DOI: https://doi.org/10.22141/2224-1485.5.61.2018.148786

Management of cardiovascular risk in patients with rheumatoid arthritis

O.O. Khaniukov, Ye.D. Yehudina, O.S. Kalashnykova

Abstract


Rheumatoid arthritis (RA) is a chronic systemic inflammatory condition which leads to joint damage and physical disability. The incidence of cardiovascular diseases (CVD) is markedly increased in patients with rheumatoid arthritis. A very important link between rheumatoid arthritis and CVD is inflammation as it plays a key role in all stages of atherosclerosis: from endothelial dysfunction to plaque rupture and thrombosis. It also has an influence on some traditional cardiovascular risk factors, such as dyslipidaemia, arterial hypertension, obesity and insulin resistance. The latter are also very common among patients with RA and increase CVD risk the same way as in the non-RA population. However, recent guidelines of the European League against Rheumatism recommend aggressive management of traditional risk factors, in addition to RA activity control, to decrease the CVD risk. Several calculators are available for clinical use to stratify the risk of developing CVD. Most of them do not take into account the presence of RA; thus, a multiplication factor of 1.5 is recommended to predict the risk more accurately. While current data suggests a protective effect of biologic and non-biologic disease-modifying anti-rheumatic drugs in terms of cardiovascular events among patients with RA, more data is needed to define this effect more precisely. In this review, issues regarding cardiovascular risk in RA and its management will be addressed, according to evidence presented in the latest studies and our own experience-based opinion.

Keywords


cardiovascular diseases; rheumatoid arthritis; inflammation; atherosclerosis; prevention; treatment

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