Where the immune response meets the vessel wall

Immune-mediated inflammatory diseases (IMIDs), including rheumatoid arthritis and spondyloarthritis, are associated with increased cardiovascular morbidity and mortality, independent of the established cardiovascular risk factors. The chronic inflammatory state, a hallmark of IMIDs, is considered to be a driving force for accelerated atherogenesis. Consequently, aggressive control of disease activity has been suggested to be instrumental for cardiovascular risk reduction. Specific guidelines for cardiovascular risk reduction in patients with IMIDs, particularly rheumatoid arthritis, are lacking, largely due to the absence of randomised clinical trial data. In this review, we focus on pathophysiology and observational evidence of cardiovascular risk in different prototypes of IMIDs.