Rheumatoid arthritis and cardiovascular disease

Area of Science:

• Rheumatology
• Cardiology
• Immunology

Background:

• Rheumatoid arthritis (RA) is a chronic systemic inflammatory disease affecting ~1% of adults.
• Cardiovascular disease (CVD) is the leading cause of death in RA patients, responsible for ~40% of mortality.
• RA patients have a 2-3x increased risk of myocardial infarction and stroke, independent of traditional CVD risk factors.

Purpose of the Study:

• To discuss the pathogenic mechanisms underlying accelerated atherosclerosis in RA.
• To review the effects of common RA therapies on cardiovascular risk.
• To provide a therapeutic perspective for managing CVD in RA patients.

Main Methods:

• Literature review of pathogenic mechanisms in RA-associated CVD.
• Analysis of studies on the impact of methotrexate, TNF antagonists, steroids, and statins on CVD risk in RA.
• Synthesis of current understanding of immune and non-immune pathways contributing to CVD in RA.

Main Results:

• Accelerated atherosclerosis in RA is driven by pro-oxidative dyslipidemia, insulin resistance, prothrombotic state, and immune mechanisms.
• T-cell activation leads to endothelial dysfunction, reduced endothelial progenitor cells, and arterial stiffness.
• Congestive heart failure contributes more to excess mortality than ischemia in RA patients.

Conclusions:

• RA patients exhibit a heightened CVD risk due to specific pathogenic pathways.
• Therapeutic strategies targeting inflammation and traditional CVD risk factors are essential.
• Further research into novel therapeutic approaches is warranted to mitigate CVD burden in RA.