title: Cardiovascular risk in rheumatoid arthritis: how to lower the risk?
abstract: Patients with rheumatoid arthritis (RA) carry an excess risk for cardiovascular disease, which is comparable to the risk in patients with type 2 diabetes mellitus. The mechanisms involved are partly related to traditional cardiovascular risk factors, disease-associated inflammation and undertreatment of traditional cardiovascular disease (CVD) risk factors. Since atherosclerosis is an inflammatory disease, the auto-immune mediated inflammation observed in RA patients contributes to increased endothelial dysfunction, oxidative stress and activation and vascular migration of leukocytes. This concept is underscored by the CVD risk reduction that is seen by anti-inflammatory disease modifying anti-rheumatic drugs such as methotrexate and TNFα inhibitors. The evidence for underdiagnosis and undertreatment of traditional CVD risk factors in RA strengthens the potential benefit of structured CVD risk management in these patients. Current cardiovascular guidelines recommend screening and treatment of CVD risk factors in RA patients, without well defined treatment targets. At present, there is a lack of scientific evidence to establish treatment targets for CVD risk factors in RA. Therefore, expanding research regarding screening and treatment of traditional CVD risk factors in RA patients is needed.
authors.affiliation: Department of Rheumatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands. Electronic address: d.vanderstoep@sfg.nl.
authors.forename: D F
authors.initials: DF
authors.lastname: van Breukelen-van der Stoep
authors.forename: B
authors.initials: B
authors.lastname: Klop
authors.forename: D
authors.initials: D
authors.lastname: van Zeben
authors.forename: J M W
authors.initials: JM
authors.lastname: Hazes
authors.forename: M
authors.initials: M
authors.lastname: Castro Cabezas
mesh_terms: D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D050197:Atherosclerosis / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000188:drug therapy; D008727:Methotrexate / Q000627:therapeutic use; D012307:Risk Factors; D040242:Risk Reduction Behavior; D014409:Tumor Necrosis Factor-alpha / Q000037:antagonists & inhibitors
chemical_list: D018501:Antirheumatic Agents; D014409:Tumor Necrosis Factor-alpha; D008727:Methotrexate
keywords: Atherosclerosis; Cardiovascular risk factor; DMARD; Rheumatoid arthritis; TNFα