[Cardiovascular comorbidities in rheumatoid arthritis]

Area of Science:

• Rheumatology
• Cardiology
• Internal Medicine

Background:

• Rheumatoid arthritis (RA) patients have a significantly higher prevalence of cardiovascular (CV) diseases, with over 50% affected.
• Inflammatory activity in RA is a primary driver of atherosclerosis, coronary heart disease, stroke, thromboembolic events, and heart failure, leading to a doubled CV event rate and increased mortality in RA patients.
• Traditional CV risk factors like hypertension, diabetes, and hyperlipidemia are more common in RA patients and often go undetected or untreated, contributing to overall CV risk.

Purpose of the Study:

• To highlight the connection between RA inflammatory activity and increased cardiovascular risk.
• To emphasize the importance of managing traditional cardiovascular risk factors in RA patients.
• To discuss the impact of RA medications on cardiovascular risk and propose strategies for risk assessment and management.

Main Methods:

• Review of existing literature on RA, comorbidities, and cardiovascular disease.
• Analysis of the role of inflammatory activity and traditional risk factors in RA-associated CV events.
• Evaluation of the cardiovascular risk profiles of different RA treatment modalities.
• Discussion of current gaps in CV risk assessment and management in RA care.

Main Results:

• Inflammatory activity in RA is a major contributor to cardiovascular disease, which affects RA patients twice as frequently as the general population.
• While some RA medications (NSAIDs, glucocorticoids) increase CV risk with long-term use, others (hydroxychloroquine, methotrexate, biologics) can reduce it.
• Untreated traditional CV risk factors are prevalent in RA patients, and addressing them can improve life expectancy.

Conclusions:

• Cardiovascular risk is substantially elevated in rheumatoid arthritis patients, primarily due to inflammatory activity and often compounded by traditional risk factors.
• Rheumatologists should be responsible for assessing and managing CV risk factors in RA patients, as current practices often fall short.
• Standardized, nursing-based assessments and regular risk reassessment (every 1-5 years) are recommended to mitigate CV risks and improve outcomes in RA patients.