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Epidemiology of CVD in rheumatic disease, with a focus on RA and SLE

Deborah P M Symmons¹, Sherine E Gabriel

¹Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Center, University of Manchester, Oxford Road, Manchester M13 0PT, UK. deborah.symmons@ manchester.ac.uk

Nature Reviews. Rheumatology

|June 2, 2011

Insights

Patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) face higher cardiovascular disease (CVD) risks. Standard risk assessments may underestimate CVD in these inflammatory rheumatic diseases, necessitating aggressive management.

Area of Science:

Rheumatology
Cardiology
Immunology

Background:

Inflammatory rheumatic diseases like rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE) are linked to increased cardiovascular disease (CVD) risk and mortality.
Cardiovascular disease accounts for over 50% of premature deaths in RA patients and contributes to a significant portion of excess mortality in SLE patients, particularly later in life due to atherosclerosis.
Patients with RA and SLE experience higher rates of nonfatal ischemic heart disease, and their management of conditions like myocardial infarction and heart failure differs from the general population.

Purpose of the Study:

To highlight the elevated cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
To discuss the limitations of traditional cardiovascular risk factors (TRFs) and standard risk scores in accurately assessing CVD risk in these patient populations.
To provide recommendations for managing CVD risk in patients with RA and SLE.

Main Methods:

Review of existing literature on cardiovascular disease (CVD) risk in patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
Analysis of the prevalence and impact of traditional cardiovascular risk factors (TRFs) in these specific patient groups.
Comparison of CVD risk assessment tools and management strategies for RA/SLE patients versus the general population.

Main Results:

Patients with RA and SLE exhibit significantly higher mortality rates compared to the general population, largely due to CVD.
Traditional cardiovascular risk factors (TRFs) show altered prevalence and paradoxical relationships in RA and SLE patients, leading to underestimation of CVD risk by standard scores.
The management and outcomes of cardiovascular events differ in RA and SLE patients.

Conclusions:

Standard cardiovascular risk prediction tools are inadequate for patients with rheumatoid arthritis (RA) and systemic lupus erythematosus (SLE).
Aggressive management of disease activity and thorough screening for and treatment of traditional cardiovascular risk factors are crucial.
Further research is needed to develop disease-specific risk prediction tools for these inflammatory rheumatic diseases.

Read full analysis

Abstract:

The excess risk of cardiovascular disease (CVD) associated with inflammatory rheumatic diseases has long been recognized. Patients with established rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) have higher mortality compared with the general population. Over 50% of premature deaths in RA are attributable to CVD. Excess mortality in SLE follows a bimodal pattern, with the early peak predominantly a consequence of active lupus or its complications, and the later peak largely attributable to atherosclerosis. Patients with RA or SLE are also at increased risk of nonfatal ischemic heart disease. The management and outcome of myocardial infarction and congestive heart failure in patients with RA or SLE differs from that in the general population. Traditional CVD risk factors (TRF) include increasing age, male gender, smoking, hypertension, hypercholesterolemia and diabetes. Whereas some TRFs are elevated in patients with RA or SLE, several are not, and others exhibit paradoxical relationships. Risk scores developed for the general population based on TRFs are likely, therefore, to underestimate CVD risk in RA and SLE. Until additional research and disease-specific risk prediction tools are available, current evidence supports aggressive treatment of disease activity, and careful screening for and management of TRFs.

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