title: Prevention of cardiovascular disease in rheumatoid arthritis.
abstract: The increased risk of cardiovascular disease (CVD) in rheumatoid arthritis (RA) has been recognized for many years. However, although the characteristics of CVD and its burden resemble those in diabetes, the focus on cardiovascular (CV) prevention in RA has lagged behind, both in the clinical and research settings. Similar to diabetes, the clinical picture of CVD in RA may be atypical, even asymptomatic. Therefore, a proactive screening for subclinical CVD in RA is warranted. Because of the lack of clinical trials, the ideal CVD prevention (CVP) in RA has not yet been defined. In this article, we focus on challenges and controversies in the CVP in RA (such as thresholds for statin therapy), and propose recommendations based on the current evidence. Due to the significant contribution of non-traditional, RA-related CV risk factors, the CV risk calculators developed for the general population underestimate the true risk in RA. Thus, there is an enormous need to develop adequate CV risk stratification tools and to identify the optimal CVP strategies in RA. While awaiting results from randomized controlled trials in RA, clinicians are largely dependent on the use of common sense, and extrapolation of data from studies on other patient populations. The CVP in RA should be based on an individualized evaluation of a broad spectrum of risk factors, and include: 1) reduction of inflammation, preferably with drugs decreasing CV risk, 2) management of factors associated with increased CV risk (e.g., smoking, hypertension, hyperglycemia, dyslipidemia, kidney disease, depression, periodontitis, hypothyroidism, vitamin D deficiency and sleep apnea), and promotion of healthy life style (smoking cessation, healthy diet, adjusted physical activity, stress management, weight control), 3) aspirin and influenza and pneumococcus vaccines according to current guidelines, and 4) limiting use of drugs that increase CV risk. Rheumatologists should take responsibility for the education of health care providers and RA patients regarding CVP in RA. It is immensely important to incorporate CV outcomes in testing of anti-rheumatic drugs.
authors.affiliation: Lillehammer Hospital for Rheumatic Diseases, Norway.
authors.forename: I
authors.initials: I
authors.lastname: Hollan
authors.affiliation: Cardiovascular Pathophysiology and Genomics Research Unit, School of Physiology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
authors.forename: P H
authors.initials: PH
authors.lastname: Dessein
authors.affiliation: Department of Pharmacy, University of Parma, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Ronda
authors.affiliation: Department of Rheumatology, West Penn Hospital Allegheny Health Network, USA.
authors.forename: M C
authors.initials: MC
authors.lastname: Wasko
authors.affiliation: Rheumatology Unit, Department of Medicine, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
authors.forename: E
authors.initials: E
authors.lastname: Svenungsson
authors.affiliation: Department of Cardiology, Oslo University Hospital Ullevål, University of Oslo, Oslo, Norway; Institute of Clinical Sciences, University of Oslo, Oslo, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Agewall
authors.affiliation: Clinical and Experimental Immunology, Maastricht University, Maastricht, The Netherlands.
authors.forename: J W
authors.initials: JW
authors.lastname: Cohen-Tervaert
authors.affiliation: Division of Experimental Medicine and Immunotherapeutics, University of Cambridge, Cambridge, United Kingdom.
authors.forename: K
authors.initials: K
authors.lastname: Maki-Petaja
authors.affiliation: Department of Medicine, Innlandet Hospital Trust, Lillehammer, Norway.
authors.forename: M
authors.initials: M
authors.lastname: Grundtvig
authors.affiliation: Division of Rheumatology, Harbor-UCLA Medical Center, Torrance, USA; Los Angeles Biomedical Research Institute, Torrance, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Karpouzas
authors.affiliation: Department of Clinical Sciences and Community Health, University of Milan, Italy; IRCCS Istituto Auxologico Italiano, Italy.
authors.forename: P L
authors.initials: PL
authors.lastname: Meroni
mesh_terms: D000818:Animals; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000188:drug therapy; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D009017:Morbidity; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology
chemical_list: D018501:Antirheumatic Agents