title: Cardiovascular risk in rheumatoid arthritis.
abstract: The objectives of this review are to discuss data on the cardiovascular risk increase associated with rheumatoid arthritis (RA), the effects of RA treatments on the cardiovascular risk level, and the management of cardiovascular risk factors in patients with RA. Overall, the risk of cardiovascular disease is increased 2-fold in RA patients compared to the general population, due to the combined effects of RA and conventional risk factors. There is some evidence that the cardiovascular risk increase associated with nonsteroidal anti-inflammatory drug therapy may be smaller in RA patients than in the general population. Glucocorticoid therapy increases the cardiovascular risk in proportion to both the current dose and the cumulative dose. Methotrexate and TNFα antagonists diminish cardiovascular morbidity and mortality rates. The management of dyslipidemia remains suboptimal. Risk equations may perform poorly in RA patients even when corrected using the multiplication factors suggested by the EUropean League Against Rheumatism (EULAR) (multiply the score by 1.5 when two of the following three criteria are met: disease duration longer than 10 years, presence of rheumatoid factor or anti-cyclic citrullinated peptide (CCP) antibodies, and extraarticular manifestations). Doppler ultrasonography of the carotid arteries in patients at moderate cardiovascular risk may allow a more aggressive approach to dyslipidemia management via reclassification into the high-risk category of patients with an intima-media thickness greater than 0.9 mm or atheroma plaque.
authors.affiliation: Service de rhumatologie, Hôpital G.-Montpied, 63003 Clermont-Ferrand, France. Electronic address: msoubrier@chu-clermont-ferrand.fr.
authors.forename: Martin
authors.initials: M
authors.lastname: Soubrier
authors.affiliation: Service de cardiologie, Hôpital G.-Montpied, 63003 Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Barber Chamoux
authors.affiliation: Service de rhumatologie, Hôpital G.-Montpied, 63003 Clermont-Ferrand, France.
authors.forename: Zuzana
authors.initials: Z
authors.lastname: Tatar
authors.affiliation: Service de rhumatologie, Hôpital G.-Montpied, 63003 Clermont-Ferrand, France.
authors.forename: Marion
authors.initials: M
authors.lastname: Couderc
authors.affiliation: Service de rhumatologie, Hôpital G.-Montpied, 63003 Clermont-Ferrand, France.
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Dubost
authors.affiliation: Service de rhumatologie, Hôpital G.-Montpied, 63003 Clermont-Ferrand, France.
authors.forename: Sylvain
authors.initials: S
authors.lastname: Mathieu
mesh_terms: D018501:Antirheumatic Agents / Q000009:adverse effects*; D001172:Arthritis, Rheumatoid / Q000188:drug therapy / Q000453:epidemiology* / Q000401:mortality / Q000503:physiopathology; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D012307:Risk Factors
chemical_list: D018501:Antirheumatic Agents
keywords: Cardiovascular risk; Dyslipidemia; Glucocorticoid therapy; NSAID; Rheumatoid arthritis; Risk equation