients who have had the disease for 10 years or more. Congestive heart failure appears to be a greater contributor to excess mortality than ischemia. This increased cardiovascular disease risk in RA patients seems to be independent of traditional cardiovascular risk factors. Pathogenic mechanisms include pro-oxidative dyslipidemia, insulin resistance, prothrombotic state, hyperhomocysteinemia, and immune mechanisms such as T-cell activation that subsequently lead to endothelial dysfunction, a decrease in endothelial progenitor cells, and arterial stiffness, which are the congeners of accelerated atherosclerosis observed in RA patients. This paper discusses pathogenic mechanisms, effects of methotrexate, tumor necrosis factor antagonists, steroids, and statins, with a perspective on therapy.
Dhawan
Saurabh S
SS
Division of Cardiology, Department of Medicine, Emory University, 1364 Clifton Road NE, Suite 403C, Atlanta, GA 30322, USA.
Quyyumi
Arshed A
AA
D001172:Arthritis, Rheumatoid / Q000453:epidemiology*; D015496:CD4-Positive T-Lymphocytes; D018414:CD8-Positive T-Lymphocytes; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood; D050171:Dyslipidemias / Q000097:blood; D004730:Endothelium, Vascular / Q000503:physiopathology; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D020138:Hyperhomocysteinemia / Q000453:epidemiology; D007333:Insulin Resistance / Q000502:physiology; D009203:Myocardial Infarction / Q000453:epidemiology; D018570:Risk Assessment; D013234:Stem Cells / Q000502:physiology
D008076:Cholesterol, HDL; D008078:Cholesterol, LDL